The Urinary System

Principles of Anatomy and Physiology

Meet your Kidneys!
Two small, bean-shaped organs that remove
excess fluid and waste products from the body

The right kidney sits a The kidneys are

little lower to located right below
accommodate the liver, the rib cage on
just below the each side of the
diaphragm. spine.
Layers of the Kidney
Renal capsule
Renal cortex

Renal
medulla
Adipose capsule
(perirenal fat)
Renal capsule

Pararenal fat

Renal

fascia
Renal Capsule

Renal capsule
• Tough fibrous connective
tissue layer that covers the
outside of each kidney

• Composed primarily of
collagen and elastin
 Renal Cortex and Medulla
Outer cortex:
 Forms the outer part of the kidney and projects into the
medullary region between the renal pyramids as Renal Columns
 Contains RENAL CORPUSCLES (Glomerulus surrounded by
Bowman’s capsule), PCT and DCT
 Extends into medulla between adjacent pyramids (Renal
columns)
Inner medulla:
 Forms the inner part, consists of 8 to 12 RENAL PYRAMIDS
which contain straight tubules (Henle’s loops) and Collecting
tubules
 Apex of the Renal pyramid called as Renal Papilla fits into the
Minor Calyx on which the collecting tubules open
 12 renal pyramids (base toward cortex; apex – renal papilla
oriented medially),
 Medullary rays: Striations from bases of pyramids to cortex
Renal Pelvis:
 Upper expanded end of ureter
 Divided into 2 or 3 major calyces
 Subsequently divided into 2 or 3 minor calyces
 Each minor calyx indented by apex of renal pyramid (renal
papilla)
 About 142 liters
of blood

How many liters of blood do kidneys filter per

day?
Renal Ins and Outs

Blood flows into your kidneys

through the renal artery that is
connected to the aorta. Renal
artery

Blood exits each kidney through

the renal vein that is connected to
the inferior vena cava.
Renal
vein
Urine exits the kidneys via the ureter
Ureter
to the bladder.
The Renal Artery
The renal artery branches
into progressively smaller
blood vessels until the blood
reaches the nephrons.

Renal
artery

Blood enters each kidney

through the renal artery. Capillary

Nephron
Renal Cortex
2 3
Production of

erythropoietin
The space where the nephrons 1
of the kidneys are perfused by:

1. Renal artery arterioles Cortex

2. Renal vein venules

3. Glomerular capillaries
Nephron

Nephron

• Functional unit of the kidney

• Each kidney has ~1,000,000 nephrons Cortex Medulla

• Nephrons stretch from the cortex to

the
medulla of the kidney
3 Main Parts of a Nephron

Distal capsule
Proximal convoluted
Glomerulus
convoluted tubule (DCT)
tubule (PCT)
• The glomerulus is a tangle of capillaries.

• When blood flows into the glomerulus,

blood pressure forces water and solutes
out of the capillaries and into the lumen of
the Bowman’s capsule

• Water, salts, amino acids, and wastes

that make it into the capsule are
collectively called the filtrate. capsule
Glomerulus
• The filtrate is filtered from the blood into the
tubules that is why this stage is called
filtration.
Function of Kidneys
The kidneys are major
Producing renin (regulates blood
Regulating the total water volume and the
pressure) and erythropoietin (regulates
total solute concentration in water
RBC production)

Regulating ion concentrations in

Activating vitamin D
the extracellular fluid (ECF)

Ensuring long-term acid-base balance Carrying out gluconeogenesis, if needed

Regulating the total water volume and the

total solute by excreting metabolic wastes,
toxins, and drugs
Function of Kidneys

Ureters: transport
urine from
kidneys to
urinary bladder

Urinary bladder:
temporary
Urethra: storage reservoir
transports urine for urine
out of body
Physiology of Kidneys

180 L of fluid is processed 1.5 L of fluid is excreted

daily. daily.

The kidneys filter the entire plasma volume 60 times a day.

Physiology of Kidneys

• Filtrate (produced by glomerular filtration):

• Blood plasma minus proteins

• Urine:

• Produced from filtrate

(< 1% of original filtrate)

• Contains metabolic wastes

and unneeded substances
Physiology of Kidneys Urine Formation
Afferent Efferent
arteriole arteriole

11. Glomerular filtration:produces

cell- and protein-free filtrate
22. Tubular reabsorption:selectively
returns 99% of substances from
the filtrate to the blood in the 1
renal tubules and collecting ducts

33. Tubular secretion:selectively moves 2

substances from the blood to the
filtrate in the renal tubules and 3
collecting ducts
Step 1: Glomerular Filtration (Passive
Process) Hydrostatic
through
pressure forces fluids and solutes

the filtration membraneinto the glomerular capsule.

