Excretory System

Parts of The System

Pair of Kidneys

Pair of Ureters

Urinary Bladder

Urethra

Kidneys

They are a pair of excretory organs situated on the posterior abdominal wall, 1
on each side of the vertebral column

They occupy the epigastric, hypochondriac, lumbar & umbellical regions

Vertically, they extend from the upper border of the 12th thoracic vertebra to
the body of the 3rd lumbar vertebra

The right kidney is slightly lower than the left, hence the transpyloric plane
passes through the upper part of the hilus of the right kidney & the lower part
of the hilus of the left kidney

Each kidney measures 11 cm in length, 6 cm in breadth & 3 cm in thickness

The kidney weighs 150 gms in males & 135 gms in females

Excretory System 1
 External Features of the Kidney

2 Poles

The upper pole is broad & is in close association with the suprarenal gland,
the lower pole is pointed

2 Surfaces

The anterior surface is irregular & the posterior surface is flat

2 Borders

The lateral border is convex & the medial border is concave

Excretory System 2
 Hilum

The middle part shows a depression called the hilum. The following
structures are not seen in the hilum

Renal Vein

Renal Artery

Renal Pelvis

Capsules or coverings of kidney

The Fibrous Capsule

Thin membrane which is closely attached to the kidney

Perirenal or perinephric fat

This is a layer of adipose tissue lying outside the fibrous capsule

Renal Fascia

This is the outermost layer which consist of 2 fasciae, anterior &

posterior which face laterally

Internal Structures of Kidney

The coronal section of the kidney shows

An outer reddish-brown cortex

An inner pale medulla

A space, the renal sinus

Renal Cortex is divided into 2 parts

Cortical lobules or arches which form caps over the pyramids

Renal column which dips in between the pyramids

Renal medulla is made up of about 10 conical masses called renal pyramids.

The apices form renal papilla which indent the minor calyces

Each pyramid along with the cortical arch form a lobe of the kidney

Excretory System 3
 Structure of Kidney

The renal sinus is a space that extents into the kidney from the hilus, it
contains

Branches of renal artery

Tributaries of renal vein

Renal pelvis

Divides into 2-3 major calyces & these turn to 7-13 minor

Each minor calyx ends in an expansion which is indented by one to

three renal papillae

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Excretory System 5
 Applied Anatomy

Kidney stone

It is also called renal calculus (pleural - calculi), they are solid crystals
formed from the minerals in the urine

Polycystic Kidney Disease

This is a genetic disease in which multiple cysts develop and grow on the
kidneys, which prevent the kidney’s ability to filter water

Horseshoe Kidney

Fusion of lower poles of kidney

Unilateral Aplasia

Absence of One Kidney

Hypoplasia

Underdeveloped Kidneys

Functions

Regulation of Extracellular Fluid Volume

The kidneys work to ensure an adequate quantity of plasma to help blood

flowing to vital organs

Regulation of Osmolarity

The kidneys help keep extracellular fluid from becoming too dilute or
concentrated with respect to the solute carried in the fluid

Regulation of Ion Concentration

The kidneys are responsible for maintaining relatively constant levels of

key ions including Na, K & Ca

Regulation of pH

Excretory System 6
 The kidneys prevent blood plasma from becoming too acidic or basic by
regulating ions

Excretion of Wastes & Toxins

The kidneys filter out a variety of water-soluble waste products &

environmental toxins into the urine for excretion

Production of Hormones

The kidneys produce erythropoietin, which stimulates RBC synthesis &

renin which helps control salt & water balance alongside blood pressure.
They are also involved in regulating plasma calcium and glucose levels

Nephron

Each kidney is composed of one ~ three million uriniferous tubules

Each tubule consists of 2 parts

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 Excretory Part

Also called nephron, it is the functional unit of the kidney which

comprises

Renal Corpuscle

Made up of glomerulus, tuft of capillaries & bowman’s capsule

Glomerulus

About 200 μm in diameter formed by the infolding of a

tuft of capillaries into the Bowman’s capsule. The
capillaries are supplied by the afferent arteriole & leave
from the tuft by the efferent arteriole

