The urinary System

Dr. Ali Ebneshahidi

 Functions of the Urinary System
• Excretion – removal of waste material from the blood plasma
and the disposal of this waste in the urine.
• Elimination – removal of waste from other organ systems
- from digestive system – undigested food, water, salt, ions,
and drugs.
- from respiratory system – CO2, H+, water, toxins.
- from skin – water, NaCl, nitrogenous wastes (urea , uric acid,
ammonia, creatinine).
• Water balance -- kidney tubules regulate water reabsorption
and urine concentration.
• regulation of PH, volume, and composition of body fluids.
• production of Erythropoietin for hematopoieseis, and renin
for blood pressure regulation.
 Anatomy of the Urinary System
Gross anatomy:
• kidneys – a pair of bean –
shaped organs located
retroperitoneally,
responsible for blood
filtering and urine
formation.
• Renal capsule – a layer of
fibrous connective tissue
covering the kidneys.
• Renal cortex – outer region
of the kidneys where most
nephrons is located.
• Renal medulla – inner
region of the kidneys where
some nephrons is located,
also where urine is
collected to be excreted
outward.
• Renal calyx – duct – like
sections of renal medulla for
collecting urine from
nephrons and direct urine
into renal pelvis.
• Renal pyramid –
connective tissues in the
renal medulla binding
various structures together.
• Renal pelvis – central urine
collecting area of renal
medulla.
• Hilum (or hilus) – concave
notch of kidneys where
renal artery, renal vein,
urethra, nerves, and
lymphatic vessels converge.
• Ureter – a tubule that
transport urine (mainly by
peristalsis) from the
kidney to the urinary
bladder.
• Urinary bladder – a
spherical storage organ
that contains up to 400 ml
of urine.
• Urethra – a tubule that
excretes urine out of the
urinary bladder to the
outside, through the
urethral orifice.
 Microscopic anatomy:
• each kidney consists of about 1 million basic functional units
called nephrons where blood filtering and urine formation
occur.
• each nephron is composed of the following parts –
• afferent arteriole → glomerulus →Bowman's capsule →
proximal convoluted tubule (PCT) →descending limb of
loop of Henle → ascending limb of loop of henle → distal
convoluted tubule(DCT) → collecting duct (not a part of
nephron).
• molecules in the blood that will be transformed to become part
of urine travel through the above structures to be processed
(some of these molecules will be reabsorbed), while
molecules that will be retained and reabsorbed back to the
blood will come out of the bowman's capsule, and go into
efferent arteriole and the peritubular capillaries.
 Urine Formation
1. during rest, about 15-30% of cardiac output (CO) enters the
kidneys.
2. circulation through the kidneys (blood cells and plasma proteins
follow the following pathway, while smaller substances will be
filtered into renal tubules and are mostly reabsorbed).
aorta → renal artery → interlobular arteries → afferent arterioles
→ glomeruli → efferent arterioles → peritubular capillaries →
interlobular veins → renal vein → inferior vena cava.
3. 80% of all nephrons is located in the renal cortex and called
cortical nephrons which contain shorter loops of henle (for less
efficient water reabsorption), while the remaining 20% of
nephrons is located between renal cortex and medulla and called
juxtamedullary nephrons which contain longer loops of henle
(for efficient water reabsorption).
Renal Vasculature Pathway
• Vasa recta:
efferent
arterioles of the
juxtamedullary
nephron form a
unique bundle
of straight
vessels, called
the vasa recta.
4. urine formation involves 4
processes:
• filtration – small molecules
are filtered from glomerulus
to bowman's capsule.
• reabsorption – nutrient
molecules are transported
from PCT and DCT to
peritubular capillaries.
• concentration – water is
reabsorbed from descending
limb of loop of henle and
from collecting duct into
peritubular capillaries.
• secretion – waste or harmful
substances are transported
from peritubular capillaries
to PCT and DCT.
 Juxtaglomerular Apparatus (JGA)
• Macula densa – epithelial cells of the distal convulated tubule that are
densely packed. These cells are chemo and osmoreceptors that detect
changes in solute concentration and blood pressure.
• Juxtaglomerular cells (Granular cells) – large cells in the wall of the
afferent arterioles that secrete renin and act as mechanoreceptor. Renin
plays an important role in control of blood pressure.
