Lecture 11 – The Urinary System

• Principal organs
– Kidneys
• Accessory organs
– Ureters
– Urinary bladder
– Urethra
 Urinary System - Functions
• Removal of metabolic wastes, drugs & toxins from
the blood
• Regulation of fluid & electrolyte balance
• Regulation of acid-base balance (blood pH)
• Maintain & adjust blood pressure and volume
• Regulation of erythropoiesis (stimulated by hormone
erythropoietin which is mainly produced by the
kidneys)
• Other metabolic functions
 Kidneys
• Roughly oval with a medial indentation
• Left kidney often larger than the right
• Right kidney located a little lower
• Each capped by an adrenal gland
 Kidneys – Gross Anatomy
• Held in place on posterior body wall
• Protected by 3 external layers of CT
– Renal fascia
– Adipose capsule (perinephric fat capsule)
– Renal capsule (fibrous capsule)
 Kidneys – Gross Anatomy
Renal fascia
• Dense irregular CT
• Anchors kidneys to peritoneum and to fascia
covering the muscles of the posterior
abdominal wall
 Kidneys – Gross Anatomy
Adipose capsule
• Thick middle layer
• Keeps each kidney in place
• Shield from shock
• Used for fuel during prolonged starvation
– Nephroptosis
 Kidneys – Gross Anatomy
Renal capsule (fibrous capsule)
• Very thin layer
• Dense irregular CT
• Protection
– Infection
– Physical trauma
 Kidneys – Gross Anatomy
Hilum
• On the medial surface
• An opening
– Renal artery
– Renal vein
– Renal nerves
– Ureter
 Kidneys – Gross Anatomy
Renal sinus
• Central cavity
• Filled with urine draining structures and
adipose tissue
• Lined by renal capsule
– Anchor/support
• ureter
• blood vessels
• nerves
 Kidneys – Gross Anatomy
Internal gross anatomy:
• Renal cortex
– Outermost
– In contact with fibrous capsule
• Renal medulla
– Middle
– Renal pyramids
Renal sinus

cortex
 Kidneys – Gross Anatomy
Renal cortex
• Houses 90-95% of the kidney’s blood vessels
– Blood vessels branch from the renal artery
Renal columns
• Bands of cortical tissue
• Extend into the medulla
– Separate adjacent pyramids
 Kidneys – Gross Anatomy
A kidney lobe consists of:
• A renal pyramid
• Overlying cortex
• Adjacent columns
 Kidneys – Gross Anatomy
Renal medulla
• Tip of each pyramid tapers into a slender renal
papilla

• Boarders on the minor calyx

– Major calyx
– Renal pelvis
– ureter
 Kidneys – Microanatomy
Nephrons
• Functional unit of the kidneys
• Cortex & medulla  over a million nephrons
• Filter blood and produce urine
2 main components
• Renal corpuscle Renal tubule Collecting
System

• Renal tubule
 Nephrons – Renal Corpuscle
• Filters the blood
Consists of 2 parts:
• Glomerulus
– Group of looping fenestrated capillaries
• Glomerular capsule
– Outer sheath of epithelial tissue
 Nephrons – Renal Corpuscle
Glomerular capsule
• Double layered membrane Ren
a l tu
bul
e
• Capsular Outer Layer
– Continuous with 1st segment of the renal tubule
– Simple squamous
• Inner layer (visceral layer)
– Covers the glomerular capillaries
– Modified epithelial cells  podocytes
Renal Corpuscle
Podocytes – specialized cells, crucial role in
filtration of blood to form urine

Pedicels – foot-like projections, create filtration

slits that allow small molecules like water and
solutes to pass
Renal Corpuscle
 Nephrons – Renal Tubule
• The “pipes” of the nephron
• Winding tube
• Modifies the filtrate Minor calex

3 regions
• Proximal tubule
• Nephron loop (loop of Henle)
• Distal tubule
 Nephrons – Renal Tubule
Proximal tubule

Nephron loop

Distal tubule
 Nephrons – Renal Tubule
Juxtaglomerular complex (JGC)
• Transition point between ascending limb and
distal tubule
• Regulates BP and filtration rate

Distal
tubule
 Juxtaglomerular Complex Cells
• Macula densa
– Chemoreceptors – respond to changes in blood Na+
– Baroreceptors – respond to changes in blood pressure
• Juxtaglomerular cells (granular cells)
– Secrete renin
– Baroreceptors
• Mesangial cells
– Feedback control
– Communication between
Other two specialized cells
 Renal Blood Supply
• Highly vascular organs
• Blood supply in through a renal artery
– Which branch from abdominal aorta
• Renal arteries fan into smaller vessels
• Through sinus, to columns and cortex

