Introduction to the Body

UNIT SIX
The Urinary System
and
Fluid Balance

© Centre for Nutrition Education and Lifestyle Management

 The Urinary system

The urinary system is made up of:

• 2 kidneys
• 2 ureters
• 1 bladder
• 1 urethra
These are all located in the abdomen and
they form one of the excretory systems of
the body.
 The Urinary system
Renal vein Renal artery

Cortex
Kidney Medulla
Calyx
Pelvis

Ureter

Ureteral openings
Trigone
Bladder
Sphincter

Urethra
 Excretory Systems
Together with the lungs and the skin, the
kidneys are the main organs responsible for
• purifying the blood of the waste products
of metabolism, and of toxic substances;
• regulating loss of water and salt from the
body;
• maintaining the neutrality of the blood and
tissue fluids by adjusting the acid-base
balance.
 Homeostasis
• ‘The tendency of biological systems to maintain
relatively constant conditions in the internal
environment while continuously interacting with and
adjusting to changes originating within or outside
the system.’
• Examples include: our body temperature regulation
and maintenance of blood pressure within a
specific range of values. Additionally, its through
homeostatic controls that nutrients are supplied to
cells as needed, and waste products are removed
before they accumulate and reach toxic levels of
concentration.
 Homeostasis
So, homeostasis means “to keep things at a
constant equilibrium”. The body operates within
set limits of water content, blood glucose,
waste compounds, salt balance etc.
Homoeostatic mechanisms help to maintain
these limits. If homeostatic mechanisms fail
and balance is lost, we rapidly become very ill
and may die.
The kidneys, alongside other organs, are
extremely important as homoeostatic
regulators.
 Negative Feedback

Taken from: Anatomy and Physiology, Openstax college, chapter 1, page 22

 Functions of the Urinary system
• Excrete waste products in urine
• Regulate blood in terms of:
– Ionic composition
– pH
– Volume
– Pressure
– Osmolarity
– Glucose levels
• Produce hormones, e.g.:
– Calcitriol to regulate calcium levels
– Erythopoietin to stimulate red blood cell
production
 Kidneys
• Kidneys lie just above the waist, the right kidney being
a little lower than the left one.
• They are partially protected from the lower rib cage
and they are about 10-12 cm in length, 5-7 cm wide,
and 3-4 cm thick. Each kidney weighs approximately
135-150gr.
• Kidneys are covered by a fibrous capsule composed
of dense, irregular connective tissue that helps to hold
their shape and protect them. This capsule is covered
by a shock-absorbing layer of adipose tissue called
the renal fat pad which in turn is encompassed by a
tough renal fascia
Taken from: Anatomy and Physiology, Openstax college, chapter 25, page 1150
 Kidney

Taken from: Anatomy and Physiology, Openstax college, chapter 25, page 1151
 Structure of the kidney
• Under the fibrous tissue capsule of the kidney
is the outer cortex where ‘filtering’ units, the
renal corpuscles, lie.
• The innermost part of the kidney is called
medulla which contains 7 to 18 pyramids
which in turn contain the reabsorbing tubules
and collecting ducts of the renal tubules. The
ducts convey urine to the pelvis of the kidney
for passage to the ureters and the bladder.
The renal corpuscle (in the cortex) and renal
tubules (in pyramids) make up the nephrons
which are the urine-making units.
 Nephrons
Nephrons are the functional units of the kidney.
They are essentially long, narrow funnels with a
cup at one end and opening into a collection
area at the other. Nephrons can be divided into:
• the renal corpuscle – located in the renal
cortex
• the renal tubule – with convoluted parts
being located in the renal cortex and the
straight parts are in the renal medulla
within the pyramids
Taken from: Structure & Function of the Body, Patton and Thibodeau, chapter 18, page 413
 Structure of Nephron
afferent arteriole second (distal)
efferent arteriole convoluted tubule
Glomeruli
Bowman's
capsule

first
(proximal)
convoluted
Cortex
tubule Medulla
collecting
Capillary
network duct

to Pelvis

Loop of
Henle
 The Renal Corpuscle
The renal corpuscle is made up of two parts:
• Bowman's capsule – a thin-walled, cup
shaped structure which encloses the
• glomerulus – a ‘knot’ of capillaries. The
blood is supplied into the glomerulus by the
afferent arteriole and leaves via the efferent
arteriole. The afferent arteriole has a larger
diameter than the efferent arteriole and this
creates pressure within the glomerulus which
is required for blood filtration to occur.
 The Renal Tubule
The renal tubule is made up of four parts:
• the proximal convoluted tubule, nearest to
the Bowman's capsule
• the Loop of Henle, made up of the [straight]
descending loop and ascending loop
• the distal convoluted tubule, distant from
the Bowman's capsule
• the collecting tubule, leading into the
collecting duct. Several collecting tubules
drain into a common duct.
 Distal convoluted tubule

