URINARY

SYSTEM
Presented by: GROUP 4

Functions
1. Excretion.
2. Regulation of blood
volume and pressure.

Functions
3. Regulation of
the concentration
of solutes in the

Functions
4. Regulation of
extracellular fluid
pH.

Functions
5. Regulation of red
blood cell synthesis.

Functions
6. Regulation of
vitamin D synthesis.

ANATOMY
OF THE URINARY
SYSTEM

Kidney

Kidney
Left and right kidneys are located behind the
peritoneum, along the posterior abdominal wall.
Renal fat pad- tissue that surrounds and protects
each kidney.
Renal capsule- the fibrous outer wall of the
kidney.

Kidney
Hilum- an indentation on
the medial side of each
kidney where vessels and
nerves enter and exit.

Kidney
Structures located within the hilum:
1. Renal Sinus- fat-filled cavity
2. Renal pelvis- wide section of the urinary
channel, distal to the ureter
3. Calyces- branches of the pelvis extending
from the kidney tissue proper

Kidney
Kidney Tissue Proper is divided into:
1. Outer Cortex
2. Inner medulla
3. Renal pyramids- cone-shaped
sections of tissue lying mostly within the
medulla. Each is composed of collecting
ducts that conduct urine toward its tip
(papilla), which is surrounded by the end

Ureter

Ureter
Muscular tube that
exits each kidney at
the hilum and
extends posteriorly

Urinary Bladder

Urinary Bladder
Collapsible, muscular sac
for the temporary storage
of urine. The two ureters
enter on each side of the
posterior floor of the

Urethra

Urethra
Muscular tube that extends from the
anterior floor of the bladder to the
outside of the body
In the female, it is a short tube that
ends just anterior to the vagina
In the male, it is much longer,
extending all the way through the

Renal Arterial Supply

Renal Artery - branch of abdominal aorta entering the

hilum and extends through the renal sinus

Interiobar Arteries - branch of the renal arteries that
extend outward through the tissue between the pyramids
Arculate Arteries - branches of the interiobar arteries
that turn to extend between cortex and medulla

 Interiobular Arteries - branches of the arcuate arteries

that extend outward, into the cortex

Afferent arterioles - small arteries that arise from
branches of interiobular arteries, each one extending to a
glomerulus
Glomerular capillaries - capillaries arising from an
afferent arteriole and forming a ball or small capillary bed
called a glomerulus

The kidney is supplied with

blood via the renal arteries that
branch directly from the aorta,
and enter the kidney at the
hilus.

TheINTERLOBARARTERYis
the first branch of the renal
artery.
TheARCUATEarteries (which
arise from the interlobar
arteries) run along the corticomedullary junction and can be
seen on cross section in
histologic renal sections.
Since this vessel courses
through the cortico-medullary
junction in the shape of
an"ARC",it is called
theARCUATEARTERY.

Venous Network
Efferent arterioles - each extending from a glomerulus
Peritubular capillaries - small capillary beds arising
from an efferent arterioles (a network of peritubular
capillaries surrounds each nephron , the tubular,
microscopic unit of the kidney.)
Interiobular veins

 Arcuate veins
Interiobar veins
Renal veins - blood vessels extending through the renal
sinus and out the hilum, draining into the inferior vena
cava

NEPHRONS
Functional unit of the kidneys
Carry out the THREE BASIC PROCESSES that accomplish
the kidney's function, forming urine:
a) Filtration
b)Tubular reabsorption
c)Tubular secretion

The Nephron

glomerulus
efferent arteriole

proximal
convolute
d tubule

blood

distal
convolute
d tubule
blood

afferent arteriole

Loop of Henle

 Renal Corpuscle - rougly spherical structure at the

beginning of the nephrons

Glomerulus - inner portion of the renal corpuscle; a ball of
glomerular capillaries
Bowman's capsule - double-walled structure that
surrounds the glomerulus
Proximal Convoluted Tubule - narrow channel proceeding
from the bowman's capsule of the renal corpuscle

 Filtrate formed in the bowman's capsule flow through the

proximal convoluted tubule and into the loop of henle.

