24 PART 1

The Urinary System

The Urinary System

•Important functions of the kidneys

•Maintain the chemical consistency of blood

•Filter many liters of fluid from blood

•Send toxins, metabolic wastes, and excess water out of the body

•Main waste products are three nitrogenous compounds
•Urea
•Uric acid
•Creatinine

Organs of the Urinary System

•Kidneys

•Ureters

•Urinary bladder

•Urethra

Location and External Anatomy of Kidneys

•Kidneys are red-brown in color

•Located retroperitoneally

•Behind the peritoneum

•Lateral to T12–L3 vertebrae

•Average kidney is 12 cm tall, 6 cm wide, 3 cm thick

•Hilum

•Is the concave surface

•Vessels and nerves enter and exit

Location and External Anatomy of Kidneys

•Fibrous capsule

•Capsule of dense connective tissue surrounds the kidney

•Inhibits spread of infections

•Perirenal fat capsule

•External to renal capsule

•Renal fascia

•External to perirenal fat capsule

•Contains fat

Internal Gross Anatomy of the Kidneys

•Frontal section through the kidney

•Renal cortex

•Superficial region, granular appearance

•Renal medulla consists of

•Cone-shaped renal pyramids

•Renal pelvis

•Major calices
•Minor calices

Internal Gross Anatomy of the Kidneys

•Gross vasculature

•Renal arteries branch into segmental arteries

•Segmental arteries branch into interlobar arteries
•Arcuate arteries branch from interlobar arteries

Internal Gross Anatomy of the Kidneys

•Nerve supply—renal plexus

•A network of autonomic fibers

•An offshoot of the celiac plexus

•Supplied by sympathetic fibers from

•Lowest thoracic splanchnic nerve
•First lumbar splanchnic nerve

Microscopic Anatomy of the Kidneys

•Nephron is the functional unit of the kidney

•Over 1 million nephrons in each kidney

Mechanisms of Urine Production

•Filtration

•Filtrate of blood leaves kidney capillaries

•Resorption

•Most nutrients, water, and essential ions reclaimed

•Secretion

•Active process of removing undesirable molecules

Nephron Structure

•Nephron is composed of

•Renal tubule

•Renal corpuscle

24 PART 2

The Urinary System

Nephron Structure

•Renal corpuscle—first part of nephron

•Glomerulus and glomerular capsule

•Glomerulus—tuft of capillaries
•Capillaries of glomerulus are fenestrated
•Glomerular (Bowman’s) capsule
•Parietal layer—simple squamous epithelium
•Visceral layer—consists of podocytes

Filtration Membrane

•The filtration membrane

•Filter that lies between blood in the glomerulus and capsular space

•Consists of three layers

•Fenestrated endothelium of the capillary
•Filtration slits between foot processes of podocytes
•Basement membrane

Filtration Membrane

•Basement membrane and slit diaphragm

•Hold back most proteins

•Allow passage of

•Water

•Ions

•Glucose

•Amino acids

•Urea

Renal Tubule

•Filtrate proceeds to renal tubules from glomerulus

•Proximal convoluted tubule

•Nephron loop

•Descending limb

•Descending thin limb (DTL)

•Ascending thin limb (ATL)

•Thick ascending limb (TAL)

•Distal convoluted tubule

Renal Tubule

•Collecting ducts

•Receive urine from several nephrons

•Play an important role in conserving body fluids

•Posterior pituitary secretes ADH

•Increases permeability of collecting ducts and distal convoluted tubules to water

Classes of Nephron

•Cortical nephrons

•85% of nephrons

•Juxtamedullary nephrons

•15% of nephrons

•Contribute to kidney’s ability to concentrate urine

Blood Vessels Associated with Nephrons

•Nephrons associate closely with two capillary beds

•Glomeruli

•Peritubular capillaries in cortical nephrons or vasa recta in juxtamedullary nephrons

