The Urinary System

Kidneys, ureters, urinary

bladder & urethra
Urine flows from each
kidney, down its ureter to
the bladder and to the
outside via the urethra
Filter the blood and return
most of water and solutes
to the bloodstream

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Overview of Kidney Functions
Regulation of blood ionic composition
– Na+, K+, Ca+2, Cl- and phosphate ions
Regulation of blood pH, osmolarity & glucose
Regulation of blood volume
– conserving or eliminating water
Regulation of blood pressure
– secreting the enzyme renin
– adjusting renal resistance
Release of erythropoietin & calcitriol
Excretion of wastes & foreign substances

2
 External Anatomy of Kidney
Paired kidney-bean-shaped
organ
4-5 in long, 2-3 in wide,
1 in thick
Found just above the waist
between the peritoneum &
posterior wall of abdomen
– retroperitoneal along
with adrenal glands &
ureters
Protected by 11th & 12th
ribs with right kidney lower

3
 Internal Anatomy of Kidney
What is the
difference
between renal
hilus & renal
sinus?
Outline a major
calyx & the border
between cortex &
medulla.

4
 Blood & Nerve Supply of Kidney
Abundantly supplied with blood vessels
– receive 25% of resting cardiac output via renal arteries
Functions of different capillary beds
– glomerular capillaries where filtration of blood occurs
vasoconstriction & vasodilation of afferent & efferent
arterioles produce large changes in renal filtration
– peritubular surround tubular part of the nephron in the
cortex-capillaries that carry away reabsorbed substances
from filtrate
– vasa recta supplies nutrients to medulla without disrupting
its osmolarity form
Sympathetic vasomotor nerves regulate blood flow & renal
resistance by altering arterioles 5
Blood supply of the kidneys
 Each nephron
has the
following blood
supply:
 Afferent
arteriole
 Glomerular
capillaries
 Efferent
arteriole

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 Blood Vessels around the Nephron
Glomerular
capillaries are
formed between the
afferent & efferent
arterioles
Efferent arterioles
give rise to the:
– peritubular capillaries
in renal cortex.
– vasa recta in renal
medulla

7
 The Nephron
Kidney has over 1
million nephrons
composed of a
corpuscle and
tubule
Renal corpuscle
– site of plasma
filtration
Renal tubule
– into which filtered
fluid (filtrate)
passes 8
 The Nephron-Renal corpuscle

Kidney has over 1 million nephrons composed of a

corpuscle and tubule
Renal corpuscle = site of plasma filtration
– glomerulus is capillaries where filtration occurs
– glomerular (Bowman’s) capsule is double-walled
epithelial cup that collects filtrate 9
 The Nephron-Renal tubule
Renal tubule
proximal convoluted
tubule
loop of Henle dips
down into medulla
distal convoluted
tubule
Collecting ducts and
papillary ducts drain
urine to the renal
pelvis and ureter
10
 Number of Nephrons
Remains constant from birth
– any increase in size of kidney is size increase of
individual nephrons
If injured, no replacement occurs
Dysfunction is not evident until function
declines by 25% of normal (other nephrons
handle the extra work)
Removal of one kidney causes enlargement of
the remaining until it can filter at 80% of
normal rate of 2 kidneys
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Overview of Renal Physiology

Nephrons and collecting ducts perform 3 basic

processes
– glomerular filtration
– tubular reabsorption
– tubular secretion
Rate of excretion (urine) equal to rate of
filtration (GFR) , plus its rate of tubular
secretion (TS), minus its rate of reabsorption
(TS).
Urine = GFR + TS - TR 12
 Glomerular filtration

glomerular filtration
– a portion of the blood plasma is filtered
into the kidney 13
 Tubular reabsorption

tubular reabsorption
– water & useful substances are
reabsorbed into the blood 14
 Tubular secretion

tubular secretion
– wastes are removed from the blood &
secreted into urine 15
 Glomerular Filtration

Blood pressure produces glomerular filtrate

Filtration fraction: fraction of the plasma that is
filtered is 16-20%.
Glomerular filtration in male180 liters/day.
More than 99% of this filtrate is reabsorbed.

16
 Glomerular Filtration capacity

Filtering capacity enhanced by:

– large surface area of glomerular capillaries
– glomerular capillary BP is high due to small size of
efferent arteriole
– Type of capillaries (fenestrated). 17
 Filtration Membrane

#1 Stops all cells and platelets

#2 Stops large plasma proteins
#3 Stops medium-sized proteins, not small ones
 Net Filtration Pressure

NFP = total pressure that promotes filtration

NFP = GBHP - (CHP + BCOP) = 10mm Hg
 Glomerular Filtration Rate
Amount of filtrate formed in all renal corpuscles of both
kidneys / minute
– average adult male rate is 125 mL/min
Homeostasis requires GFR that is constant
– too high & useful substances are lost due to the
speed of fluid passage through nephron
– too low and sufficient waste products may not be
removed from the body
Changes in net filtration pressure affects GFR
– filtration stops if GBHP drops to 45mm Hg
– functions normally with mean arterial pressures 80-
180
 Renal Autoregulation of GFR