Bowman’s Capsule & Glomerulus together constitute

the Malpighian Corpuscle

Between the capillary loop & the Bowman’s space is the

glomerular membrane which is responsible for
ultrafiltration

Structure of Glomerular Membrane

It has 5 layers

Foot processes/ podocytes

Visceral layer gives out a series of

processes called pedicles which interdigitate
upon the capillary surface to form filtration
slits

Glomerular Basement Membrane

Consists of 3 layers

Lumina Rara Externa

Outer Cement Layer

Lumina Densa

Dense structural part of the

basement membrane

Excretory System 8
 Lamina Rara Interna

Inner cement layer

Endothelial Cell Layer

The endothelium is fenestrated with pores of

100 nm in diameter

The Main Function of the glomerular membrane is

ultrafiltration

Bowman’s Capsule

It is the initial dilated part of the nephron, which is

about 5 μm, it has an inner visceral layer & an outer
parietal layer.

The space between the 2 is called the Bowman’s Space

Renal Tubule

Made up of proximal convoluted tubule, loop of Henle with

ascending & descending limbs & distal convoluted tubule

Proximal Convoluted Tubule

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 Continuous with the Bowman’s Capsule

It is 15 mm long and 55 μm in diameter, consisting of a

single layer of cells with a brush border forming
microvilli which increase the surface area of absorption

PCT is divided into

Pars Convoluta (Convoluted Portion)

Pars Recta (Straight Portion)

Loop of Henle

Consists of a descending limb which arises from the

terminal part of the PCT

Then there is a thin segment which is about 2-14 mm in

length having flat epithelial cells

From this segment arises the thick ascending limb

which is formed by cuboidal epithelium

Distal Convoluted Tubule

Continuation of the thick ascending limb, it has low

cuboidal cells with few microvilli

This tubule comes close to the glomerulus & the cells

get modified into columnar cells which are closely
crowded. Hence this part is called macula densa

Collecting Part

Begins as a junctional tubule from the DCT. Many tubules unite

together to form ducts of Bellini, which open into the minor calyces

Juxtaglomerular Apparatus

It is a combination of specialised tubular & vascular cells located at the

vascular pole of the glomerulus

It is comprised of 3 types of cells

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 Juxtaglomerular Cells

They are myoepitheliod cells which synthesise and store renin

They are baroreceptors & respond to changes in the transmural

pressure gradient. They are also volume receptors which monitor renal
perfusion pressure stimulated by hypovolemia

Macula Densa Cells

They are specialised renal tubular epithelial cells which function as

chemoreceptors. They are stimulated by decrease Na+ thereby
causing increased renin release

Mesangial Cells

They are contractile cells & play a role in glomerular filteration

Supply to Kidney

Blood Supply

Kidney is supplied by the renal artery & renal vein

Lymphatics

Drain into the lateral aortic nodes

Nerve Supply

It is supplied by the renal plexus

Ureters

The ureters are a pair of narrow, thick walled, muscular tubes which convey
urine from the kidneys to the urinary bladder

Each ureter is about 25 cm long, of which the upper half lies in the abdomen &
the lower half lies in the pelvis

It measures about 3 mm, but it is slightly constricted at 5 places

Courses of Ureter

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 The ureter begins within the renal sinus as a funnel shaped dilatation called
the renal pelvis

It comes out through the hilum, runs downwards along the medial margin of
the kidney & narrows gradually at the level of the lower pole of kidney, where it
continues as the abdominal part

The ureter passes downwards and medially and crossed the psoas muscle &
enters the pelvis in front of the common iliac artery

In the pelvis, the ureter runs downwards, slightly backwards, laterally following
the anterior margin of the greater sciatic notch

Opposite the ischial spine, it turns forwards & medically to reach the base of
the urinary bladder