Collecting tubule

(henle)

Ascending
loop
Descending loop

Taken from: Anatomy and Physiology, Openstax college, chapter 25, page 1152
 Nephron facts
• 1 million nephrons per kidney, since birth
• New ones are not formed, if nephrons are
damaged or diseased
• Increased kidney size is due to increase in
nephron size, not number.
• Removal of one kidney causes the other to
enlarge (1 kidney is able to filter blood at 80% rate of
2 normal kidneys)
• Dysfunction not apparent until down to 25% of
normal function (nephrons adapt to handle larger
than normal loads)
 Kidney Function
20 – 25% of the blood from the heart goes to
the kidneys, travelling from the renal artery
through the afferent [incoming] arteriole into
the glomerulus.
The blood pressure within the glomerulus
increases because the efferent [outgoing]
arteriole is narrower, thus forcing fluids and
waste substances to be filtered out of the
blood into the nephron.
 Blood Flow in the Kidney

Taken from: Anatomy and Physiology, Openstax college, chapter 25, page 1152
 Blood flow in the kidney
• On leaving the glomerulus, the efferent arteriole
reduces down to peritubular capillaries that
wrap around the tubules and reabsorb
substances back into the blood from all parts of
the renal tubule.
• As the fluid passes through the convoluted
tubules and the loop of Henle, 99% of the fluid
and some of the solutes are reabsorbed back
into the blood.
• The remaining fluid and waste products pass into
the renal pelvis as urine.
 The Purpose of Filtration
Balance is the key word - otherwise known as
homoeostasis. Body fluids and tissues must
maintain certain levels of substances in them
for optimal function and the kidney’s function is
to ensure that excess is removed and that
enough is retained. So, there is a two-fold
action:
• Excretion of excess electrolytes, waste
metabolites and some toxins
• Reabsorption of necessary electrolytes,
water and minerals
 Electrolytes

Electrolytes are compounds that dissociate

in solution, i.e. their ionic bonds break apart
and the free ions float around. Salt [NaCl]
dissociates into Na+ and Cl- - these are
therefore electrolytes.
Other important electrolytes are:
• K+ • HCO3- [bicarbonate]
• Mg2+ • HPO42- [phosphate]
• Ca2+ • protein- ions
 Urine Composition
Urine is made up mostly of:
• water
• excess sodium, potassium, chloride and
other electrolytes
• urea
• bicarbonate ions [HCO3-]
• drugs and other toxic substances
 Urine Formation

There are three steps to this:

1. Filtration [blood nephron]
2. Reabsorption [nephron blood]
3. Secretion [blood nephron]
 Step 1: Filtration
The pressure of the blood within the
glomerulus forces fluids containing glucose,
water and salts out of the blood, through the
thin visceral layer of the Bowman’s capsule
into the capsular space and then into the
proximal convoluted tubule.
Blood cells and proteins are too large to be
filtered out of the blood vessel [unless the
glomerular capillaries are damaged, when
larger substances might get through.]
 Step 2: Reabsorption (I)

In the proximal tubule, water and glucose

are mostly reabsorbed:
97-99% water is reabsorbed
100% glucose is reabsorbed UNLESS
there is too much glucose in the blood [e.g.
in Diabetes mellitus] in which case some is
excreted in the urine – this is called
glycosuria.
 Reabsorption (II)
• Sodium, potassium, chloride and other ions
[electrolytes] are reabsorbed mainly in the
proximal tubule but also in the loop of Henle
and to a minor extent in the distal tubule.
• This fine-tunes the amount of electrolytes
being excreted.
• The amount of sodium and chloride excreted
will depend on how much is ingested as the
balance required for these is very tightly
controlled.
 Step 3: Secretion

Potassium, hydrogen ions [H+], ammonium

ions [NH4+], toxins and some drugs are
secreted into the nephron along the length
of the distal and collecting tubules.
Removal of H+ ions helps to maintain the pH
of the blood; the rest are removed as waste
products.
 Reabsorption

