Anatomic and Physiologic Overview

ANATOMIC AND PHYSIOLOGIC OVERVIEW
Anatomy of the Kidney and Urinary Systems

The kidney and urinary systems include the kidneys, ureters, bladder and urethra. Urine is formed by
the kidney and flows through the other structures to be eliminated from the body.
Kidneys
The kidneys are a pair of bean-shaped, brownish-red structures located retroperitoneally
(behind and outside peritoneal cavity) on the posterior wall of the abdomen – from the 12 th thoracic
vertebra in the adult. The rounded outer convex surface of the kidney is called the hilum. Each hilum
is penetrated with blood vessels, nerves and the ureter.
The average adult kidney weighs approximately 113 to 170g (about 4.5 oz) and is 10 to 12
cm long, 6 cm wide and 2.5 cm thick (Norris, 2019; Russell, 2017). The right kidney is slightly
lower than the left due to the location of the liver.
Renal Parenchyma
 Medulla – approximately 5cm wide, is the inner portion of the kidney. It contains the loops
of Henle, the vasa recta, and the collecting ducts of the juxtamedullary nephrons. The
collecting ducts from both the juxtamedullary and the cortical nephrons connect to the renal
pyramids, which are triangular and are situated with the base facing the concave surface of
the kidney and the point (papilla) facing the hilum or pelvis.
 Cortex – approximately 1cm wide, is located farthest from the center of the kidney and
around the outermost edges (Norris, 2019). It contains the nephrons (the structural and
functional units of the kidney responsible for urine formation), which are discussed later.
Blood Supply to the Kidneys
 The hilum is the concave portion of the kidney through which the renal artery enters and the
ureters and renal vein occurs.
 The kidneys receives 20% to 25% of the total cardiac output, which means that all of the
body’s blood circulates through the kidneys approximately 12 times per hour (Norris, 2019).
 Afferent arteriole branches to form a glomerulus, which is the tuft of capillaries forming part
of the nephron though which filtration occurs. Blood leaves the glomerulus through the
efferent arteriole and flows back to the inferior vena cava through a network of capillaries
and veins.
Nephrons
Nephrons is the functional unit of the kidney. Each kidney has one million nephrons that are located
within the renal parenchyma and are responsible for the formation of filtrate that will become urine
(Norris, 2019). The large number of nephrons allows for adequate renal function even if the opposite
kidney is damaged or becomes nonfunctional. If the total number of functioning nephrons is less than
20% of normal, kidney replacement therapy needs to be considered.
 Bowman’s Capsule - It is the first part of the nephron. It is a cup-shaped structure and
receives the blood vessels. Glomerular filtration occurs here. The blood cells and proteins
remain in the blood.
 Proximal Convoluted Tubule - The Bowman’s capsule extends downwards to form the
proximal tubule. Water and reusable materials from the blood are now reabsorbed back into
it.
 The loop of Henle - The proximal tubule leads to the formation of a u-shaped loop called the
Loop of Henle. It has three parts: the descending limb, the u-shaped bend, and the ascending
limb. It is in this area in which urine becomes concentrated as water is reabsorbed. The
descending limb is permeable to water whereas the ascending limb is impermeable to it.
 Distal Convoluted Tubule - The Loop of Henle leads into the distal convoluted tubule. It is
where the kidney hormones cause their effect.
 Collecting Duct - The Distal Convoluted Tubule of each nephron leads to the collecting
ducts. The collecting ducts together form the renal pelvis. Through renal pelvis, the urine
passes into the ureter and then into the bladder
Ureters, Bladder and Urethra
 Ureters are one ureter that comes out of each kidney as an extension of the renal pelvis. It is
a thin muscular tube that carries urine from the kidneys to the bladder.
 Urinary Bladder is a sac-like structure. And a smooth muscle layer lines it. It stores the
urine until micturition. Furthermore, Micturition is the act of expelling urine from the body.
The bladder receives urine from the ureters, one from each kidney. In addition, the level of
placement of the bladder in the body differs in men and women.
 Urethra is a tube that arises from the urinary bladder. Its function is to expel the urine
outside by micturition. In addition, it is shorter in females and longer in males. Furthermore,
in males, it functions as a common path for sperms and urine. Also, sphincter guards the
opening of the urethra.
Physiologic of the Kidney and Urinary Systems