Normal Constrictions

The ureter is constricted at 5 places

At the pelviureteric junction

At the brim of the lesser pelvis

Point of crossing of ureter by ductus deferens of broad ligament of uterus

During its oblique passage through the bladder wall

At the opening in the lateral angle of trigone

Supply to Ureter

Blood Supply

Upper part is supplied by renal artery

Middle part by the aorta

Pelvic part by the vesicle, uterine vessels

Nerve Supply

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 Ureter is supplied by sympathetic from T10-L1 segments and
parasympathetic from S2-S4 nerves

Applied Anatomy

Ureteric Colic

Severe pain due to ureteric stone or calculus

Ureteric Calculus

Ureteric Stone

Duplex Ureter

Both ureters drain renal pelvis on 1 side

Urinary Bladder

It is a muscular reservoir of urine which lies in the anterior part of the pelvic
cavity

It varies in size, shape & position according to the amount of urine it contains

When it is empty, it is flat & lies entirely in the pelvis, but as it fills it becomes
oval shaped & expands, extends upwards into the abdominal cavity reaching
up to the umbilicus or even higher

The capacity of the bladder in a healthy adult is 400-500 ml, filling beyond
this causes a desire to micturate, beyond 500 ml it becomes painful

The detrusor muscle is arranged in whirls & spirals and is adapted for
contraction

External Features

An empty bladder is tetrahedral in shape and has

Apex

Directed Forwards

It is connected to the umbilicus by the median umbilical ligament

Excretory System 13
 Base/ Fundus

Directed Backwards

In females, it is related to the uterine cervix & vagina

In males, the upper part of the base is separated from the rectum by
the rectovesical pouch & the coils of intestine & the lower part is
related to the seminal vesicles * the termination of the vas deferens

Neck

It is the lowest & most fixed part of the bladder

It lies 3-4 cm behind the pubic symphysis

It is pierced by the internal ureteral orifice

Three Surfaces - Superior, Right, Inferolateral

Four Borders - 2 Lateral, One Anterior & One Posterior

A full bladder is ovoid in shape and has

An Apex, directed towards the umbilicus

A Neck, directed downwards

2 Surfaces, anterior & posterior

Supply to the bladder

Arterial Supply

Superior & Inferior vesical arteries, branches of the internal iliac artery

Obturator & Inferior gluteal arteries

Venous Drainage

Vesical venous plexus drains into the internal iliac veins

Lymphatic Supply

Lymph drains into external iliac nodes & some into internal iliac nodes

Nerve Supply

Parasympathetic Fibres or S2, S3 & S4 are motor to the detrusor muscle

Excretory System 14
 Sympathetic Fibres are motor to the preprostatic sphincter

Pudendal nerve supplies sphincter urethra

Male Urethra

It is ~ 15-20 cm long, it extends from the internal urethral orifice in the urinary
bladder to the external opening at the end of the penis

It transports semen and secretion from the sex glands

The male urethra has 3 parts (proximal to distal)

Prostatic Urethra

It begins as a continuation of the bladder neck & passes through the

prostate gland

It receives ejaculatory ducts containing spermatozoa from the testes &

seminal fluids from the seminal vesicle glands. And the prostatic ducts
containing alkaline fluids

It is the widest portion of the urethra

Membranous Urethra

Passes through the pelvic flood & the deep perineal pouch

Surrounded by the external urethral sphincter, which provides

voluntary control of micturition

It is the narrowest & least dilatable portion of the urethra

Penile (Bulbous) Urethra

Passes through the bulb & corpus spongiosum of the penis, ending at
the external urethral orifice (the meatus)

Receives the bulbourethral glands proximally

In the gland (head) of the penis, the urethra dilates to form the
navicular fossa

Blood Supply

The arterial supply to the male urethra is via several arteries

Excretory System 15
 Prostatic urethra

Supplied by the inferior vesical artery (branch of the internal iliac

artery which also supplies the lower part of the bladder)

Membranous Urethra

Supplied by the bulbourethral artery (branch of the internal pudendal

artery)

Penile Urethra

Supplied directly by branches of the internal pudendal artery

Venous Supply

Drains into internal iliac veins through the prostatic venous plexus

Nerve Supply

The nerve supply to the male urethra is derived from the prostatic plexus,
which contains a mixture of sympathetic, parasympathetic & visceral
afferent fibres

Lymphatic Drainage

Varies according to the region of the urethra, the prostatic and

membranous portions drain to the obturator and internal iliac nodes, which
the penile urethra drains to the deep & superficial inguinal nodes.