In many nephrons, the descending limb of the loop dips
far down into the medulla, turns, and returns as the
ascending limb to the cortex.
Filtration flows from the ascending limb of the loop of
henie into the distal convoluted tubule. The filtrate is
emptied into a collecting duct, a tubule that collects urine
from many nephrons and conducts it through a renal
pyramid to a calyx.

 Podocyte - a cell with a club-shaped foot around in the tiny

round structure at the end of the nephron in the kidney,
through which blood is filtered.

Mechanisms of Urine Production"

Filtration-movement of water, ions, and small molecules
through the filtration membrane into Bowmans capsule
Tubular Reabsorption- movement of substances from the
filtrate across the wall of the nephron back into blood of
the peritubular capillaries
Tubular Secretion- transport of substances, usually waste
products, from the interstitial fluid across the wall of the
nephron into the filtrate

URINALYSIS
(PHYSICAL EXAMINATION)

A.

COLOR

Yellow color of urine is caused by presence of urochrome

Uroerythrin (pink color) is due to refrigeration of specimen/precipitation of
amorphous urates
Urobilin (orange-brown) oxidation product of normal urinary constituent
urobilinogen; specimen not fresh
Normal: varies from almost colorless, straw or light yellow to dark yelloworange, or amber
Variations:
Colorless/ Pale yellow- recent fluid consumption, polyuria, DI, DM
Dark Yellow- concentrated specimen
Amber/Orange- bilirubin
Blue/Green- Psudomonas infection, medications/drugs
Pink/Red- intact RBCs, beets, menstrual contamination, medications/drugs
Brown/Black- medications/drugs

URINALYSIS
(PHYSICAL EXAMINATION)

B.

Odor

Normal: faint aromatic due to volatile acids; becomes

ammoniacal as the specimen stands
Variations:
Ammoniacal- UTI (Proteus spp and other ureaseproducing bacteria)
Rancid- Tyrosinuria
Mousy- Phenylketonuria
Sweaty feet- Isovaleric academia
Bleach- contamination
Rotting fish- Trimethlylaminuria

URINALYSIS
(PHYSICAL EXAMINATION)

C.

Transparency

Normal: Clear- no visible particulates seen

Variations:
Hazy- few particulates, print easily seen through urine
Cloudy- many particulates, print blurred through
urine
Turbid- print cannot be seen through urine
Milky- may precipitate or be clotted

NON PATHOLOGIC CAUSES OF TURBIDITY

EPITHELIAL CELLS
NORMAL CRYSTALS
BACTERIA(OLD URINE)
SEMEN, PROSTATIC FLUID
FECAL CONTAMINATION
MUCUS
RADIOGRAPHIC CONTRAST MEDIA
VAGINAL CREAMS

PATHOLOGIC CAUSES OF TURBIDITY

RBCs
WBCs
BACETRIA, YEASTS
NONSQUAMOUS EPITHELIAL CELLS
ABNORMAL CRYSTALS, CASTS
LYMPH FLUID/CHYLE
LIPIDS
FECAL MATTER

URINALYSIS
(CHEMICAL EXAMINATION)
Specific Gravity
- ratio of urine density to water density
1.000 physiologically impossible
1.002 1.009 dilute urine
1.010 1.025 average
1.026 1.035 concentrated urine
>1.040 physiologically impossible

 pH The relative H+ concentration, pH is determinant of acidity.

6.0 average
4.5 8.0 random
5.5 6.5 fasting
Causes of acid urine: high protein diet, diarrhea, dehydration,
starvation
Causes of alkaline urine: hyperventilation, vomiting, infection, old
specimen
Protein
Albumin a small protein molecule that is normally absent or present
only in trace amounts
High level - hypertension or kidney disease.

