URINARY SYSTEM.

OBJECTIVES:

 Definition of terms.
 State the organs that constitute the urinary system.
 Identify the organs associated with the kidneys.
 Outline the GROSS and MICROSCOPIC structures of the kidney.
 Outline the functions of the kidneys.
 Describe urine formation.

DEF: Is the system that excretes waste products of metabolism to control water, electrolyte
balance and acid-base balance in the blood.

 The wastes are excreted in urine.

MAIN ORGANS:
1. Kidneys (2).
2. Ureters (2).
3. Urinary bladder.
4. Urethra.

*DIAGRAM OF THE URINARY SYSTEM*

The Kidneys.
^ Are two bean-shaped organs situated in the posterior part of the abdominal wall, one on each
side of the vertebral column, behind the peritoneum (retroperitoneally).
 Lies at the level of the 12th thoracic to the 3rd lumbar vertebrae.
 The right kidney is slightly lower (1.5cm) than the left kidney because of its relationship
to the liver.
 Each kidney is about 130-150grams in weight, 11cm long, 6cm wide, and 3cm thick and
is embedded in a bed of fat called Perirenal fat.
 The medial border is concave in the centre (hilus), is the part at which the blood
vessels, nerves and ureters enter and leaves the kidneys.
 If the kidney is bisected vertically, 3 distinct regions can be distinguished:
a. Fibrous capsule----- surrounds the kidney and can be easily stripped off.
b. The cortex------------ is reddish-brown (dark) layer immediately under the capsule and
between the pyramids.
c. The medulla---------- is the inner- most layer, consisting of pale conical-shaped
striations, the pyramids, which leads into the collecting space called the Renal Pelvis.

*DIAGRAM OF THE CROSS SECTION OF THE KIDNEY (GROSS STRUCTURE)*

THE NEPHRON (MICROSCOPIC STRUCTURE OF THE KIDNEY).

^ The basic functional unit of the kidney is the nephron, a thin, twisted tube, one end closed
and the other opens into a collecting tubule or duct.
 Each kidney has 1-1.5 million nephrons.
 Each nephron begins in a cup-shaped expansion called GLOMERULLAR CAPSULE
(Bowman`s capsule) from which the tubules leads.
 In the cup of each capsule, comes a fine branch of renal artery, forming a tuft of
capillaries in close contact with its inner wall, this tuft is called the GLOMERULUS.
 The arteriole bringing blood to the tuft is called the AFFERENT ARTERIOLE (VESSEL) and
the one which carry blood away is the EFFERENT ARTERIOLE (VESSEL) which is slightly
smaller than the afferent vessel, thus causing the pressure of blood in the tuft to be high
and also because of its nearness to the abdominal aorta.
 From the Bowman`s capsule, the nephron is described in three parts: The Proximal
Convoluted tubule, The Loop of Henle and The Distal Convoluted tubule which
empties/leads to the collecting tubule in the medulla.
 The efferent vessel divides to form a second set of capillaries around the walls of the
convoluted tubules in the cortex, thus the blood passes through two sets of capillaries
within one organ, which does not happen in any other part of the body.
 Blood from the second set of capillaries is collected by small veins, which unite with
other small veins to empty it in the renal vein.

*DIAGRAM OF THE MICROSCOPIC STRUCTURE OF THE KIDNEY (THE NEPHRON)*

FUNCTIONS OF THE KIDNEY.

1. Elimination of metabolic waste products such as urea and many foreign compounds
from the body including drugs.
2. Maintenance of electrolyte balance in the body.
3. Acid base is maintained by excretion of hydrogen ions.
4. Maintenance of homeostasis.
5. Formation of urine.
6. Control of blood pressure.
7. Renal clearance.
8. Regulation of red blood cells (RBC) production.
9. Synthesis of vitamin D to active form.
10. Secretion of prostaglandin.
FORMATION OF URINE.
 3phases in the process of urine formation are:
Simple Filtration, Selective Reabsorption and Secretion.

SIMPLE FILTRATION.
^ Takes place from the glomerulus under pressure, through the semipemeable wall of the
capillaries (glomerulus) and the glomerular capsule separate the blood from the kidney tubule.