Female Urethra

In females, the urethra is relatively short, approximately 4 cm

It begins at the neck of the bladder, and passes inferiorly through the perineal
membrane & muscular pelvic floor

The urethra opens directly onto the perineum, in an area between the labia
minor, known as the vestibule

Within the vestibule, the urethral orifice is located anteriorly to the vaginal
opening, and 2-3 cm posteriorly to the clitoris

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 The distal end of the urethra is marked by the presence of 2 mucous glands
that lie either side of the urethra

Skene’s Glands

They are homologous to the male prostate

Supply to Female Urethra

Arterial Supply

Superior vesical & vaginal arteries

Venous Supply

Vesical venous plexus into internal iliac vein

Lymphatic Supply

Internal & external iliac nodes

Nervous Supply

Parasympathetic nerves from S2 to S4

Sympathetic nerves arise from the plexus around the vaginal arteries

Urine Formation

Formation of Urine

Filtration involves the transfer of soluble components such as water &

wastes, from the blood capillaries into the glomerulus

Reabsorption involves the absorption of molecules, ions, water that are

necessary for the body to maintain homeostasis from the glomerular
filtrate back into the blood

Secretion involves the transfer of ions, creatinine, drugs & urea from the
blood into the collecting duct, and is primarily made of water

The rate at which different substances are excreted in the urine can be
expressed by:

Urinary Excretion Rate = Filtration Rate - Reabsorption Rate +

Secretion Rate

Excretory System 17
 3 Steps

Glomerular Filtration

During filtration, blood enters the afferent arteriole & flows into the
glomerulus where filterable blood components, such as water and
nitrogenous waste, will move towards the inside of the glomerulus and
non-filterable components, such as cells & serum albumins, will exit
via the efferent arteriole

The filterable components accumulate in the glomerulus to form the

glomerular filtrate

Normally, about 20% of the total blood pumped by the heart each
minute will enter the kidneys to undergo filtration, this is called the
filtration fraction

The remaining 80% of the blood flows through the rest of the body to
facilitate tissue perfusion & gas exchange

Mechanism of Glomerular Filtration

The diameter of efferent arterioles is narrower than afferent

arterioles

Due to this difference in diameter of arteries, blood leaving the

glomerulus creates the pressure known as hydrostatic pressure

The glomerular hydrostatic pressure forces the blood to leave the

glomerulus resulting in filtration of blood

A capillary hydrostatic pressure of about 7.3 kPa (55 mmHg) builds

up in the glomerulus

However, this pressure is opposed by the osmotic pressure of the

blood, provided mainly by plasma proteins, about 4 kPa (30
mmHg), and by filtrate hydrostatic pressure of about 2 kPa (15
mmHg) in the glomerular capsule

The net filtration pressure is, therefore → 55 - (30 + 15) = 10

By the net filtration pressure of 10 mmHg, blood is filtered in the

glomerular capsule

Excretory System 18
 Water & other small molecules readily pass through the filtration
slits but blood cells, plasma proteins & other large molecules are
too large to filter through & therefore remain in the capillaries

The filtrate containing large amounts of water, glucose, amino

acids, uric acids, urea, electrolytes, etc in the glomerular capsule is
known as nephric filtrate of glomerular filtrate

The volume of filtrate formed by both kidneys each minute is called

glomerular filtration rate (GFR)

In a healthy adult the GFR is about 125 ml/min (180 L) of filtrate are
formed each day by the 2 kidneys