Glomerular
capsule

Glomerula
r capillary

Podocytes

Capsular
space
Step 1: Glomerular Filtration (Passive
Process) Hydrostatic
through
pressure forces fluids and solutes

the filtration membraneinto the glomerular capsule.

Glomerular
capsule Capsular hydrostatic
Glomerula pressure (CHP) = 15
r capillary mmHg

Podocytes

Glomerular blood
hydrostatic pressure
(GBHP) = 55 mmHg
Capsular
space
Step 1: Glomerular Filtration (Passive
Process)
No reabsorption occurs from the glomerular capsule back into the
blood.

Glomerular
capsule Capsular hydrostatic
Glomerula pressure (CHP) = 15
r capillary mmHg

Podocytes

Glomerular blood
hydrostatic pressure
(GBHP) = 55 mmHg
Capsular
space
Filtration Membrane
Glomerular
Efferent capsular
arteriole space
Filtration
Glomerular membrane
• Porous membrane between capillary
the blood and the interior of
the glomerular capsule

• Allows water and solutes

smaller than plasma proteins to
pass (usually no cells can pass)
A
f
f
e
r Proximal convoluted
e tubule
n
Filtration Membrane
Fenestrated
endothelium
1. Fenestrated endothelium of
glomerular capillaries

2. Basement membrane: Podocyte

the fused basal lamina of 2 Filtration cell bodies
other slits
layers
3. Foot processes of podocytes with
filtration slits; slit diaphragms repel
larger macromolecules
Capillary
Filtration Membrane

Capillary

Capillary Fenestration
endothelium (pore)
Basement membrane Slit diaphragm
Foot processes
of a podocyte of
the glomerular
capsule

Capsular
space
Filtration Membrane
Molecules < 3 Water, glucose, amino
nm acids, nitrogenous
wastes
Filtration Membrane
Molecules < 3 Water, glucose, amino
nm acids, nitrogenous
wastes
Prevent loss of all
Plasma
water
proteins
to the capsular space
Glomerular Filtration Rate
(GFR)

The glomerular filtration rate (GFR)is the

volume of filtrate formed per minute by
both kidneys (normal = 120 125 mL/min).
Glomerular Filtration Rate
(GFR)
The GFRis directly proportional to:

Total surface area available Filtration membrane

Net filtration pressure (NFP)
for filtration permeability

Primary pressure is Much more permeable than Glomerular mesangial cells

glomerular other capillaries control by contracting
hydrostatic pressure
Regulation of Glomerular
Filtration
Maintaining a constant GFR is important because it allows the kidneys to make filtrate
and
maintain extracellular homeostasis.

Intrinsic controls (renal autoregulation) Extrinsic controls

• Directly maintain the GFR in the • Maintain the GFR by regulating

kidney despite changes in blood the systemic blood pressure
pressure
• Main extrinsic controls:
the nervous system and the
endocrine
mechanisms
Intrinsic Controls Renal
Autoregulation
Maintains nearly constant GFR when the mean arterial pressure (MAP) is 80 180 mm
Hg
(autoregulation ceases if it is out of that range)

2 types of renal autoregulation:

Tubuloglomerular feedback
Myogenic mechanism
mechanism
Myogenic Mechanism
Increased blood pressure Decreased blood pressure

Constriction of afferent arterioles Dilation of afferent arterioles

• Restricts blood flow into the glomerulus

• Protects glomeruli from damaging
high blood pressure

Maintain normal GFR despite normal

fluctuations in the blood pressure
Tubuloglomerular Feedback Mechanism

GFR increases GFR decreases

↑ Filtrate and ↑ NaCl concentration ↓ Filtrate and ↓ NaCl concentration

Macula densa cells Macula densa cells

Vasoconstriction of Vasodilatation of
afferent arterioles afferent arterioles

Maintain normal
GFR
Extrinsic Controls Neural & Hormonal
Mechanisms

The purpose of extrinsic controls is to regulate the

GFR to maintain systemic blood pressure.