 Glucose
Normally there is NO GLUCOSE in urine.
Trace amounts may be present- after eating a meal high in
carbohydrates.
Continued high levels DM or pituitary problems.

Ketones
A by-product of fat metabolism.
May be present during fasting, DM, or a low carbohydrate diet.

Blood
Normally not present
Hemoglobin kidney infection or presence of stones in kidney.

 Bilirubin
Normally not present
If present-may indicate liver disease or bile tract obstruction

Urobilinogen
Derivative of bilirubin
High level excessive RBC destruction or liver disease

Nitrite
Positive nitrite result presence of large amount of bacteria, as an
infection.

 LE (Leukocyte Esterase)
-an esterase produced by WBC.
Used for detection of bacterial and non bacterial UTI
Also used for screening of urine culture specimens.

URINALYSIS
(MICROSCOPIC EXAMINATION)

A. Cells
- Epithelial Cells from the urinary tract lining, blood cells from
injury or infection sites, or infectious microbes may be present in
sediment. If more than trace amounts of blood or microbial cells
are present. A urinary problem is indicated.

RBC

WBC

Yeast

Epithelial
Cells

B. Artifacts
Artifacts are materials that have accidentally gotten into the
sample, including fabric fibers from underwear, powder
used on the skin near the urethral opening , or skin oil
droplets

C. Crystals
Very tiny crystals of normal urine components or drugs may
be visible under high power. Small amounts of these crystals
may be normal. A large number of crystals is seen in urinary
retention. The inability to void urine from bladder. Large
masses of crystals are called stones or calculi.

D. Casts
Casts are chunks of material that have hardened
somewhere in the urinary channel and sloughed off into the
urine. They may be roughly cylindrical masses of cells,
granules, or other substances.

Disease and
Disorder
in the Urinary
System

-Type of kidney disease in which the part of your kidneys

that helps filter waste and fluids from the blood is
damaged.
-A kidney disease characterized by inflammation of renal
glomeruli.

Causes

Amyloidosis
Anti-glomerular basement membrane antibody disease
Blood vessel diseases, such as vasculitis orpolyarteritis
Focal segmental glomerulosclerosis
Goodpasture syndrome
Heavy use of pain relievers, especially NSAIDs
Henoch-Schonlein purpura
IgA nephropathy
Lupus nephritis
Membranoproliferative GN

Symptoms
Blood in the urine(dark, rust-colored, or brown

urine)
Foamy urine (due to excess protein in the urine)
Swelling (edema) of the face, eyes, ankles, feet,
legs, or abdomen
Abdominal pain
Blood in the vomitor stools
Cough and shortness of breath
Diarrhea
Excessive urination

Symptoms

Fever
General ill feeling, fatigue, and loss of appetite
Joint or muscle aches
Nosebleed
Anemia
High blood pressure
Signs of reduced kidney function

Treatment
A procedure called plasmapheresis may sometimes be used for
glomerulonephritis caused by immune problems. The fluid part of the
blood that contains antibodies is removed and replaced with
intravenous fluids or donated plasma (that does not contain antibodies).
Removing antibodies may reduce inflammation in the kidney tissues.
You may need to limit salt, fluids,protein, and other substances.
Persons with this condition should be closely watched for signs of
kidney failure. Dialysis or a kidney transplant may eventually be
needed.

- Inflammation of the renal pelvis due to an infection of

the kidney; it can be acute (generally resulting from a
bladder infection) or chronic (usually associated with a
stone or other obstruction); upper UTI

Cause
Most often, the bacteria that cause pyelonephritis are the same as

those that cause ordinary urinary tract infections. Bacteria found in

stool (such asE. colior klebsiella) are most common. Uncommonly,
bacteria from the skin or the environment cause pyelonephritis.
Conditions that create reduced urine flow make pyelonephritis more
likely. When urine flow slows or stops, bacteria can more easily
travel up the ureters. Some causes of urine obstruction include:
Benign prostatic hypertrophy (BPH)
Abdominal or pelvic masses (as fromcancer)
Stones in the bladder, ureters, or kidneys
Kidney stonescontribute to pyelonephritis by providing a place for
bacteria to grow while evading the body's defenses.
People withdiabetesor conditions that impair the immune system
are more likely to get pyelonephritis.

