THE URINARY SYSTEM

Kidney Anatomy

Location and External Anatomy

The kidneys are bean-shaped organs that lie retroperitoneal in the

superior lumbar region.

The medial surface is concave and has a renal hilus that leads into a
renal sinus, where the blood vessels, nerves, and lymphatics lie.

The kidneys are surrounded by a fibrous, transparent renal capsule; a

fatty adipose capsule that cushions the organ; and an outer fibrous renal
fascia that anchors the kidney to surrounding structures.
Internal Anatomy

There are three distinct regions of the kidney: the cortex, the medulla,
and the renal pelvis.

Major and minor calyces collect urine and empty it into the renal pelvis.
Blood and Nerve Supply

Blood supply into and out of the kidneys progresses to the cortex
through renal arteries to segmental, lobar, interlobar, arcuate, and
cortical radiate arteries, and back to renal veins from cortical radiate,
arcuate, and interlobar veins.

The renal plexus regulates renal blood flow by adjusting the diameter of
renal arterioles and influencing the urine-forming role of the nephrons.
Nephrons are the structural and functional units of the kidneys that carry
out processes that form urine .

Each nephron consists of a renal corpuscle composed of a tuft of

capillaries (the glomerulus), surrounded by a glomerular capsule
(Bowman’s capsule) and a renal tubule.

The renal tubule begins at the glomerular capsule as the proximal

convoluted tubule, continues through a hairpin loop, the loop of Henle,
and turns into a distal convoluted tubule before emptying into a collecting
duct.

The collecting ducts collect filtrate from many nephrons, and extend
through the renal pyramid to the renal papilla, where they empty into a
minor calyx.
There are two types of nephrons: 85% are cortical nephrons, which are
located almost entirely within the cortex; 15% are juxtamedullary
nephrons, located near the cortex-medulla junction.
The peritubular capillaries arise from efferent arterioles draining the
glomerulus, and absorb solutes and water from the tubules.

Blood flow in the renal circulation is subject to high resistance in the

afferent and efferent arterioles.
The juxtaglomerular apparatus (complex) is a structural arrangement
between the afferent arteriole and the ascending limb of the loop of
Henle just at the junction with the distal convoluted tubule. The JG
apparatus includes granular cells (specialized smooth muscle cells of the
afferent arteriole), macula densa cells (specialized cells in the wall of the
nephron loop) and extraglomerular mesangial cells.

The filtration membrane lies between the blood and the interior of the
glomerular capsule, and allows free passage of water and solutes.
Kidney Physiology: Mechanisms of Urine Formation

Step 1: Glomerular Filtration

Glomerular filtration is a passive, nonselective process in which

hydrostatic pressure forces fluids through the glomerular membrane.
The net filtration pressure responsible for filtrate formation is given by
the balance of glomerular hydrostatic pressure against the combined
forces of colloid osmotic pressure of glomerular blood and capsular
hydrostatic pressure exerted by the fluids in the glomerular capsule.

The glomerular filtration rate is the volume of filtrate formed each minute
by all the glomeruli of the kidneys combined. The normal adult GFR is
120 - 125 ml/min.

Maintenance of a relatively constant glomerular filtration rate is important

because reabsorption of water and solutes depends on how quickly
filtrate flows through the tubules.
The glomerular filtration rate is held relatively constant through intrinsic
autoregulatory mechanisms, and extrinsic hormonal and neural
mechanisms.

Renal autoregulation uses a myogenic control related to the degree of

stretch of the afferent arteriole, and a tubuloglomerular feedback
mechanism that responds to the rate of filtrate flow in the tubules.

Extrinsic neural mechanisms are stress-induced sympathetic responses

that inhibit filtrate formation by constricting the afferent arterioles.

The renin-angiotensin mechanism causes an increase in systemic blood

pressure and an increase in blood volume by increasing
Na+ reabsorption.
Step 2: Tubular Reabsorption

Tubular reabsorption begins as soon as the filtrate enters the proximal

convoluted tubule, and involves near total reabsorption of organic
nutrients, and the hormonally regulated reabsorption of water and ions.

The most abundant cation of the filtrate is Na+, and reabsorption is

always active.
Passive tubular reabsorption is the passive reabsorption of negatively
charged ions that travel along an electrical gradient created by the active
reabsorption of Na+.

Obligatory water reabsorption occurs in water-permeable regions of the

tubules in response to the osmotic gradients created by active transport
of Na+.

Secondary active transport is responsible for absorption of glucose,

amino acids, vitamins, and most cations, and occurs when solutes are
cotransported with Na+ when it moves along its concentration gradient.

Substances that are not reabsorbed or incompletely reabsorbed remain

in the filtrate due to a lack of carrier molecules, lipid insolubility, or large
size (urea, creatinine, and uric acid).

Different areas of the tubules have different absorptive capabilities.

The proximal convoluted tubule is most active in reabsorption, with most

selective reabsorption occurring there.

The descending limb of the loop of Henle is permeable to water, while

the ascending limb is impermeable to water but permeable to
electrolytes.

The distal convoluted tubule and collecting duct have Na+ and water
permeability regulated by the hormones aldosterone, antidiuretic
hormone, and atrial natriuretic peptide.
Step 3: Tubular Secretion

Tubular secretion disposes of unwanted solutes, eliminates solutes that

were reabsorbed, rids the body of excess K+, and controls blood pH.

Tubular secretion is most active in the proximal convoluted tubule, but

occurs in the collecting ducts and distal convoluted tubules, as well.
Regulation of Urine Concentration and Volume

One of the critical functions of the kidney is to keep the solute load of
body fluids constant by regulating urine concentration and volume.