Secretion

Taken from: Anatomy and Physiology, Openstax college, chapter 25, page 1162
 Glomerular Filtration
Blood is constantly passing through the
kidneys for filtration. 150-180 litres of fluid
filter into the nephrons every day: this is
called glomerular filtration. The percentage
of blood plasma that becomes glomerular
filtrate is 16-20% in healthy conditions. Blood
plasma normally constitutes 55% of blood
volume; so, assuming 5 litres of blood in the
body it works out that the blood cycles
through the kidneys ~300-360 times per day.
 Substances in urine
SUBSTANCES FILTERED, REABSORBED and EXCRETED in URINE
Assuming 180 Liters per day entering Glomeruli

SUBSTANCE FILTERED REABSORBED EXCRETED

Water 180 L 178 – 179 L 1–2L

Proteins 2.0 g 1.9 g 0.1 g
Sodium ions (Na+) 579 g 575 g 4g
Chlorine ions (Cl-) 640 g 633.7 g 6.3 g
Bicarbonate ions (HCO3-) 275 g 275 g 0.03 g
Glucose 162 g 162 g 0g
Urea 54 g 24 g 30 g
Potassium ions (K+) 29.6 g 29.6 g 2.0 g
Uric acid 8.5 g 7.7 g 0.8 g
Creatinine 1.6 g 0g 1.6 g
 Glomerular Filtration Rate
[GFR]
Glomerular filtrate is produced at the rate of:
•125ml / min [males]
•105ml / min [females]
This needs to be maintained at about this rate
for homoeostasis:
• much faster and essential substances may
not be reabsorbed but be lost by excretion;
• much slower and waste products may be
reabsorbed instead of being excreted.
 GFR control

GFR is affected by:

• the volume of fluid intake
• the systemic blood pressure
GFR is controlled by three mechanisms:
• kidney auto-regulation
• neural regulation
• hormonal regulation
 Fluid Volume
• The main purpose of urinary excretion is to
remove fluid from the body, with a greater or less
amount of waste products in it. This maintains a
fairly constant volume.
• If we take in extra fluid, then we excrete more
and the GFR will increase.
• If we take in less fluid, then we excrete less and
the GFR will decrease - also if there is a sudden
drop in blood volume due to rapid blood loss.
 Fluid Pressure

If there is a sudden large drop in blood

pressure it may be due to a sudden large
drop in blood volume e.g. in a massive
bleed. Large drops in blood pressure result
in a decreased GFR.
However, small changes and large rises in
blood pressure do not automatically increase
the GFR; in fact, it is quite stable up to really
quite high pressures.
 Kidney Auto-regulation
This is the predominant GFR control mechanism
in health and ‘normal’ conditions.
As systemic blood pressure rises, the afferent
arterioles are stretched by the greater pressure.
This triggers a mechanism to contract the walls
of the arterioles, thus reducing the blood flow
through them and therefore keeping the GFR
down to ‘normal’.
As the systemic pressure drops so the arteriole
walls relax and increase the blood flow, thus
keeping the GFR up to ‘normal’.
 Urinary Volume Control

As well as the GFR control, the actual

amount of urine produced is controlled
principally by hormones.
The main hormones involved are:
• Anti-Diuretic Hormone (ADH)
• Aldosterone
• Atrial Natriuretic Hormone (ANH)
[also sometimes called Atrial
Natriuretic Peptide (ANP)]
 Anti-Diuretic Hormone (ADH)
ADH is secreted from the posterior pituitary gland and
it controls the amount of urine produced by making
collecting ducts permeable to water. Therefore:
1.Increased ADH secretion increased water-
permeability of renal tubules increased water
reabsorption lower urine volume.

2.Decreased ADH secretion decreased

permeability of renal tubules decreased water
reabsorption higher urine volume.
 Aldosterone

• Aldosterone is produced in the adrenal cortex

and is primarily involved in the reabsorption of
sodium.
• Primarily, it stimulates the faster reabsorption
of sodium from the tubules.
• Secondarily, it increases water reabsorption
with water following sodium through osmosis.
 low blood
pressure!

