Urinary system

Miss. Ashwini C. Kotkar

Contents
• a) Anatomy and physiology of urinary system
• b) Formation of urine
• c) Renin Angiotensin system – Juxtaglomerular apparatus - acid base
Balance
• d) Clearance tests and micturition
Introduction to Urinary system

The urinary system is a group of organs in the body concerned with

filtering out excess fluid and other substances from the blood stream.
The urinary system, also known as the urinary tract or renal system,
consists of the kidneys, ureters, bladder, and the urethra.
FUNCTIONS OF THE URINARY
SYSTEM:
• Eliminate waste from the body
• Regulates blood volume
• Regulates blood pressure
• Control levels of electrolytes and metabolites
• Regulates blood pH.
• Production and secretion of renin, an important enzyme in the control
of blood pressure
• Production and secretion of erythropoietin, the hormone that
stimulates formation of red blood cells
ANATOMY OF
URINARY TRACT:
The urinary tract is made up of
the following organs:
• A pair of Kidneys - forms the
urine
• A pair of Ureters - Transports
the urine
• A urinary Bladder - stores urine
• A Urethra - carries urine outside
the body
 KIDNEYS:
➢ The kidneys lie on the posterior abdominal
wall, one on each side of the vertebral
column, behind the peritoneum and below the
diaphragm.
➢ They extend from the level of the 12th
thoracic vertebra to the 3rd lumbar vertebra,
receiving some protection from the lower rib
cage.
➢ The right kidney is usually slightly lower than
the left, probably because of the considerable
space occupied by the liver.
➢ Kidneys are bean-shaped organs, about 11 cm
long, 6 cm wide, 3 cm thick and weigh 150 g.
 Gross structure of the kidney

➢There are three areas of tissue

➢An outer fibrous capsule, surrounding the
kidney.
➢The cortex, a reddish-brown layer of tissue
immediately below the capsule and outside
the renal pyramids.
➢The medulla, the innermost layer,
consisting of pale conical-shaped striations,
the renal pyramids.
➢Urine formed within the kidney passes
through a renal papilla at the apex of a
pyramid into a minor calyx.
Gross structure of the kidney
➢Several minor calyces merge into a major calyx and two or three
major calyces combine forming the renal pelvis.
➢A funnel shaped structure that narrows when it leaves the kidney as
the ureter.
➢The walls of the calyces and renal pelvis are lined with transitional
epithelium and contain smooth muscle.
➢Peristalsis, intrinsic contraction of smooth muscle, propels urine
through the calyces, renal pelvis and ureters to the bladder.
Microscopic structure of the kidney
• The kidney contains about 1–2 million functional units, the nephrons.
• A much smaller number of collecting ducts.

❖ NEPHRONS:
• It is the basic structural and functional unit of the kidney.
• The nephron is essentially a tubule closed at one end that joins a
collecting duct at the other end.
• The closed or blind end is indented to form the cup-shaped glomerular
capsule (Bowman’s capsule), which almost completely encloses a
network of tiny arterial capillaries, the glomerulus.
Nephron is about 3 cm
long and described in
three parts:
• the proximal
convoluted tubule
• the medullary loop
(loop of Henle)
• the distal convoluted
tubule, leading into a
collecting duct
 A nephron and associated blood vessels.
• In the cortex an arteriole, the afferent
arteriole, enters each glomerular capsule
and then subdivides into a cluster of tiny
arterial capillaries, forming the
glomerulus.
• The blood vessel leading away from the
glomerulus is the efferent arteriole.
• The efferent arteriole divides into a
second peritubular (meaning ‘around
tubules’) capillary network, which wraps
around the remainder of the tubule,
allowing exchange between the fluid in
the tubule and the bloodstream
• Venous blood drained from
capillary bed eventually leaves
the kidney in the renal vein,
which empties into the inferior
vena cava.
Functions of the kidney
1. Formation of urine
The kidneys form urine, which passes to the bladder for storage prior to
excretion.
There are three processes involved in the formation of urine:

➢filtration
➢selective reabsorption
➢secretion
 Filtration
• This takes place through the
semipermeable walls of the
glomerulus and glomerular capsule.
• Water and other small molecules
readily pass through, although some
are reabsorbed later.
• Blood cells, plasma proteins and other
large molecules are too large to filter
through and therefore remain in the
capillaries.
• Filtration takes place because there is a
difference between the blood pressure in
the glomerulus and the pressure of the
filtrate in the glomerular capsule.
• The volume of filtrate formed by both
kidneys each minute is called the
glomerular filtration rate (GFR).
• In a healthy adult the GFR is about 125
mL/min, i.e. 180 litres of filtrate are
formed each day by the two kidneys.
Selective reabsorption
• Most reabsorption from the filtrate
back into the blood takes place in
the proximal convoluted tubule,
whose walls are lined with
microvilli to increase surface area
for absorption.
• Many substances are reabsorbed
here, including some water,
electrolytes and organic nutrients
such as glucose.
Selective reabsorption
• Only 60–70% of filtrate reaches the medullary loop. Much of this,
especially water, sodium and chloride, is reabsorbed in the loop, so
that only 15–20% of the original filtrate reaches the distal convoluted
tubule.
• Sodium is reabsorbed here.
• Reabsorption of nitrogenous waste products, such as urea, uric acid
and creatinine is very limited.
• The kidneys’ maximum capacity for reabsorption of a substance is the
transport maximum, or renal threshold.
Tubular secretion
• Filtration occurs as blood flows through the glomerulus.
• Substances not required and foreign materials, e.g. drugs including
penicillin and aspirin, may not be entirely filtered out of the blood
because of the short time it remains in the glomerulus.
• Such substances are cleared by secretion from the peritubular
capillaries into the filtrate within the convoluted tubules.
• Tubular secretion of hydrogen ions (H+ ) is important in maintaining
normal blood pH.
Summary of
urine formation
Composition of urine
• Urine is clear and amber in color.
• The specific gravity is between 1020 and 1030, and the pH is around 6
(normal range 4.5–8).
• The constituents of urine are:
Water 96%
Urea 2%
Uric acid Chlorides
Creatinine Phosphates
Ammonia 2% Sulphates 2%
Sodium Oxalates
Potassium
• Physiology of urine formation video link
Ureters
• The ureters carry urine from the
kidneys to the urinary bladder.
• They are about 25–30 cm long with a
diameter of approximately 3 mm.
• It passes downwards through the
abdominal cavity, behind the
peritoneum in front of the psoas
muscle into the pelvic cavity, and
passes obliquely through the posterior
wall of the bladder.
Structure of ureters
• The walls of the ureters consist of
three layers of tissue
➢an outer covering of fibrous tissue
➢a middle muscular layer
➢an inner layer, the mucosa,
composed of transitional
epithelium
Function:
• Transport urine from the renal
pelvis into the bladder.
Urinary bladder
• The urinary bladder is a reservoir for urine.
• It lies in the pelvic cavity.
Structure:
➢Roughly pear shaped, but becomes more
balloon shaped as it fills with urine.
➢The posterior surface is the base. The
bladder opens into the urethra at its lowest
point, the neck.
➢The three orifices in the bladder wall form
a triangle or trigone
The bladder wall is composed of three
layers:
• the outer layer of loose connective
tissue,
• the middle layer, consisting of
interlacing smooth muscle fibers and
elastic tissue loosely arranged in three
layers. This is called the detrusor
muscle and when it contracts, it
empties the bladder
• the inner mucosa, composed of
transitional epithelium that readily
permits distension of the bladder as it
fills.
• The internal urethral sphincter,
controls outflow of urine from the
bladder.
• This sphincter is not under
voluntary control.
Urethra
• The urethra is a canal extending from the
neck of the bladder to the exterior, at the
external urethral orifice.
• It is longer in the male than in the female.
Male Urethra
• The male urethra is approximately 15-20cm
long.
• In addition to urine, the male urethra
transports semen.
• Divided into 3 parts- Prostatic urethra,
Membranous urethra, Penile urethra.
 The female urethra
• Approximately 4 cm long and 6 mm in diameter.
• It runs downwards and forwards behind the symphysis pubis and opens at
the external urethral orifice just in front of the vagina.
• The external urethral orifice is guarded by the external urethral sphincter,
which is under voluntary control.
• The wall of the female urethra has two main layers:

an outer muscle layer and

an inner lining of mucosa.
Hormones that influence selective
reabsorption
• Parathyroid hormone - This is secreted by the parathyroid glands and together
with calcitonin from the thyroid gland regulates the reabsorption of calcium and
phosphate from the distal collecting tubules, so that normal blood levels are
maintained. Parathyroid hormone increases the blood calcium level and
calcitonin lowers it.
• Antidiuretic hormone, ADH - This is secreted by the posterior pituitary. It
increases the permeability of the distal convoluted tubules and collecting
tubules, increasing water reabsorption. Secretion of ADH is controlled by a
negative feedback system
• Aldosterone - increases the reabsorption of sodium and water, and the
excretion of potassium
• Atrial natriuretic peptide, ANP - decreases reabsorption of sodium and water
from the proximal convoluted tubules and collecting ducts.
Renin-Angiotensin-Aldosterone System
RAAS System
• Sodium is a normal constituent of urine and its excretion is regulated
by the hormone aldosterone, secreted by the adrenal cortex.
• Cells in the afferent arteriole of the nephron release the enzyme renin
in response to sympathetic stimulation, low blood volume or by low
arterial blood pressure.
• Renin converts the plasma protein angiotensinogen, produced by
the liver, to angiotensin 1.
• Angiotensin converting enzyme (ACE), formed in small quantities in
the lungs, proximal convoluted tubules and other tissues, converts
angiotensin 1 into angiotensin 2, which is a very potent
vasoconstrictor and increases blood pressure.
Angiotensin II affects renal physiology in
three main ways:
1. It decreases the glomerular filtration rate by causing
vasoconstriction of the afferent arterioles.

2. It enhances reabsorption of Na, Cl, and water in the proximal

convoluted tubule by stimulating the activity of Na-H antiporters.

3. It stimulates the adrenal cortex to release aldosterone, a hormone

that in turn stimulates the principal cells in the collecting ducts to
reabsorb more Na and Cl and secrete more K.
Acid Base Balance
• pH balance
An acid substance releases hydrogen ions when in solution.
On the other hand, a basic (alkaline) substance accepts hydrogen ions,
often with the release of hydroxyl (OH− ) ions.
The kidneys regulate blood pH by adjusting the excretion of hydrogen
and bicarbonate ions as required.
In order to maintain normal blood pH (acid–base balance), the proximal
convoluted tubules secrete hydrogen ions into the filtrate where they
combine with buffers.
• bicarbonate, forming carbonic acid
• Carbonic acid is converted to carbon dioxide (CO2) and water (H2O),
and the CO2 is reabsorbed, maintaining the buffering capacity of the
blood.
• Hydrogen ions are excreted in the urine as ammonium salts and
hydrogen phosphate.
Micturition
In infants accumulation of urine in the bladder activates stretch
receptors in the bladder wall

generates sensory (afferent) impulses that are transmitted to the spinal

cord, where a spinal reflex is initiated

This stimulates involuntary contraction of the detrusor muscle and

relaxation of the internal urethral sphincter

expels urine from the bladder – this is micturition or voiding of urine.

• When bladder control is established,
the micturition reflex is still stimulated
but sensory impulses also pass
upwards to the brain and there is
awareness of the need to pass urine as
the bladder fills (around 300–400 mL
in adults).
• By learned and conscious effort,
contraction of the external urethral
sphincter and muscles of the pelvic
floor can inhibit micturition until it is
convenient to pass urine
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