Renal artery
Renal vein
Renal Blood Supply
 Types of Nephrons
Cortex
2 types of nephrons
• Structurally different
– Cortical nephrons
– Juxtamedullary nephrons

Medulla
Peritubular Capillaries & Vasa Recta
Peritubular capillaries
– collect water and solutes reabsorbed
by the nephron and deliver other solutes
to the nephron for secretion
- surround proximal and distal tubules of
both types of nephrons and the nephron
loop of cortical nephrons

Vasa Recta
– collect and transport water and solutes
within the medulla
- long straight capillaries that connect to
the peritubular
 Renal Physiology
• 3 main processes in urine formation
• Carried out by nephrons
– Filtration – remove metabolic and potentially
harmful waste from blood
– Reabsorption – substances that were filtered out
can be reabsorbed as needed
– Secretion – remove unwanted substances from
blood to maintain pH of urine and blood (fine
tuning)
 Filtration
• As blood passes through the membrane of the
glomerular capillaries
• Some plasma is filtered into surrounding
glomerular space
• Selective
• Based on size
– Cells and most protein remain in blood
– Smaller substances enter the capsule
 Filtration
What makes up filtrate:
• Glucose
• Electrolytes
• Very small proteins
• Nitrogenous wastes  urea, ammonium ions
• Waste products of protein digestion
– Urea – by-product of amino acid
– Creatinine – breakdown product of creatine phosphate
– Uric acid - breakdown product of nitrogenous bases
 Filtration
Filtration fraction
• % of plasma that passes through filtration
membrane
• Average is ~20%
• Looping of capillaries increases surface area
 Glomerular Filtration Rate (GFR)
• Amount of filtrate formed by the kidneys/min
• ~180 L of filtrate formed / day
• Rate is ~125 mL/min
• Fenestrations enable efficient, rapid rate
• Still need a pressure gradient
 Filtration Pressures
2 forces that drive fluid movement in a typical
capillary bed
• Hydrostatic pressure
– Force of a fluid on the wall of its container
– Equal to BP
• Colloid osmotic pressure
– Created by proteins in plasma
 Filtration Pressures
• The 2 forces work together
• Determine net filtration pressure (NFP)
• NFP determines the direction of water
movement
– Water moves out of capillaries if Hydrostatic
Pressure > Colloid Osmotic Pressure
– Water moves into capillaries if Colloid Osmotic
Pressure > Hydrostatic Pressure
 Renal Filtration Pressures
Glomerular hydrostatic pressure (GHP)
• Largely determined by systemic BP
• ~55 mm Hg
• Considerably higher than typical capillary bed
– Higher resistance
• This causes back up of blood
• Pushes against capillaries
• Favours movement through filtration membrane
 Renal Filtration Pressures
Blood Colloid Osmotic Pressure (BCOP)
• ~30 mm Hg
• Due to suspended proteins in the blood
• Slightly higher than typical capillary bed
– Blood is a little more concentrated
• Opposes filtration
 Renal Filtration Pressures
Capsular hydrostatic pressure (CsHP)
• Opposes GHP
• Due to resistance of flow along nephron and
collecting system
• Filtrate can only drain so fast
• ~15 mm Hg
 Renal Filtration Pressures
Capsular Colloid Osmotic Pressure (CsCOP)
• Under normal circumstances very few plasma
proteins enter capsular space
– No opposing Colloid Osmotic Pressure within the
capsule
• Damaged glomeruli  proteins begin to pass
– CsCOP is created
– Increased fluid loss in the urine
Net Filtration Pressure (NFP)

10 mmHg
GHP
BCOP
-30 mmHg

GHP NFP
55 mmHg

CsHP
-15 mmHg

GFR depends on
NFP
 Glomerulonephritis
• Damage to the glomeruli
• Leads to inflammation of the capillaries and
the basement membrane
• What happens with inflammation??
– Increased blood flow
– Increased permeability of capillaries
 Glomerulonephritis
Results:
• Increased Glomerular hydrostatic pressure
(GHP)
• Filtration membrane excessively leaky
– Loss of blood cells
– Loss of protein