 Water and other small molecules pass through, some of which are absorbed later.
 Blood cells, plasma proteins and other large molecules are unable to pass and remain in
the capillaries.
 The fluid that pass is called Glomerular Filtrate, which has a composition similar to
plasma in that it contains Glucose, Amino Acids, Fatty Acids, Salts, Urea and Uric Acid in
the same proportion.
 Filtration is assisted by the difference between the blood pressure in the glomerulus and
the pressure of the filtrate in the glomerular capsule.
 Because the efferent arteriole is narrower than the afferent arteriole, a Capillary
Hydrostatic Pressure of about 55mmHg (7.3 KPa) builds up in the glomerulus, which is
opposed by the Osmotic Pressure of the blood (provided mainly by plasma proteins)
about 30mmHg (4 KPa) and by Filtrate Hydrostatic Pressure of about 15mmHg (2 KPa) in
the glomerular capsule.
 Therefore the net filtration pressure is 55-(30+15) =10mmHgor 7.4-(4+2) =1.3KPa.
 Glomerular filtration rate (GFR) is the volume of filtrate formed by both kidneys each
minute. In health adult 125ml/min, i.e. 180 litres of filtrate are formed by each day by
the two kidneys. Nearly all of it is later reabsorbed with less than 1% i.e. 1-1.5 litres,
excreted as urine.
 Blood cells and proteins are only filtered if the kidney is diseased.

SELECTIVE REABSORPTION.
^ It is a process by which the composition and volume of the glomerular filtrate are altered
during its passage through the convoluted tubules, the medullary loop (Loop of Henle) and
collecting tubule.

 The process occurs because the cells lining the convoluted tubules are able to absorb
the water, glucose, salts and their ions which the body needs.
 It allows reabsorption into the blood, of the constituents of the filtrate needed by the
body to maintain fluid, electrolyte balance and the pH of the blood.
 Active transport takes at carrier sites in the epithelial membrane using chemical energy
to transport substances against their concentration gradients.
 Some constituents e.g. glucose and amino acids do not normally appear in urine
because they are completely reabsorbed unless their blood levels excessive.
  Other substances reabsorbed by active transport include Sodium, Calcium, Potassium,
Phosphate and Chloride. Some ions e.g. sodium and chloride can be absorbed by both
active and passive mechanism.
 Reabsorption is also regulated by hormones:
a. Parathyroid Hormone (parathyroid gland) and Calcitonin (thyroid gland) together
regulate reabsorption of Calcium and Phosphate.
b. Antidiuretic Hormone (posterior lobe of the pituitary gland) increases the
permeability of the distal convoluted tubules and collecting ducts, increasing Water
reabsorption.
c. Aldosterone (adrenal cortex) increases the reabsorption of Sodium and excretion of
Potassium.
d. Atrial Natriuretic Peptide (ANP), a hormone secreted by the atria in response to
stretching of the atrial wall, decreases reabsorption of Sodium and Water in the
proximal convoluted tubules and collecting ducts. It also inhibits secretion of
Antidiuretic hormone and Aldosterone.

Nb. Nitrogenous waste products such as Urea and Uric Acid`s reabsorption is very
limited.

SECRETION (tubular).
^ Occurs because the cells lining the tubules have the ability to secrete some substances
from the blood in the second capillary network into the lumen of the tubules (filtrate).

 Substances not required by the body and foreign materials e.g. drugs may not be
cleared from the blood by filtration because of the short time it remains in the
glomerulus, are cleared by secretion into the convoluted tubules and excreted from the
body in urine.
 Tubular secretion of hydrogen ions (H+) maintains normal blood pH.

COMPOSITION OF URINE.
 Normal urine, therefore, is formed partly by filtration under pressure from the capsule
and partly by reabsorption and by secretion in the tubules.
 It is an Amber-coloured fluid varying in colour according to its quantity.
 It is Acid in reaction.
 Composed of: Water—96%; Urea—2%: Other substances—2%.
 Its specific gravity is 1.020-1.030.