Renal Tubular Reabsorption

When the filtrate exits the glomerulus, it flows into the duct of the renal
tubule

As it moves, the useful substances, such as glucose, amino acids,

sodium, calcium, potassium, chloride, phosphate, and some water are
reabsorbed through the tubal wall into the blood in the adjacent
capillaries

This reabsorption of vital nutrients from the filtrate in the second step
in urine creation & is called selective reabsorption

Some of the substances (negatively charged ions) are reabsorbed by

passive transport which some substances (positively charged ions) are
reabsorbed by active transport. Most of the water is reabsorbed by
osmosis

Mechanism of Selective Reabsorption

Reabsorption in PCT involves active & passive transport

mechanisms

The active transport process reabsorbs glucose & amino acids

The passive transport process reabsorbs chlorides & water

Active Transport

Excretory System 19
 A transport mechanism that involves the movement of
molecules across the membrane against the concentration
gradient, meaning the transport of substances from low to
high concentration. This movement is achieved by the
energy expenditure from ATP

Passive Transport

This transport mechanism involves the movement of

substances across the membrane down the concentration
gradient from high to low without employing any energy
expenditure.

Reabsorption in Loop of Henle

The descending loop of Henle has thin epithelium which is

permeable to water & impermeable to salt

The ascending loop of Henle has cuboidal epithelium, which is

permeable to salts but impermeable to water

The ascending loop of Henle cotransports Na+, K+, Cl-, ions

like Mg2+, Ca2+ are actively reabsorbed

What is Cotransport

Transport of 1 substance, coupled with the transport of

another substance across the membrane, water can follow
other molecules that are actively transported, particularly
glucose & sodium ions in the nephron

Reabsorption in the Distal Convoluted Tubule

Water reabsorption is regulated by antidiuretic hormone (ADH)

It depends on amount of fluid intake by the body

Hormones that influence reabsorption

Parathyroid

Secreted by the parathyroid glands, PTH along with

calcitonin regulate the absorption of calcium & phosphate

Excretory System 20
 from the DCT, PTH increases blood calcium level &
calcitonin lowers it

Antidiuretic Hormone

Secreted by the posterior pituitary. It increases the

permeability of the DCT & collecting tubules increasing
water reabsorption

Secretion of ADH is controlled by negative feedback

mechanism

Aldosterone

Secreted by the adrenal cortex.

It increases reabsorption of sodium and water and

excretion of potassium

Secretion is controlled by a negative feedback mechanism

Atrial natriuretic peptide

It is secreted by the atria of the heart in response to

stretching of the atrial wall

It decreases reabsorption of Na+ and H2O from the PCT &

collecting ducts

Secretion is controlled by a negative feedback mechanism

Renal Tubular Secretion

Tubular secretion is the transfer of materials from peritubular

capillaries to the renal tubular lumen, it is the opposite process of
reabsorption

The filtrate absorbed in the glomerulus flows through the renal tubule,
where nutrients & water are reabsorbed into capillaries

At the same time, waste ions like drugs, toxins & hydrogen ions pass
from the capillaries into the renal tubule

This process is called secretion

Excretory System 21
 The secreted ions combine with the remaining filtrate and become
urine

The urine flows out of the nephron tubule into a collecting duct

It passes out of the kidney through the renal pelvis, into the ureter &
down to the bladder

Tubular secretion occurs throughout the different parts of the nephron,

from the PCT to the collecting duct at the end of the nephron

Mechanism of Tubular Secretion

The mechanisms by which secretion occurs are by active transport

& passive diffusion, which are similar to those of reabsorption,
however these processes occur in the opposite direction

The substances that are secreted into the tubular fluid for removal
from the body include

Potassium (K+)

Hydrogen (H+) (Helps in pH balance)

Ammonium (NH4+) (Helps in pH balance)

Creatinine

Urea

Some Hormones & Drugs (Penicillin)

Excretory System 22