Extrinsic controls will override renal intrinsic controls

if the blood volume needs to be increased.
Extrinsic Controls Neural & Hormonal
Mechanisms ↓ Blood pressure

Sympathetic response

Afferent arteriole constriction Norepinephrine

↓ Urine Vasoconstriction

↑ Blood volume (BV) ↑ Blood pressure

Renin-angiotensin-aldosterone Mechanism
↓ Blood pressure

Sympathetic response ↓ Filtrate NaCI

Juxtaglomerular cells Macula densa cells

Reduced stretch Renin

Angiotensin

Aldosterone

Na/water retention ↑ Blood volume ↑ Blood pressure

Step 2: Tubular
Reabsorption
• Tubular reabsorptionquickly reclaims
Afferent
arteriole
Efferent
arteriole
most of the tubular contents and
returns them to blood.

• This is a selective
transepithelial process:

• Almost all organic nutrients

are
reabsorbed.
2
• Water and ion reabsorption
is
hormonally regulated and
adjusted.

• This includes active and

Step 2: Tubular
Reabsorption
Substances can follow 2 routes:

Transcellular route Paracellular route

Transcellular and Paracellular
Routes

H2O and
solutes Transcellular route

Apical Basolateral
membranes
Peritubular
membrane Paracellular route capillary
H2O and
solutes
Tight junction
Transport across the Basolateral
Membrane
NaK
ATPas
Glucose
e
Na+
1 K+ 2

Apical
membrane
Basolateral
membranes Peritubular
capillary

↑ Na+
Tubular Reabsorption of Nutrients, Water, and Ions

Na+ reabsorption by primary active transport

provides energy and the means for
reabsorbing almost every other substance.
Tubular Reabsorption of Nutrients, Water, and Ions
Secondary active transport
NaK
Glucose, amino acids, ATPas
some ions, vitamins e
Na+
K+
K+

Basolateral
Apical membranes
membrane Peritubular
capillary
Tubular Reabsorption of Nutrients, Water, and Ions
NaK
Glucose, amino ATPas
acids, e
some ions, vitamins
Na+
K+
K+

Basolateral
Apical membranes
membrane Peritubular
H2 O capillary

Passive transport
.
Tubular Reabsorption of Nutrients, Water, and Ions
Obligatory water reabsorption: Aquaporins are always present in
PCT.

NaK
Glucose, amino acids,
ATPas
some ions, vitamins
e
Na+
K+
K+

Basolateral
Apical membranes
membrane Peritubular
H2O capillary
Passive transport
.
Tubular Reabsorption of Nutrients, Water, and Ions
Facultative water reabsorption:Aquaporins are
inserted
in collecting ducts only if ADH is present

NaK
Glucose, amino acids,
ATPas
some ions, vitamins
e
Na+
K+
K+

Basolateral
Apical membranes
membrane Peritubular
H2O capillary
Passive transport
Tubular Reabsorption of Nutrients, Water, and Ions
NaK
Glucose, amino ATPas
acids, e
some ions, vitamins
Na+
K+
K+
Lipid-soluble
substances and ions Basolateral
membranes
Passive tubular reabsorption Peritubular
H2 O capillary
Proximal Convoluted Tubule
(PCT) Proximal convoluted tubule
The site of most reabsorption within
the nephron:

• Glucose and amino acids

• 65% of Na+ and water

• Many ions

• Almost all uric acid

• About half of urea

(later secreted back into the filtrate)
Reabsorption by PCT
Cells
Na+

Glucose, amino acids,

some ions, vitamins

H2 O

Lipid-soluble substances
Various ions and urea
Paracellular
route
Reabsorption by PCT
Cells
Na+ 3 Na+ 3 Na+

Glucose, amino 2 K+ 2 K+
acids,
some ions, vitamins
K+

H2 O

Lipid-soluble substances
Various ions and urea
Paracellular
route
Nephron
Loop

Ascending limb:
water-impermeable
and solute-permeable

Descending limb:
water-permeable and
solute-impermeable
Nephron Ascending Limb
Loop
• The thin segment is passive to Na+
movement.

• The thick segment has Na+-K+-2Cl

symporters and Na+-H+ antiporters
that transport Na+ into the cell.