The countercurrent mechanism involves interaction between filtrate flow

through the loops of Henle (the countercurrent multiplier) of
juxtamedullary nephrons and the flow of blood through the vasa recta
(the countercurrent exchanger).
Since water is freely absorbed from the descending limb of the loop of
Henle, filtrate concentration increases and water is reabsorbed.
The ascending limb is permeable to solutes, but not to water.
The vasa recta aids in maintaining the steep concentration gradient of
the medulla by cycling salt into the blood as it descends into the medulla,
and then out again as it ascends toward the cortex.
In the collecting duct, urea diffuses into the deep medullary tissue,
contributing to the increasing osmotic gradient encountered by filtrate as
it moves through the loop.

Since tubular filtrate is diluted as it travels through the ascending limb of

the loop of Henle, production of a dilute urine is accomplished by simply
allowing filtrate to pass on to the renal pelvis.

Formation of a concentrated urine occurs in response to the release of

antidiuretic hormone, which makes the collecting ducts permeable to
water and increases water uptake from the urine.
Diuretics act to increase urine output by either acting as an osmotic
diuretic or by inhibiting Na+ and resulting obligatory water reabsorption.

Osmotic: substances like mannitol, which are filtered but not reabsorbed,
remain in the filtrate and hold water in the filtrate by increasing the
osmolality of the filtrate.

Loop diuretics - act on the ascending limb of the loop of Henle, prevent
Na+ from entering the interstitial fluid, disrupting the osmotic gradient and
preventing water reabsorption.

Thiazides - act on the distal convoluted tubule and inhibit the sodium-
chloride symporter, which inhibits Na+ (and water) reabsorption .
Thiazides may also be potassium sparing and are considered to be
calcium sparing.
Renal Clearance

Renal clearance refers to the volume of plasma that is cleared of a

specific substance in a given time.

Inulin is used as a clearance standard to determine glomerular filtration

rate since it is not reabsorbed, stored, or secreted.

If the clearance value for a substance is less than that for inulin, then
some of the substance is being reabsorbed; if the clearance value is
greater than the inulin clearance rate, then some of the substance is
being secreted. A clearance value of zero indicates the substance is
completely reabsorbed.

Urine

Physical Characteristics

Freshly voided urine is clear and pale to deep yellow due to urochrome,
a pigment resulting from the destruction of hemoglobin.

Fresh urine is slightly aromatic, but develops an ammonia odor if allowed

to stand, due to bacterial metabolism of urea.

Urine is usually slightly acidic (around pH 6) but can vary from about
4.5–8.0 in response to changes in metabolism or diet.

Urine has a higher specific gravity than water, due to the presence of
solutes.

Chemical Composition

Urine volume is about 95% water and 5% solutes, the largest solute
fraction devoted to the nitrogenous wastes urea, creatinine, and uric
acid.
Ureters

Ureters are tubes that actively convey urine from the kidneys to the
bladder.

The walls of the ureters consist of an inner mucosa continuous with the
kidney pelvis and the bladder, a double-layered muscularis, and a
connective tissue adventitia covering the external surface.
Urinary Bladder

The urinary bladder is a muscular sac that expands as urine is produced

by the kidneys to allow storage of urine until voiding is convenient.

The wall of the bladder has three layers: an outer adventitia, a middle
layer of detrusor muscle, and an inner mucosa that is highly folded to
allow distention of the bladder without a large increase in internal
pressure.
Urethra

The urethra is a muscular tube that drains urine from the body; it is 3–4
cm long in females, but closer to 20 cm in males.

There are two sphincter muscles associated with the urethra: the internal
urethral sphincter, which is involuntary and formed from detrusor muscle;
and the external urethral sphincter, which is voluntary and formed by the
skeletal muscle at the urogenital diaphragm.
The external urethral orifice lies between the clitoris and vaginal opening
in females, or occurs at the tip of the penis in males.

Micturition

Micturition, or urination, is the act of emptying the bladder.

As urine accumulates, distention of the bladder activates stretch

receptors, which trigger spinal reflexes, resulting in storage of urine.

Storage Reflexes
Voluntary initiation of voiding reflexes results in activation of the
micturition center of the pons, which signals parasympathetic motor
neurons that stimulate contraction of the detrusor muscle and relaxation
of the urinary sphincters.

Micturition Reflex
Developmental Aspects of the Urinary System

In the developing fetus, the mesoderm-derived urogenital ridges give

rise to three sets of kidneys: the pronephros, mesonephros, and
metanephros.

The pronephros forms and degenerates during the fourth through sixth
weeks, but the pronephric duct persists, and connects later-developing
kidneys to the cloaca.

The mesonephros develops from the pronephric duct, which then is

named the mesonephric duct, and persist until development of the
metanephros.

The metanephros develops at about five weeks, and forms ureteric buds
that give rise to the ureters, renal pelvises, calyces, and collecting ducts.

The cloaca subdivides to form the future rectum, anal canal, and the
urogenital sinus, which gives rise to the bladder and urethra.
Newborns void most frequently, because the bladder is small and the
kidneys cannot concentrate urine until two months of age.

From two months of age until adolescence, urine output increases until
the adult output volume is achieved.

Voluntary control of the urinary sphincters depends on nervous system

development, and complete control of the bladder even during the night
does not usually occur before 4 years of age.

In old age, kidney function declines due to shrinking of the kidney as

nephrons decrease in size and number; the bladder also shrinks and
loses tone, resulting in frequent urination.

Reference

Accessed on 18th March 2016 at

http://classes.midlandstech.edu/carterp/Courses/bio211/chap25/chap25.
htm