 Composition of Urine
– transparency is clear, indicating the lack of large solutes such as
plasma proteins or blood cells [can be influenced by bacterial
metabolism in older urine samples].
– Color is from light yellow to amber, due to urochrome pigments as
byproduct of bile metabolism [can be influenced by food,
menstrual bleeding, and metabolic products].
– Odor is from aromatic to slightly ammonia – like, due to the
nitrogenous wastes in urine [can be influenced by disorders such as
diabetes, or by food such as garlic, and by drugs].
– pH is from 4.6 to 8.0 with an average of 6.0, due to H+ in the urine
[strongly influenced by diet where protein cause acidic urine, and
vegetables and wheat cause alkaline urine].
– Specific gravity (a measurement of dissolved solutes in a solution)
is from 1.001 to 1.035, due to the 5% solute composition in normal
urine.
 – Volume is 1-2 liters per day (about 1% of filtration input). [can be
influenced by body activities, water intake, hormonal regulation, or
disorders such as diabetes].
• chemical composition of urine:
- normal urine is 95% water and 5% solutes.
- most solutes are derived from cellular metabolism, and they include
urea, uric acid, creatinine, ketene bodies, salts, ions, excessive
vitamins, and drugs.
 Abnormal Constituents of Urine
– albumin – a large plasma protein that should not be filtered
out of glomerulus; when it is present, it is called albuminuria
which may be due to kidney infection called
glomerulonephritis.
– glucose – a nutrient molecules that should have been
reabsorbed (in the case of high carbohydrate diets, trace
amount of glucose may be found in urine); when is present, it
is called glucosuria which may be due to insulin – related
problems in a disease called diabetes mellitus.
– blood or erythrocytes – any blood cell should not be filtered
out of glomerulus or be present in the urine (except in
menstruation – related bleeding); when it is present, it is called
Hematuria which may be caused by glomerulonephritis,
hemolytic anemia, or urinary tract in infections (UTI).
– hemoglobin – pigment protein that normally should be enclosed in
erythrocytes and not filtered out of glomerulus; when it is present,
it is called hemoglobinuria which may indicated hemolytic
anemia.
– leukocytes – large white blood cells that should not be present in
urine (except in UTI where leukocytes are present to fight the
infection); when it is present, it is called Pyuria which may be
caused by glomerulonephritis, UTI, or even strenuous exercise.
– ketones – byproduct of metabolism that may occur in trace
amounts, but not large quantities in the urine; when it is present, it
is called Ketonuria which may indicate certain infections in the
urinary system.
– Bilirubin – a bile pigment that is normally recycled in lipid
metabolism; when it is present, it is called bilirubinuria which
may be due to abnormal lipid metabolism, or certain infections in
the urinary system.
 Micturition
• elimination of urine from the urinary system to the outside.
• pathway of waste molecules:
afferent arteriole glomerulus Bowman’s capsule
proximal convoluted tubule loop of henle distal convoluted
tubule collecting duct renal calyx renal pelvis
ureter urinary bladder urethral orifice.
• middle layer of urethra wall is made of smooth muscle, which
performs peristalsis under involuntary control, to push urine from the
kidney to urinary bladder.
• urinary bladder contains elastic tissues in its walls and normally holds
200-400 ml of urine, or maximally up to 600 ml.
• micturition involves the contraction of detrusor muscles that
surround the urinary bladder and the relaxation of external urethral
sphincter.
• At the bladder-urethral junction a thickening of the detrusor smooth
muscle forms the internal urethral sphincter which keeps urethra
closed when urine is not being passed and prevents leaking between
voiding.
• Parasympathetic nerves stimulate contraction of detrusor muscles,
forcing urine into urethra.
• Voluntary contraction of external urethral sphincter (which is made up
of skeletal muscles) allows urine to flow outside.
 Clinical Terms
• Cystectomy: surgical removal of the urinary bladder.
• Dysuria: painful or difficult urination.
• Hematuria: blood in the urine.
• Nephrectomy: surgical removal of a kidney.
• Acute glomerulonephritis: inflammation of the glomeruli.
• Uremia: condition in which substances ordinarily
excreted in the urine accumulates in the blood.
• Incontinence: inability to control urination.
• Urinalysis: analysis of urine to diagnose health or disease
(to detect protein, glucose, blood or pus).
• Urologist: physician who specializes in diseases of the
urinary structures in both male and female.