Increases blood
pressure to normal!
Taken from: Anatomy and Physiology, Openstax college, chapter 25, page 1157
 Atrial Natriuretic Hormone (ANH)
• Also called ‘atrial natriuretic peptide’ is produced
in the atrial wall of the heart in response to the
heart muscle stretching due to increased fluid
volume (increased blood pressure).
• It works in opposition to aldosterone, i.e. it
decreases the rate of sodium reabsorption and
therefore decreases water reabsorption (and blood
pressure).
• The more ANH produced, the more water is lost in
the urine thus reducing the fluid volume in the body.
 Ureters
All the collecting tubules within the kidney
drain into the renal pelvis and then into the
ureter. This is a tube of approximately 25-30
cm in length and is composed of three layers
of tissue:
Inner = stretchy mucosal transitional epithelium
Mid = muscularis – layers of circular muscle
around longitudinal muscle
Outer = areolar tissue called adventitia
The diameter varies from 1 – 10mm down the
length of the ureter.
 Kidney

Taken from: Anatomy and Physiology, Openstax college, chapter 25, page 1151
 Ureters

Taken from: Anatomy and Physiology, Openstax college, chapter 25, page 1150
 Ureter

Taken from: Anatomy and Physiology, Openstax college, chapter 25, page 1149
 Urine movement in Ureters
The two cross-layers of muscle in the ureters
produce a peristaltic motion, pushing the urine
down into the urinary bladder. There are no
physical valves as such from the ureter into
the bladder but the opening into the bladder
from the ureter is structured in such a way that
as the bladder fills up, the oblique opening is
compressed to prevent backflow of urine up
into the kidney. If this mechanism fails and
there is backflow, it is called renal reflux and
can result in kidney infections.
 Urinary Bladder

The urinary bladder is located deep in the

abdomen, within the peritoneal cavity. When
empty it is a small, collapsed structure located
behind the pubis symphysis joint. As it fills, it
swells upwards, becoming first spherical and then
pear-shaped.
The walls of the bladder are in the same three
layers as the ureter. The inner bladder wall also
folds into wrinkles called rugae which allow the
bladder to expand as they unwrinkled.
 Urinary Bladder

Taken from: Anatomy and Physiology, Openstax college, chapter 25, page 1147
 Features of the bladder
• The average capacity of a bladder is 700-
800ml in males, slightly less in females.
• One area of the bladder never wrinkles, it is
always smooth and is called the trigone. It is
positioned on the back wall of the bladder
between the openings of the ureters and the
single urethra.
• There are two sphincters [tight rings of
muscle] where the bladder opens into the
urethra – these control the flow of urine into
the urethra.
 Urethra
The urethra is the last part of the urinary tract.
It exits the bladder via the urinary meatus.
In females, the urethra is only about 4cm long.
In males it is much longer as it has the length of
the penis to travel as well; in males the urethra
also performs the secondary function of passing
semen as well as urine, although not at the
same time. The prostate gland surrounds the
top of the urethra and if it has a problem [such
as prostate cancer] it can interfere with urinary
flow.
 Male and Female Urethra

Taken from: Anatomy and Physiology, Openstax college, chapter 25, page 1146
 Micturition (Urination)
Essentially a reflex action; although after infancy
it becomes voluntary to start and stop.
When the volume of urine exceeds 200-400 ml,
the pressure stretches the wall and nerves in the
wall transmit impulses to the spinal cord. This
stimulates a desire to micturate.
Rhythmic contractions begin. The bladder wall
muscles contract and the sphincters relax. It is
assisted by contraction of the abdominal wall
muscles and diaphragm. A ring of muscle just
below the bladder squeezes out the last drop.
 Urinary system disorders

The most common disorders are:

• Cystitis (inflammation of the bladder)
• Renal calculi (kidney stones)
• Incontinence or Enuresis (involuntary
urination)
More serious conditions, where the kidneys are
damaged or lost, require intervention to prevent
death – this is called renal dialysis.
 Cystitis

This is an inflammation of the urinary bladder,

caused by irritation, infection or incomplete
voiding of the bladder (which may occur if
there is loss of spinal response to the bladder
wall impulses, e.g. in people with damaged
spinal cords, MS etc.)
Prolonged, untreated cystitis may have some
serious consequences like bladder damage,
kidney damage, prostate infection etc.
 Renal calculi
• Kidney stones are becoming more common. They
are often made up of crystal-forming substances -
such as calcium, oxalate and uric acid.
• Tiny stones may form and pass through the
ureters without notice; larger stones may still pass
through but are often associated with excruciating
pain (renal colic).
• Large stones form in the calyx and renal pelvis
areas of the kidney and may obstruct urinary flow.
Ultrasound treatment is used to shatter the large
stones into particles small enough to pass out
naturally.
 Incontinence

