ANATOMY OF THE URINARY SYSTEM

INTRODUCTION

 Consist of two kidneys, two ureters, one urinary bladder and one urethra.
 Nephrology-scientific study of the anatomy, physiology and pathology of the
kidneys.
 Urology-A branch of medicine that deals with the male and female urinary
system and the male reproductive system.

ANATOMY OF THE KIDNEYS

 KIDNEY
 Reddish in color, bean-shaped and located just above the waist b/n the
peritoneum and the posterior wall of the abdomen and is said to be
retroperitoneal.
 Located between the last thoracic and third lumbar vertebrae, partially
protected by ribs 11 and 12.
 Right kidney is slightly lower than the left.

EXTERNAL ANATOMY

 Renal Hilum- Is an indentation near the center of the concave border in which
the ureter emerges from the kidney along with blood vessels, lymphatic vessels
and nerves.
 Three layers that surround the kidney
 Renal Capsule- The deepest layer, smooth and composed of dense irregular
connective tissue that is continuous with the outer coat of the ureter.
- Functions as a barrier against trauma and help maintain the shape of the
kidney.
 Adipose Capsule-The middle layer, mass of fatty tissue surrounding the renal
capsule.
- Protects the kidney from trauma and holds the kidney firmly in place.
 Renal Fascia- The superficial layer, composed of dense irregular connective
tissue.
- Anchors the kidney to the surrounding structures and to the abdominal wall.
Renal fascia is deep to the peritoneum.

1|Page
INTERNAL ANATOMY

 Renal Cortex- superficial, light red region. It is a smooth-textured area extending

from the renal capsule to the bases of the renal pyramids and into the spaces
between them.
- It is divided into outer cortical zone and inner juxtamedullary zone
- The portion of the renal cortex that extend between renal pyramids are
called renal columns
 Renal Medulla- deep, darker reddish-brown inner region and consists of several
cone-shaped renal pyramids.
- The base of each pyramid faces the renal cortex and its apex is called as
renal papilla that points toward the renal hilum.
 Parenchyma- Constitutes of renal cortex and renal pyramids. It is the functional
unit of the kidney containing millions of nephrons.
 Papillary ducts- Catch basin of the filtrates formed by the nephrons. It extends
through renal papillae of the pyramids.
- It drains to cuplike structure called minor and major calyces. Each kidneys
contain 2 or 3 major calyces.
 Renal Pelvis- A single large cavity in which the urine drains.
 Renal Sinus- A cavity in the kidney where the hilum expands and contains the
part of the renal pelvis, calyces, branches of the renal blood vessels and nerves.

BLOOD AND NERVE SUPPLY OF THE KIDNEYS

 Renal Arteries- Recieves the resting cardiac output.

- Segmental arteries- Supply different segments of the kidney. It gives off
several branches that enter the parenchyma and pass through renal
columns.
 Renal Lobe- Consists of a renal pyramid, renal column on either side of the renal
pyramid, and the renal cortex at the base of the renal pyramid.
 Arcuate arteries- Located at the base of the renal pyramids, the interlobar
arteries arch between the renal medulla and cortex.
- Cortical Radiate Arteries- Arteries that radiate outward and enter the renal
cortex. Here, they give off branches called afferent arterioles.
- A nephron receives one afferent arteriole, which divides into a tangled, ball-
shaped capillary network called glomerulus.
- The glomerular capillaries then reunite to form an efferent arteriole that
carries blood out of the glomerulus.
- The efferent arterioles divide to form the peritubular capillaries, which
surround tubular parts of the nephrons in the renal cortex.
- Vasarecta- Supplies the tubular portions of the nephron in the renal medulla.

2|Page
 - Peritubular capillaries eventually reunite to form cortical radiate veins which
also receive blood from the vasa recta. Then the blood drains through the
arcuate veins to the interlobar veins running between the renal pyramids that
exits at the renal hilum and carries venous blood to the inferior vena cava.

THE NEPHRON

 Nephrons are the functional units of the kidneys. Each nephron consists of two
parts:
 Renal corpuscle, where blood plasma is filtered.

Two components:

- Glomerulus (capillary network)

- Glomerular Capsule(Bowman’s Capsule)is a double-walled epithelial cup
that surrounds the glomerular capillaries.

 Renal tubule into which the filtered fluid passes

Three Main Sections:

- Proximal Convoluted Tubule(PCT)- Attached to the glomerular capsule, lies

within renal cortex
- Nephron Loop- Extends into the renal medulla
- Distal Convoluted Tubule(DCT)-Further away, lies within renal cortex
o Collecting ducts- where the distal convoluted tubules of several nephrons
drains.