• Some Na+ can pass into the cell by the Ascendin

paracellular route in the ascending g limb
limb portion of the loop.
Distal Convoluted Tubule and Collecting
Duct
Antidiuretic hormone Collectin
(ADH): g duct
Posterior
pituitary
gland

Distal convoluted
tubule

R ADH
H2O
Distal Convoluted Tubule and Collecting
Duct
Antidiuretic hormone Collectin
(ADH): g duct
Posterior
pituitary
gland

H2 O
Distal convoluted
H2O tubule

H2 O R ADH
H2O
Reabsorptive Capabilities
Aldosterone: Collectin
Cortex g duct

Na+
R Aldosteron
e
H2 O ATP Distal convoluted
K+ tubule
K+ Na+

ADP
Functions:increase blood
pressure and decrease K+
levels
Reabsorptive
Capabilities Atrial natriuretic peptide

↑ Blood volume Atrial

Reduces
or blood natriuretic
blood Na+
pressure peptide
elevated

↓ Blood volume
and blood
pressure
Reabsorptive
Capabilities Parathyroid hormone
Parathyroid hormone

Distal convoluted
tubule

↑ Ca2+ reabsorption
Step 3: Tubular
Secretion Afferent
arteriole
Efferent
arteriole
• Occurs almost completely in the PCT

• Selected substances: are moved

from peritubular capillaries through
the tubule cells out into the filtrate:

• K+, H+, NH4 +, creatinine,

and organic acids
and bases
• Substances synthesized in
the tubule cells: also are 3
secreted (example: HCO3 )
Step 3: Tubular
Secretion

that are bound to plasma proteins.

(example: urea and uric acid).

+ (aldosterone effect).

+ or HCO3 in the urine.

Tubular Reabsorption and Secretion
65% of filtrate
volume reabsorbed
(H2O; Na+, HCO3 ,
and many other
ions; glucose, amino
acids, and other
nutrients

H+ and NH 4+;
some
drugs

H2O

Reabsorption Reabsorption or secretion to maintain

Secretion blood pH; involves H+, HCO3 , and NH4+
Tubular Reabsorption and Secretion
65% of filtrate
volume reabsorbed
(H2O; Na+, HCO3 ,
and many other
ions; glucose, amino
acids, and other
nutrients

H+ and NH 4+;
some
drugs Na+, K+,
Cl

H2O Urea

Reabsorption Reabsorption or secretion to maintain

Secretion blood pH; involves H+, HCO3 , and NH4+
Tubular Reabsorption and Secretion
65% of filtrate Regulated reabsorption (Na+ (by aldosterone;
volume reabsorbed Cl follows) and Ca2+ (by parathyroid hormone))
(H2O; Na+, HCO3 ,
and many other
ions; glucose, amino
acids, and other
nutrients DCT

H+ and NH 4+;
some
TA Regulated secretion
Na+, K+, L → K+ (by aldosterone)
drugs
Cl
Regulated reabsorption Regulated
(H2O (by ADH); Na+ (by secretion
H2O Urea aldosterone; Cl follows) and → K+ (by
urea (increased by ADH) aldosterone
)

Reabsorption Reabsorption or secretion to maintain

Secretion blood pH; involves H+, HCO3 , and NH4+
Formation of Dilute or Concentrated
Urine
Overhydration produces Dehydration produces
large volumes of dilute urine. small volumes of concentrated urine.

• ADH production • Maximal ADH is

decreases; urine is ~100 released; urine is ~1,200
mOsm. mOsm.
• If aldosterone is present, • In severe dehydration,
additional ions ~99% of water
can be removed, causing in the filtrate is
water reabsorbed.
to dilute to ~50 mOsm.
Diuretics

Diuretics are chemicals that enhance urinary output.

• ADH inhibitors, such as alcohol

• Na+ reabsorption inhibitors (and resultant H2O reabsorption),

such as caffeine or drugs for hypertension or edema

• Loop diuretics that inhibit medullary gradient formation

• Osmotic diuretics: substances that are not reabsorbed, so

water remains in the urine; for example, in a patient with
diabetes, the high glucose concentration pulls water from the
body
Clinical Evaluation of
Kidneys
• Urinalysis:Urine is examined for signs
of disease.

• Urinalysis can also be used to test

for
illegal substances.

• Assessing renal function requires

both blood and urine examination.

• Example: Renal function can be

assessed by measuring
nitrogenous wastes in the blood
only.