Blood Vessels Associated with Nephrons

•Glomeruli

•Produce filtrate that becomes urine

•Fed and drained by arterioles

•Afferent glomerular arteriole

•Efferent glomerular arteriole

Blood Vessels Associated with Nephrons

•Glomeruli

•Efferent arteriole has a smaller diameter than afferent arteriole

•Generate 1 liter of fluid every 8 minutes

•99% of filtrate is resorbed by tubules

Blood Vessels Associated with Nephrons

•Peritubular capillaries

•Arise from the efferent arterioles draining cortical glomeruli

•Are adapted for absorption

•Low-pressure, porous capillaries

•All molecules secreted by nephrons into urine are from peritubular capillaries

Blood Vessels Associated with Nephrons

•Vasa recta

•Continue from efferent arterioles of juxtamedullary nephrons

•Are thin-walled looping vessels

•Descend into the medulla

•Are part of the kidney’s urine concentrating mechanism

24 PART 3

The Urinary System

Juxtaglomerular Complex

•Juxtaglomerular complex

•Functions in regulating blood pressure

•An area of specialized contact between terminal end of the ascending limb and afferent arteriole

•Granular cells—modified smooth muscle cells with secretory granules

•Contain the hormone renin

•Renin—secreted in response to falling blood pressure in afferent arteriole

Juxtaglomerular Complex

•Macula densa—end of nephron loop

•Adjacent to granular cells

•Tall, closely packed epithelial cells

•Monitor solute concentration in the filtrate

•Signal granular cells to secrete renin

•Initiates renin-angiotensin mechanism

Juxtaglomerular Complex

•Mesangial cells

•Located around base of the glomerulus

•Regulate blood flow within the glomerulus

•Extraglomerular mesangial cells

•Interact with macula densa and granular cells

• Help regulate blood pressure

Ureters

•Carry urine from the kidneys to the urinary bladder

•Oblique entry into bladder prevents backflow of urine

•Histology of ureter

•Mucosa—transitional epithelium

•Muscularis—two layers

•Inner longitudinal layer

•Outer circular layer

•Adventitia—typical connective tissue

Urinary Bladder

•A collapsible muscular sac

•Stores and expels urine

•Full bladder—spherical

•Expands into the abdominal cavity

•Empty bladder—lies entirely within the pelvis

Urinary Bladder

•Urachus—closed remnant of the allantois

•Prostate

•In males

•Lies directly inferior to the bladder

•Surrounds the urethra

Urinary Bladder

•Urinary bladder is composed of three layers

•Mucosa—transitional epithelium

•Thick muscular layer—detrusor

•Fibrous adventitia

Urethra

•Epithelium of urethra

•Transitional epithelium

•At the proximal end (near the bladder)

•Stratified and pseudostratified columnar—mid urethra (in males)

•Stratified squamous epithelium

•At the distal end (near the urethral opening)

Urethra

•Internal urethral sphincter

•Involuntary smooth muscle

•External urethral sphincter

•Voluntarily inhibits urination

•Relaxes when one urinates

Urethra

•In females

•Length of 3–4 cm

•In males—20 cm in length; three named regions

•Prostatic urethra

•Passes through the prostate gland

•Intermediate part of urethra

•Through the urogenital diaphragm

•Spongy (penile) urethra

•Passes through the length of the penis

Disorders of the Urinary System

•Urinary tract infections

•More common in females

•Burning sensation during micturition

•Renal calculi

•Kidney stones

•Bladder cancer

•3% of cancers—more common in men

•Kidney cancer

•Arises from epithelial cells of uriniferous tubules

The Urinary System Throughout Life

•Embryo develops three pairs of kidneys

•Pronephros

•Mesonephros

•Metanephros

•Only metanephros persists to become the adult kidneys

•Metanephric kidney produces urine by fetal month 3

•Contributes to the volume of amniotic fluid

The Urinary System Throughout Life

•Kidney and bladder function declines with advancing age

•Nephrons decrease in size and number

•Tubules are less efficient at secretion and resorption

•Filtration declines

•Recognition of desire to urinate is delayed

•Loss of muscle tone in the bladder