Hematuria Proteinuria RBC Cast

 Glomerulonephritis
Further damage leads to:
• Decrease in GFR
– Triggers further increase of GHP to maintain GFR
– Additional loss of cells and proteins
• Eventually GFR cannot be restored
– Toxic substances accumulate in blood
– Can lead to complete renal failure
3 Major Renal Processes
 Reabsorption
• Occurs in tubules and collecting ducts
• Filtrate is reclaimed and returned to blood
• 180 L of filtrate formed a day
– Only ~ 1.8 L is ultimately lost as urine
• Water and solutes reabsorbed
• Substances not needed  urine
• Substances needed  reabsorbed
• Proximal tubules do majority of reabsorption (99%)
Role of the Nephron Loop
 Secretion
• Occurs in tubules & collecting ducts
• Removal of substances from the blood
• Certain substances are secreted into filtrate
– Non-reabsorbed, secreted substances
– Often toxic when in high concentrations
– High GFR = rapid clearance
The Journey of Filtrate
 Renal Failure
• Kidneys unable to carry out their vital functions
• May occur if GFR decreases
• May be prerenal (before the kidney), intrarenal (problem with
the kidney), postrenal (i.e., urinary obstruction)
• May be acute or chronic
• Symptoms progress
– fatigue
– Edema
– Nausea
– Loss of appetite
 Renal Failure
Uremia
• Buildup of waste products
• Fluid, electrolyte and acid base imbalances
• GFR less than 50% increases risk of uremia
• Untreated  coma, seizures, death
• Treatment  Hemodialysis
 Renal Clearance
• Assessment of renal function
• Measures rate at which kidneys remove a
substance from the blood
• This rate is used to estimate the GFR (eGFR)
- calculation used to assess kidney function
• Need a substance that is completely filtered
– Creatinine
 Renal Threshold
• The concentration level up to which a filtered
substance can be reabsorbed
• ie glucose
• Once over the threshold  spills over into
urine
Diabetic
 Total Body Water
• Fluid content of the human body ranges from
45% to 75% of total weight
• Varies according to:
– Age – less water as get older
– Gender – females have less water
– Fat content of the body – adipose tissue holds less
water, muscle tissue holds more water
 Principle of Mass Balance
• What is gained by the body must equal what is
lost by the body
• Multiple influences
– Amount of water ingested
– Amount of physical activity
– Kidney function
– Medications
– Digestive activities
 Water Loss
• Most water is lost in urine via the kidneys
– ~1500 mL / day
• Small amount in feces
– ~100 mL / day
• Sweating & evaporation
– ~600 mL / day
• Expiration
– ~300 mL / day
 Water Loss
Obligatory water loss
• Certain amount of urine must be produced
• This is the minimum amount of water lost
daily
• ~500 mL / day
• To excrete a minimum amount of solutes
• Water must be lost with solutes
 Water Gain
• Metabolic water (water of oxidation)
– ~300 mL / day
• Food
– ~1000mL / day
• Liquid
– ~1200 mL / day
Homeostasis of Total Fluid Volume
Under normal conditions
• Primary adjustment
– urine volume
– ADH
• Secondary adjustment
– fluid intake (thirst mechanism)
 Regulation of Urine Volume
Determined by two factors
• Glomerular filtration rate
– remains constant under normal conditions
• Rate of tubular reabsorption of water
– fluctuates considerably
– normally adjusts urine volume to fluid intake
– Influenced by amount of ADH, ANP and
aldosterone
 Thirst Mechanism
• Drives water intake from liquids
• Controlled by hypothalamus
• Many stimuli can trigger
– Most significant  increase in plasma osmolarity
– Detected by osmoreceptors (specialized cells in
hypothalamus)
– Increase in solute concentration of ECF
– Very sensitive! (2-3% increase)
 Thirst – Other Triggers
• Decreased plasma volume
– Generally accompanied by reduced BP
– Detected by baroreceptors (in several arteries)
– Much less potent stimulus
– Need a decrease of at least 10 -15 mmHg
• Angiotensin II
– Also stimulated by decreased plasma volume
– Renin-angiotensin-aldosterone system (RAAS)
 ADH
- Synthesized in hypothalamus
- Stored in & secreted from pituitary

- Increases water reabsorption in

tubules

- Constricts blood vessels ( levels)

Aldosterone
- Secreted by adrenal glands

- Increases Na reabsorption

ANH
Atrial Natriuretic Hormone
(Atrial Natriuretic Peptide)
- Secreted from the atria

- Inhibits Na & water reabsorption

 RAAS
• Juxtagolmerular cells secrete renin

• Renin converts angiotensin (protein synthesized and secreted

by the liver to angiotensin I
(AT)  AT I
• Angiotensin converting enzyme (found primarily in the lungs
and kidney epithelial cells) converts it to Angiotensin II
(ACE) ATII
ATII biochemically active product of the system
 RAAS
ATII has 3 major physiological effects:
• Systemic vasoconstriction
• Renal efferent arterial constriction
– Acute  increases GRF
– Chronic  glomerular damage
• Increased secretion of aldosterone
– Sodium reabsorption (water)
– Potassium & hydrogen secretion
 Clinical Terms
• Glucosuria  glucose in the urine
• Hematuria  blood in the urine
• Pyuria  pus in the urine
• Dysuria  painful urination
• Polyuria  unusually large amount of urine
• Oliguria  scant urine
• Anuria  absence of urine
Kidney H&E