Symptoms

Back painor flank pain

Fever (usually present) or chills
Feeling sick (malaise)
Nausea and vomiting
Confusion (especially in the elderly)

Pyelonephritis may cause noticeable changes in the

urine, such as:
Blood in the urine(hematuria)
Cloudy or foul-smelling urine
Pain when urinating
Increased frequency or urgency of urination

Treatment
Hospitalization is required to treat more severe
pyelonephritis, however. Delivering antibiotics
intravenously in the hospital ensures that the medicine is
reaching the kidneys.
Antibiotics are generally prescribed for a total at least
seven days. Part of this course of treatment ,may be given
in the hospital intravenously; remainder of the treatment
may be taken at home in the form of pills.

-refers to inflammation of the

bladder, specifically,
inflammation of the wall of the
bladder.

Cause
There are many possible causes of cystitis:
When women insert a tampon there is a slight risk of

bacteria entering via the urethra.

When a urinary catheter is changed there may be damage
to the area.
There is a higher incidence of cystitis among women who
use the diaphragm forcontraception, compared to
sexually active women who don't.
The patient does not empty his/her bladder completely,
creating an environment for bacteria to multiply in the
bladder. This is fairly common among pregnant women, and
also men whose prostates are enlarged.
Sexually active women have a higher risk of bacteria
entering via the urethra.

Cause
Part of the urinary system may be blocked.
Other bladder or kidney problems.
Frequent and/or vigorous sex increases the chances of physical damage or
bruising, which in turn makes the likelihood of cystitis developing higher.
During themenopausewomen produce less mucus in the vaginal area.
This mucus stops the bacteria from multiplying. Women onHRT(hormone
replacement therapy) have a lower risk of developing cystitis compared to
menopausal women not on HRT.
During the menopause the lining of a woman's urethra gets thinner as her
levels ofestrogendrop. The thinner the lining becomes, the higher the
chances are of infection and damage.
A woman's urethra opening is much nearer the anus than a man's.
Consequently, there is a higher risk of bacteria entering the urethra from
the anus.

Symptoms

Urine may have traces of blood

Urine is dark and/or cloudy
Urine has a strong smell
Pain just above the pubic bone
Pain in the lower back
Pain in the abdomen
Only small amount of urine is passed each time
Frequent need to urinate
Burning sensation when urinating
Older women may feel weak and feverish but have none of the
other symptoms mentioned above
When children have cystitis they may have any of the
symptoms listed above, plus vomiting and general weakness.

Treatment
Painkillers, such as paracetamol (Tylenol) or ibuprofen may help with the discomfort. If you are
pregnant discuss this with either your doctor or a well-qualified pharmacist.
Drink plenty of fluids. This will help flush the bacteria from the system.
Do not consume alcohol.
Sodium citrate orpotassiumcitrate in sachets or solutions sometimes ease symptoms.

Cranberry juice may or may not help with cystitis and UTIs.
Cranberry juice has been shown to be good for the urinary tract and
effective in fighting urinary tract infections (2010 study). Drinking some cranberry juice
each day may prevent recurrences - some people have even experienced relief of symptoms.
Cranberry juice also has condensed tannins, Manoose - D and proanthocyanidins which have
been found to inhibit the activity ofE. coliby preventing the bacteria from sticking to mucosal
surfaces lining the bladder and gut, helping to clear bacteria from the urinary tract.

Prevention

Many cases of cystitis are not preventable.

However, the following measures may help:
When you urinate try to make sure you have
emptied your bladder completely.
If you feel you need to urinate go straight away do not postpone it.
Avoid tight underwear, and tight pants (trousers).
Wear cotton underwear.
Wipe from front to back.