The loss of voluntary control over urination

means that there is no control over the
external sphincter. This often happens in the
case of stroke victims but can also happen
after childbirth when the pelvic floor muscles
are weak. Exercises can be done to tone up
the external sphincter and also to improve
the pelvic floor muscles.
 Renal Dialysis
When the kidneys are not able to function
anymore, there is a rapid build-up of toxins in
the blood and, if untreated, can lead to death.
Dialysis does the same job as the kidney
would do – blood from the radial artery goes
into the machine through a tube of semi-
permeable material immersed in a bath of
solution containing electrolytes etc. Urea and
waste products pass into the bath and the
cleaned blood returns into the body via a wrist
vein.
 Homeostasis
For the purposes of this module we are
going to concentrate only on homoeostasis
of fluids in the body, otherwise known as the
fluid balance.
What this means is that the amount and
composition of the fluids in the body is kept
relatively constant by various mechanisms.
The electrolyte balance in the fluids is
equally important and has a large role to
play in maintaining the overall fluid balance.
 Body Water Content

The water content is relatively constant in the

body, depending on size and fat content:
• Adult males - 55-60%
• Adult females - 50-55%
• Infants - 75-80%

The amount of water in the body is retained

constant.
 Water in the body

Water in the body is found in three main

areas:
• Intracellular (ICF) fluid inside the
cells (by far the largest in volume)
• Interstitial (IF) fluid in between the
cells
• Plasma
IF and Plasma together make up the
Extracellular fluid.
Mechanisms for maintaining water
balance
The main mechanism for this job is the
control of fluid output.
A secondary control is that of our fluid intake
but this is minor in comparison.
Fluid output organs are:
• Kidneys
• Lungs
• Skin
• Intestines
 Water balance
Excretion Intake

Skin 450-600ml Water from:

Lungs 300-350ml Metabolism 200ml
Gut 100-200ml Fluids in diet 1500-1600ml
Kidneys 1400-1500ml Foods in diet 700ml

Total 2400-2500ml Total 2400-2500ml

Daily water balance in an adult.

 Water loss

As you can see from the table, water loss

should equal water gain to maintain fluid
balance. Under different conditions, more
water may be lost e.g.:-
exercising vigorously on a hot day will
increase the skin’s output as sweat;
having a GI tract infection with diarrhoea will
increase fluid loss via the large intestine or
vomiting.
 Water gain
The main way we increase our water gain is
by drinking more. We do this when thirsty, and
our thirst reflex is governed by the thirst
centre in the hypothalamus [see Unit 11, the
Endocrine System, for more on this gland].
The thirst centre is triggered by various
factors, including:
• mouth dryness due to reduced saliva
• receptors for reduced blood pressure
in the kidneys, heart and blood vessels.
 Water imbalances

Excess fluid in the body tissues is known as

oedema. It is characterised by swollen areas
that are soft and puffy to the touch and that
have low elasticity so that a fingertip imprint
still shows after a couple of seconds.
Insufficient fluid is called dehydration. This
appears as dry skin which also has reduced
elasticity, such that if you pick up a fold
between fingertips, it doesn’t ‘spring back’, it
returns to its normal position slowly.
 Control of water balance
The most obvious control is:
The more you put in, the more comes out.
In other words, the higher the fluid intake,
the higher the output volume. The majority of
the volume control is via the kidneys and
the urine. So, the more you drink, the more
you urinate and similarly, the less you drink,
the less you urinate.
 Salt and water balance

The concentrations of Na+ and Cl- in the

blood plasma affect the volume of water lost
in the urine as well.
If a high amount of Na+ is lost in the urine
then more water will also be lost to keep up
the concentration of the Na+ left in the body.
If a low amount of Na+ is lost in the urine [i.e.
more is reabsorbed] then less water will be
lost, so that the concentration of Na+ doesn’t
become too high in the body
 Electrolyte Balance
Electrolytes in the body have important
functions e.g. calcium is essential in muscle
contraction, sodium and potassium in nerve
action potentials, iodine is essential for the
production of thyroid hormones and many
others.
Excess or insufficiency of any electrolytes can
cause problems but two of the most important
are sodium and potassium, especially in
relation to the cardiovascular,neural and
muscular systems.
 Excess blood volume
If the blood volume is too high, then the
pressure within the blood capillaries
increases. This forces more fluid out into the
tissues as interstitial fluid and it is harder for it
to return because of the physical pressure in
the vessels. Diuretics, which help to increase
urinary output, are taken to reduce the blood
volume and therefore the blood pressure in
the capillaries.