THE URETERS.
^ Are two tubes which carry/convey urine from the kidneys to the urinary- bladder.
  Each is about 25-30cm long and is a thick walled, narrow tube which is continuous with
the renal pelvis and opens into the base of the bladder. Is about 3mm in diameter, but is
slightly constricted in 3 places: (a) At the junction with the renal pelvis. (b) Where it
crosses the brim of the lesser pelvis. (c) As it passes through the walls of the bladder.
 These narrow portions may be the site of impaction of a ureteric calculus (stone).
 Consists of three (3) layers of tissue:
a. The Outer Fibrous Coat----This is continuous with the fibrous capsule of the kidney.
b. The Middle Muscular layer/coat---- which has an outer circular layer and an inner
longitudinal layer.
c. The Inner layer of Mucous membrane--- This is continuous with the lining of the
bladder.

THE BLADDER.
^ Is a reservoir for urine, its shape, size and position vary with the amount of fluid it contains.

 When empty, it lies within the lesser pelvis (pelvic organ).

 When full, it expands upwards and forwards into the abdominal cavity (abdominal
organ).
 The base faces posteriorly and receives the ureters and the neck from which the urethra
comes (both ureters enter and the urethra leaves the bladder at this base).
 The 3 orifices in the bladder wall form a triangle or a Trigone, the upper 2 on the
posterior wall are the openings of the ureters and the lower 1 is the point of origin of
the urethra.
 The neck of the bladder is the lowest and most fixed part of the organ. It lies 3-4cm
behind the symphysis pubis.
 The bladder can hold over 500mls of urine though it will cause pain, however, the desire
to urinate is normally felt when the organ contains 250-300mls of urine.

Consists of 3 layers:

a. The Outer serous layer is the peritoneum, but it is found only on the superior surface.
b. The Middle muscular layer contain both circular and longitudinal muscle fibres, there
are also two bands of oblique fibres which are close to the ureteric opening and which
prevents urine flowing back into the ureters.
c. The Inner mucous layer is loose and is thrown into rugae when the bladder is empty.
 The bladder collectively is lined with transitional epithelial tissue which allows for
expansion when the organ is full (DETRUSOR MUSCLE).

THE URETHRA.
^ Is a small tube leading from the internal urethral orifice in the bladder floor to the
external urethral orifice.
 MALE URETHRA.

 Is about 18-20cm long and serves as a common canal for both reproductive and urinary
systems.
 It is S-shaped.
 It is divided into 3 portions:
a. Prostatic portion—3cm long, surrounded by the prostate gland. It is lined with
epithelium and the orifices of the prostatic ducts and the ejaculatory ducts.
b. Membranous portion—1-2cm long, is the narrowest part of the urethra, it passes
through the pelvic floor.
c. Spongy portion—15cm long, lies within the penis.

FEMALE URETHRA.

 Is small and wide, about 4cm long and serves the urinary system only.
 It begins at the internal urethral orifice of the bladder and passes downwards behind
the symphysis pubis, embedded in the anterior wall of the vagina.
1. Nb There are 2 sphincters to the urethra: Internal and External sphincters.
 The internal sphincter is involuntary and the external sphincter is a voluntary control
except in early infancy and in nerve injury or disease.

MICTURITION
^ Is passing of urine.

 Urine is constantly passing into the bladder from the ureters.

 When there is 200-300mls of urine in the bladder, the desire to pass urine occurs due to
stimulation of the sensory nerves which results from the increased tension in the
bladder.
 As the sensory impulses increase in number and frequency, the motor impulses cause a
reflex contraction of the bladder and relaxation of the internal sphincter. The external
sphincter is controlled by the PUDENDAL nerve.
 When the child has learned to inhibit spinal reflexes, micturition can be delayed for a
considerable time or can be induced voluntarily.

SPASTIC PARALYSIS—is paralysis of the bladder sphincter in a state of contraction so

that it cannot be relaxed. This will cause Retension of urine and the bladder will become
over full. If this is not relieved by catheterization, distension will continue and will distend
the orifice which the sphincters guards, allowing a little urine to dribble out continuously
though the bladder still remains full (RETENSION WITH OVERFLOW).
 The sphincter may be paralysed in a state of relaxation. This will cause urine to dribble
constantly from an empty bladder, as the bladder cannot retain it. (Rare).

BA T