Mechanisms that maintain a constant GFR

despite changes in mean arterial BP:

 Myogenic mechanism.
 Tubuloglomerular feedback.
 Neural regulation.
 Hormonal regulation.
 Myogenic mechanism

systemic increases in BP, stretch the

afferent arteriole
smooth muscle contraction reduces the
diameter of the arteriole returning the
GFR to its previous level in seconds

22
 Tubuloglomerular feedback
- elevated systemic BP
raises the GFR so that fluid
flows too rapidly through the
renal tubule & Na+, Cl- and
water are not reabsorbed

- macula densa detects that

difference & decreases
release of NO from the
juxtaglomerular apparatus

- afferent arterioles constrict

& reduce GFR 23
 Neural Regulation of GFR
Blood vessels of the kidney are supplied by sympathetic
fibers that cause vasoconstriction of afferent arterioles
At rest, renal BV are maximally dilated because sympathetic
activity is minimal
– renal autoregulation prevails
With moderate sympathetic stimulation, both afferent &
efferent arterioles constrict equally
– decreasing GFR equally
With extreme sympathetic stimulation (exercise or
hemorrhage), vasoconstriction of afferent arterioles reduces
GFR
– lowers urine output & permits blood flow to other tissues
 Hormonal Regulation of GFR
Atrial natriuretic peptide (ANP) increases GFR
– stretching of the atria that occurs with an
increase in blood volume causes hormonal
release
relaxes glomerular mesangial cells increasing
capillary surface area and increasing GFR
Angiotensin II reduces GFR
– potent vasoconstrictor that narrows both afferent
& efferent arterioles reducing GFR
 Tubular Reabsorption
Normal GFR is so high that volume of filtrate in
capsular space in half an hour is greater than the total
plasma volume
Nephron must reabsorb 99% of the filtrate
– PCT with their microvilli do most of work with rest of
nephron doing just the fine-tuning
solutes reabsorbed by active & passive
processes
water follows by osmosis
small proteins by pinocytosis
 Tubular Secretion
Important function of nephron is tubular
secretion
– transfer of materials from blood into tubular
fluid
helps control blood pH because of
secretion of H+
helps eliminate certain substances (NH4+,
creatinine, K+)

27
 Reabsorption Routes
Paracellular reabsorption
– 50% of reabsorbed material
moves between cells by
diffusion in some parts of
tubule
Transcellular reabsorption
– material moves through
both the apical and basal
membranes of the tubule
cell by active transport

28
 Transport Mechanisms
Apical and basolateral membranes of tubule cells have different
types of transport proteins
Reabsorption of Na+ is important
– several transport systems exist to reabsorb Na+
– Na+/K+ ATPase pumps sodium from tubule cell cytosol through
the basolateral membrane only
Water is only reabsorbed by osmosis
– obligatory water reabsorption (90%) occurs when water is
“obliged” to follow the solutes being reabsorbed
– facultative water reabsorption(10%) occurs in collecting duct
under the control of ADH.

29
 Glucosuria

Renal symporters can not reabsorb glucose fast

enough if blood glucose level is above 200 mg/mL
– some glucose remains in the urine (glucosuria)
Common cause is diabetes mellitis because insulin
activity is deficient and blood sugar is too high
Rare genetic disorder produces defect in
symporter that reduces its effectiveness

30
 Reabsorption in the PCT
Na+ symporters help
reabsorb materials from
the tubular filtrate
Glucose, amino acids,
lactic acid, water-soluble
vitamins and other
nutrients are completely
reabsorbed in the first
half of the proximal
convoluted tubule
Intracellular sodium
levels are kept low due
Reabsorption of Nutrients to Na+/K+ pump 31
Reabsorption of Bicarbonate, Na+Ions

Na+ antiporters reabsorb

Na+ and secrete H+
– PCT cells produce the H+ &
release bicarbonate ion to
the peritubular capillaries
– important buffering system
For every H+ secreted into
the tubular fluid, one
filtered bicarbonate
eventually returns to the
blood
Passive Reabsorption in the 2nd Half of PCT

Electrochemical gradients
produced by symporters &
antiporters causes passive
reabsorption of other
solutes
Cl-, K+, Ca+2, Mg+2 and
urea passively diffuse into
the peritubular capillaries
Promotes osmosis in PCT
(especially permeable due
to aquaporin-1 channels
Secretion of NH3 & NH4+ in PCT
Ammonia (NH3) is a poisonous waste product of
protein deamination in the liver
– most is converted to urea which is less toxic
Both ammonia & urea are filtered at the glomerus
& secreted in the PCT
– PCT cells deaminate glutamine in a process that
generates both NH3 and new bicarbonate ion.
Bicarbonate diffuses into the bloodstream
– during acidosis more bicarbonate is generated