Understanding the physiology of the kidney and urinary systems includes comprehending urine
formation, antidiuretic hormone, osmolarity and osmolality; the regulation of water excretion,
electrolyte excretion, and acid-base balance; auto-regulation of blood pressure, renal clearance,
regulation of red blood cell (RBC) production, vitamin D synthesis, secretion of prostaglandins and
other substances, excretion of waste products, urine storage as well as bladder emptying.
Urine Formation
Water balance is regulated by the kidneys and results in the formation of urine. Urine is formed in
the nephrons through a complex three-step process: glomerular filtration, tubular reabsorption and
tubular secretion. Each nephron functions independently from other nephrons because each has its
own blood supply (Norris, 2019).
Glomerular Filtration
The normal blood flow through the kidneys is between 1000 and 1300 mL/min (Norris, 2019). As
blood flows into the glomerulus from an afferent arteriole, filtration occurs. The filtered fluid, also
known as filtrate or unfiltrate, then enters the renal tubules. The filtrate normally consists of water,
electrolytes, and other small molecules, because water and small molecules are allowed to pass,
whereas larger molecules stay in the bloodstream.
Tubular Reabsorption and Tubular Secretion
In tubular reabsorption, a substance moves from the filtrate back into the peritubular filtrate.
Reabsorption and secretion in the tubule frequently involve passive and active transport and may
require the use of energy. Tubular secretion occurs when substances move from the peritubular
capillary blood plasma (blood) and the tubular lumen (filtrate).
Regulation of Electrolyte Excretion
When the kidneys are functioning normally, the volume of electrolytes excreted per day is equal to
the amount ingested. The regulation of sodium volume excreted depends on the aldosterone, a
hormone synthesized and released by the adrenal cortex.
Regulation of Acid-Base Balance
The kidney performs major functions to assist in this balance. One function is to reabsorb and return
to the body’s circulation any bicarbonate from the urinary filtrate; other functions are to excrete or
reabsorb acid, synthesize ammonia and excrete ammonium chloride (Fischbach & Fischbach, 2018).
Auto-regulation of Blood Pressure
Specialized vessels of the kidney, called the vasa recta, constantly monitor blood pressure as blood
begins its passage into the kidney.
Renal Clearance
Renal clearance refers to the ability of the kidneys to clear solutes from the plasma. A 24-hour
collection of urine is the primary test of renal clearance used to evaluate how well the kidney
performs this important excretory function.
Regulation of Red Blood Cell Production
Erythropoietin is a glycoprotein from the kidney that stimulates from the kidney that stimulates the
bone marrow to produce RBCs which carry oxygen throughout the body (Norris, 2019).
Vitamin D Synthesis
Vitamin D is necessary for maintaining normal calcium balance in the body.
Secretion of Prostaglandins and Other Substances
The kidneys also produce prostaglandin E and prostacyclin, thromboxanes and leukotrienes which
have vasoactive effects.
Excretion of Waste Products
The kidneys eliminate the body’s metabolic waste products. The major waste product of protein
metabolism is urea, of which about 25 to 30g are produced and excreted daily (Norris, 2019). The
kidneys serve as the primary mechanism for excreting drug metabolites.
Urine Storage
The bladder is the reservoir for urine. Both filling and emptying and emptying of the bladder are
mediated by coordinated sympathetic and parasympathetic nervous system control mechanisms
involving the detrusor muscle and the bladder outlet.
Bladder Emptying
Micturition normally occurs approximately eight times in a 24-hr period.
Actual Anatomy and Physiology of Chronic Kidney Disease
As renal function declines, the end products of protein metabolism (normally excreted in
urine) accumulate in the blood. Uremia develops and adversely affects every system in the body. The
greater the buildup of waste products, the more pronounced the symptoms.
Glomerular Filtration Rate
As the GFR decreases (due to nonfunctioning glomeruli), the creatinine clearance decreases, whereas
the serum creatinine and BUN level increase.
Sodium and Water Retention
The kidney is incapable of concentrating or diluting the urine normally.
Acidosis
Metabolic acidosis occurs because the kidneys are unable to excrete increased loads of acid.
Anemia
Anemia develops as a result of inadequate erythropoietin production, the shortened lifespan of
RBCs, nutritional
Calcium and Phosphorus Imbalance
Serum calcium and phosphate sulfates have a reciprocal relationship in the body: as one increases,
the other decreases. With a decrease in filtration through the glomerulus of the kidney, there is an
increase in the serum phosphorus level and a reciprocal or corresponding decrease in the serum
calcium level.

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ANATOMIC AND PHYSIOLOGIC OVERVIEW

Anatomy of the Kidney and Urinary Systems

Physiologic of the Kidney and Urinary Systems

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