HISTOLOGY OF THE NEPHRON AND COLLECTING DUCT

- A single layer of epithelial cells forms the entire wall of the glomerular
capsule, renal tubule, and ducts.
 Glomerular Capsule - also known as Bowman’s capsule
- Consists of visceral and parietal layers
o Podocytes - Simple squamous epithelial cells.
- The footlike projections of these (pedicels) wrap around the
single layer of endothelial cells of the glomerular capillaries.
o Capsular space-The space between the two layers of the glomerular
capsule, which is the lumen of the urinary tube
 Renal Tubule and collecting duct- Cells are simple cuboidal epithelial
cells with a prominent brush borer of microvilli on their apical surface.
o Macula densa- Columnar tubule cells crowded together in the
ascending limb of the nephron loop.

3|Page
 o Juxtaglomerular cells (JG)- Modified smooth muscle fibers in the walls
of afferent and efferent arterioles.
o Juxtaglomerular apparatus (JGA)- Constitutes of juxtaglomerular cells
and macula densa. It also helps regulate blood pressure within the
kidneys.
o Principal Cells- Contains receptors for both antidiuretic hormone and
aldosterone.
o Intercalated Cells- Plays a role in the homeostasis of blood pH.

OVERVIEW OF RENAL PHYSIOLOGY

- To produce urine, nephrons and collecting ducts perform three basic
processes – glomerular filtration, tubular reabsorption and tubular secretion.

1. Glomerular Filtration- First step of urine production.

- water and most solutes move across the wall of glomerular capillaries where
they are filtered and move in the glomerular capsule and renal tubule.
2. Tubular Reabsorption- All along the renal tubule an collecting duct, water, ions,
and other substances get reabsorbed from the renal tubule lumen into the
peritubular capillaries and ultimately into the blood.
3. Tubular Secretion- The renal tubule and collecting duct, substances such wastes,
drugs, and excess ions get secreted from the peritubular capillaries into the renal
tubule. These substances unltimately make their way into the urine.2

GLOMERULAR FILTRATION

 Glomerular Filtrate- The fluid that enters the capsular space.

 Filtration Fraction- The fraction of blood plasma in the afferent arterioles
of the kidney.
 Filtration membrane- A sandwichlike assembly permits filtration of water
and small solutes but prevents filtration of most plasma proteins, blood
cells, and platelets. Substances filtered from blood cross three filtration
barriers:
1. glomerular endothelial cell- regulates glomerular filtration
2. basal lamina – Acellular material between endothelium and podocytes
3. filtration slit – Allows passage of water, glucose,vitamins,amino acids and
very small plasma proteins.

Net Filtration Pressure

- One pressure promotes filatration while two pressures opposite filtration.

4|Page
 1. Glomerular blood hydrostatic pressure (GBHP) – Blood pressure in glomerular
capillaries.
-It is about 55mmHg.
- It promotes filtration by forcing water and solutes in blood plasma through
filtration membrane.
2. Capsular hydrostatic pressure (CHP)- Hydrostatic pressure exerted against the
filtration membrane by fluid already in the capsular space and renal tubule.

-It opposes filtration and represents a “back pressure” of about 15mmHg.

3. Blood colloid osmotic pressure ( BCOP)- Opposes filtration which is due to the
presence of proteins such as albumin, globulins, and fibrinogen in blood plasma

-BPCOP in glomerular capillaries is 30 mmHg.

Glomerular Filtration Rate

- The amount of filtrate formed in all renal corpuscles of both kidneys each
minute.
- GFR averages in 125mL/min in males 105 mL/min in females .

Three mechanisms of control GFR:

1. Renal Autoregulation- The capability to maintain renal blood flow and GFR
despite normal, everyday changes in blood pressure, like those that occur during
exercise.
- Two mechanisms:
a. Myogenic mechanism- Increased stretching of smooth muscle fibers in
afferent arteriole walls due to increased blood pressure.
-Stretched smooth muscle fibers contract, thereby narrowing lumen of
afferent arterioles.
-Decrease effect on GFR.
b. Tubuloglomerular feedback- Rapid delivery of Na and Cl to the macula
densa due to high systematic blood pressure.
- Decreased release of nitric oxide by juxtaglomerular apparatus causes
constriction of afferent arterioles.
- Decrease effect on GFR

2. Nueral Regulation- Increase in activity level of renal sympathetic nerves releases

norepinephrine.

5|Page
 -Constriction of afferent arterioles through activation of ∝1 receptors and
increased release of renin.

-Decrease effect on GFR.

3. Hormonal Regulation

a. Angiotensin II – Decrease blood volume or blood pressure stimulates production of

angiotensin II.

-Constriction of afferent and efferent arterioles.

-Decrease effect on GFR.

b. Atrial natriuretic peptide (ANP)- Stretching of atria of heart stimulates secretion of

ANP.

-Relaxation of mesangial cells in glomerulus increases capillary suface area available

for filtration.

-Increase effect on GFR

6|Page