34
Reabsorption in the Loop of Henle
Tubular fluid
– PCT reabsorbed 65% of the filtered water so
chemical composition of tubular fluid in the
loop of Henle is quite different from plasma
– since many nutrients were reabsorbed as well,
osmolarity of tubular fluid is close to that of
blood
Sets the stage for independent regulation of both
volume & osmolarity of body fluids
35
Symporters in the Loop of Henle
Thick limb of loop of
Henle has Na+ K- Cl-
symporters that reabsorb
these ions
K+ leaks through K+
channels back into the
tubular fluid leaving the
interstitial fluid and blood
with a negative charge
Cations passively move
to the vasa recta
36
 Reabsorption in the DCT
Removal of Na+ and Cl- continues in the DCT
by means of Na+ Cl- symporters
Na+ and Cl- then reabsorbed into peritubular
capillaries
DCT is major site where parathyroid hormone
stimulates reabsorption of Ca+2
– DCT is not very permeable to water so it is
not reabsorbed with little accompanying
water
37
Reabsorption & Secretion in the Collecting Duct

By end of DCT, 95% of

solutes & water. have
been reabsorbed and
returned to the
bloodstream.
Cells in the collecting
duct make the final
adjustments.
– principal cells reabsorb
Na+ and secrete K+.
– intercalated cells reabsorb
K+ & bicarbonate ions
and secrete H+. 38
 Actions of the Principal Cells
Na+ enters principal cells
through leakage channels
Na+ pumps keep the
concentration of Na+ in
the cytosol low
Cells secrete variable
amounts of K+, to adjust
for dietary changes in K+
intake
– down concentration gradient due to Na+/K+ pump
Aldosterone hormone increases Na+ and water
reabsorption & K+ secretion by principal cells by
stimulating the synthesis of new pumps and channels.
39
 Hormonal Regulation

Hormones that affect Na+, Cl- & water reabsorption and

K+ secretion in the tubules
1- Angiotensin II and aldosterone
decreases GFR by vasoconstricting afferent
arteriole
enhances absorption of Na+
promotes aldosterone production which causes
principal cells to reabsorb more Na+ and Cl- and
less water excreted.
increases blood volume by increasing water
reabsorption
40
 Hormonal Regulation
2- Atrial natriuretic peptide (ANP)
inhibits reabsorption of Na+ and water
in PCT & suppresses secretion of
aldosterone & ADH
increase excretion of Na+ which
increases urine output and decreases
blood volume

41
 3- Antidiuretic Hormone
Increases water permeability of
principal cells so regulates
facultative water reabsorption
Stimulates the insertion of
aquaporin-2 channels into the
membrane
– water molecules move more
rapidly
When osmolarity of plasma &
interstitial fluid increases, more
ADH is secreted and facultative
water reabsorption increases.
Production of Dilute or Concentrated
Urine
Homeostasis of body fluids despite variable
fluid intake
Kidneys regulate water loss in urine
ADH controls whether dilute or concentrated
urine is formed
– if lacking, urine contains high ratio of water to
solutes

43
Formation of Dilute Urine
Dilute = having fewer solutes
than plasma (300 mOsm/liter).
– diabetes insipidus
Filtrate and blood have equal
osmolarity in PCT
Water reabsorbed in thin limb,
but ions reabsorbed in thick limb
of loop of Henle create a filtrate
more dilute than plasma
– can be 4x as dilute as
plasma
– as low as 65 mOsm/liter
Principal cells do not reabsorb
water if ADH is low
Formation of Concentrated Urine
Compensation for low water intake or heavy perspiration
Urine can be up to 4 times greater osmolarity than plasma
The production of concentrated urine involves:
1- countercurrent mechanism:
– Long loop juxtamedullary nephrons make that possible
– Na+/K+/Cl- symporters reabsorb Na+ and Cl- from tubular
fluid to create osmotic gradient in the renal medulla
2-Cells in the collecting ducts reabsorb more water & urea
when ADH is increased
3-Urea recycling causes a buildup of urea in the renal medulla
4-Vasa recta minimize excessive loss of solute from interstitium
(maintenance of countercurrent gradient).
 Countercurrent Mechanism
Descending limb is very permeable to water
– higher osmolarity of interstitial fluid outside the
descending limb causes water to mover out of the
tubule by osmosis
at hairpin turn, osmolarity can reach 1200 mOsm/liter
Ascending limb is impermeable to water, but symporters
remove Na+ and Cl- so osmolarity drops to 100
mOsm/liter, but less urine is left
Vasa recta blood flowing in opposite directions than the
loop of Henle -- provides nutrients & O2 without affecting
osmolarity of interstitial fluid
46
Reabsorption within Loop of Henle
 Summary
H2O Reabsorption
– PCT---65%
– loop---15%
– DCT----10-15%
– collecting duct---
5-10% with ADH
Dilute urine has not
had enough water
removed, although
sufficient ions have
been reabsorbed.
48
 Disorders of Urinary System

Renal calculi
Urinary tract infections
Glomerular disease
Renal failure
Polycystic kidney disease
Urinary bladder cancer

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