• To determine renal clearance,

both blood and urine are required.
Renal
Clearance
• Renal clearance:The volume of plasma that
kidneys can clear of a particular substance in
a given time.

• Renal clearance tests are used to determine

the

•
Renal
Clearance
The renal clearance rate is calculated as:

C = UV/P

• C = renal clearance rate (mL/min)

• U = concentration (mg/mL) of a substance in the urine

• V = flow rate of urine formation (mL/min)

• P = concentration of the same substance in the

plasma
Renal
Clearance

Inulin, a plant polysaccharide, is the standard

used.

• It is freely filtered and neither reabsorbed

nor secreted by the kidneys.

• Its renal clearance = GFR (~125 mL/min).

Renal
Clearance

C < 125 mL/min C = 0 mL/min C = 125 mL/min C > 125 mL/min

Substance Substance completely No net reabsorption Substance

reabsorbed reabsorbed, or secretion secreted (most
or not filtered drug metabolites)
Chemical Composition of
Urine
5%
solutes
Nitrogenous wastes:

• Urea (from amino acid breakdown): largest

solute component

95% • Uric acid (from nucleic acid metabolism)

water
• Creatinine (metabolite of creatine
phosphate)
Chemical Composition of
Urine
5%
solutes
Other solutes found in
urine:
• Na+, K+, PO4 3 , and SO 42 , Ca2+, Mg2+ and
HCO3 .

• Abnormally high concentrations of any

95% constituent, or abnormal components such
water as blood proteins, WBCs, and bile
pigments, may indicate pathology.
Abnormal Urinary
Constituents
Substance Name of condition

Glucose Glycosuria

Proteins Proteinuria, albuminuria

Ketone bodies Ketonuria

Hemoglobin Hemoglobinuria

Bile pigments Bilirubinuria

Erythrocytes Hematuria

Leukocytes Pyuria
Physical Characteristics of
Urine Color and transparency
• Clear Abnormal color
• (pink, brown, smoky)

• If cloudy may indicate • Can be caused by

a urinary tract certain foods, bile
infection pigments, blood, or
drugs
• Pale to deep yellow from
urochrome

• Pigment from
hemoglobin
breakdown

• Yellow color that

Physical Characteristics of
Urine Odor
• Slightly aromatic when fresh • Disease may alter the
smell
• Develops ammonia odor upon • Patients with diabetes
standing as bacteria may have an acetone
metabolize the urea smell to their urine

• May be altered by some drugs

or vegetables
Physical Characteristics of
Urine pH
• Urine is slightly acidic (~pH 6, with An alkaline diet (vegetarian),
• prolonged vomiting, or
a range of 4.5 8.0). urinary tract infections can
cause an increase in the pH.
• An acidic diet (protein, whole
wheat) can cause a drop in
the pH.
Specific gravity
• Specific gravity is the ratio of a • The range is from 1.001
mass of a substance to a mass 1.035
of an equal volume of water (the because urine is made
specific gravity of water = 1). up of water and solutes.
Micturition
Micturition is also called urination or voiding.

3 simultaneous events must occur:

1 Contraction of the detrusor by the ANS

Opening of the internal urethral sphincter by

2
the ANS
1
Opening of the external urethral
3 sphincter 2
by the somatic nervous system
3
In a
Nutshell

 The urinary system is responsible

for filtering the blood plasma to
remove metabolic waste.
 The main organ of the urinary system is the
kidney, but other organs include the
ureters, bladder, and urethra.
 The functional unit of the kidney is the
nephron. Within the nephron are the
glomerulus, tubules, and collecting
ducts.
In a
Nutshell
 Blood plasma is filtered through the
glomerulus, where it becomes filtrate.
This filtrate is moved to the tubules
and collecting ducts.
 Within the tubules and collecting ducts,
solutes and water are reabsorbed into
the blood or secreted into the tubules.
 What remains of the filtrate in the collecting
ducts will become urine. The
concentration of urine is regulated by the
medullary gradient, hormones, and the
systemic blood pressure.
In a
Nutshell

 Kidney function can be measured by

the renal clearance.
 The chemical composition of urine can
also
give information about kidney function.
 Micturition, or urination, is controlled
involuntarily by the ANS and voluntarily
by the skeletal muscles of the urethra.
In a
Nutshell

THE
END