CHAP 33: ORGANIZATION OF THE URINARY SYSTEM

3 essential functions of kidney: Juxtamedullary glomeruli (located near the junction of cortex
and medulla)
1. Filters – removes metabolic products & toxins
2. Regulate body’s fluids, electrolyte and acid-base Supplied by small branches of Arcuate artery or prox portion of
balance interlobular artery
3. Produce/activate hormones (erythogenesis, Ca2
metabolism, and regulation of blood pressure & blood Efferent arterioles of these nephrons descend into renal
flow) papillae to form hairpin-shaped vessels called Vasa Recta
(provide capillary networks for tubules in the medulla)
FUNCTIONAL ANATOMY OF THE KIDNEY
90% of blood entering – perfuses superficial glomeruli & cortex
Functional unit – nephron (repeated 1M each kidney)
10% - perfuses juxtamedullary glomeruli & medulla
The kidneys are paired, retroperitoneal organs with
vascular and epithelial elements Lymph vessels

 Paired, bean-shaped, behind the peritoneum on each  Drain the interstitial fluid of cortex
side of the vertebral column  May contain high concentrations of hormones
 T12-L3 (erythropoietin)
 <0.5% of total BW  Absent from the renal medulla
 Male: 125-170 g
The functional unit of the kidney is the nephron
 Female: 115-155 g
 Hilus: middle of the concave surface, a slit of the 800,000 – 1,200,000 each kidney
capsule
o Enters: renal artery Consists of a glomerulus & tubule
o Exits: renal vein, lymphatics & ureters
 Renal sinus: shallow space; completely surrounded Glomerulus – cluster of blood vessels
by parenchyma except where it connects at the upper
end of ureter Tubule – epithelial structure consisting of many subdivisions,
o Urine-filled spaces: designed to convert the filtrate into urine
 Renal pelvis proper & its extensions
Bowman’s/glomerular capsule – where 2 entities meet at the
 Major & minor calyces
blind end of the tubule epithelium; contiguous with the lumen of
 2 basic layers
the tubule
Cortex (granular outer) Medulla (darker inner)
Epithelial elements:
Glomeruli Parallel arrangement of
tubules
Capillaries Small blood vessels 1. Bowman’s capsule
Tubules 2. Prox tubule
Medulla – subdivided to 8-18 conical renal pyramids 3. Thin descending
4. Thin ascending
The kidneys have a very high blood flow and glomerular 5. Thick ascending
capillaries flanked by afferent and efferent arterioles 6. Distal convoluted
7. Connecting tubule
 20% of Cardiac output
 Renal circulation sequence of vascular elements: 2 populations of nephrons (within renal cortex):
1) High resistance arteriole (efferent arteriole)
2) High pressure glomerular filtration 1. Superficial nephrons – short loops extending to the
nd
3) 2 high resistance arteriole (afferent) boundary between outer & inner medulla
4) Low-pressure capillary network that 2. Juxtamedullary nephrons – special role in the
surrounds renal tubules (peritubular production of a concentrated urine, long loops that
capillaries) extend at the tip of medulla

Renal artery -> ant & post branches -> interlobar & arcuate The renal corpuscle has 3 components: vascular
(corticomedullary junction) arteries -> ascending interlobular elements, the mesangium, and bowman’s capsule
arteries (enters the cortex) -> numerous afferent arterioles ->
Renal corpuscle – site of formation of glomerular filtrate
glomerular efferent arterioles
(glomerulus, Bowman’s space & Bowman’s capsule)
Efferent arterioles are the origin of dense peritubular capillary
Podocytes
network
- Covers glomerular capillaries thru their foot processes
 Nephrons in the superficial portion of cortex
- Modified epth cells
 Supplies O2 & nutrients to the tubules in the cortex
- Represent the visceral layer of the Bowman’s capsule
- Continued with the parietal layer at the vascular pole
Afferent & efferent arterioles determines the hydrostatic
- Bowman’s space: space between the 2 layers where
pressure
glomerular filtrate flows into the prox tubule
 Both arterioles – sympathetic innervation, and
chemical mediators

BY: PATRICK LIM & GREGORIO GERONIMO S. SALAZAR 1

Glomerular filtration barrier Proximal tubule

- b/w glomerular capillary lumen & Bowman’s space 1) Proximal convoluted tubule (PCT)
- comprises 4 elements: 2) Proximal straight tubule (PST)
1) glycocalyx covering the luminal surface of epith cells
- negatively charged GAGs Ultrastructure (can be subdivided into 3 segments):
- prevents leakage of large NEGATIVELY

st
charged macromolecules S1 segment – glomerulus to 1 portion of PCT

nd st
2) endothelial cells S2 segment – 2 half of PCT to 1 half of PST
- contain large fenestrations (70 nm holes) – o  S3 segment – distal half of PST to medulla
restriction to water & small solutes out of the
lumen Tubule Segment Abbreviation
- only serve to limit filtration of cellular Proximal convoluted tubule PCT
Proximal straight tubule PST
elements (RBC)
Thin descending limb of loop tDLH
- ALMOST surrounded by glomerular of Henle
basement membrane & podocyte foot Thin ascending limb of loop of tALH
process Henle
- Center of glomerulus – devoid of foot Thick ascending limb of loop TAL
processes & basement membrane and come of Henle
into direct contact with MESANGIAL CELLS Distal convoluted tubule DCT
- Mesangial cells – resemble smooth ms Connecting tubule CNT
Initial collecting tubule ICT
- Filtration occurs AWAY from the mesangial
Cortical collecting tubule CCT
cells. At the PERIPHERAL portion of the
Outer medullary collecting OMCD
capillary wall duct
3) glomerular basement membrane Inner medullary collecting IMCD
- b/w endothelial cells & podocyte foot duct
processes
- separates the endo from epithelial layer
- has 3 layers: Apical membrane (luminal)
- inner thin layer (lamina rara interna)
- thick layer (lamina densa) - Has infoldings in the form of well-developed brush
- outer thin layer (lamina rara externa) border
- restricts intermediate to large sized solutes - Reabsorb the bulk of filtered fluid back into
(>1 kDa) circulation
- contains HEPARAN SULFATE - Central cilium – senses fluid flow
PROTEOGLYCANS (HPSGs) – restricts
Basolateral membrane (peritubular)
large, negatively charged solutes
4) epithelial podocytes - Forms numerous interdigitations
- have foot interdigitating processes - Abundant mitochondria in close contact with plasma
- filtration slits – between these interdigitations membrane
(nose-like stx) - Bounded by tight junctions at one end & basement
- slit diaphragms – connects the membrane at other end
interdigitations - S1 to S3 – cell complexity declines, gradual
- glycoproteins w/ negative charge – cover the decrease of reabsorptive rates, less developed
podocytes, interdigitations, and slit brush border, diminished complexity of
diaphragms interdigitations, lower BL membrane area & dec
- restricts LARGE ANIONS mitochondria
- nephrin and NEPH1 – zip together
- Podocin – contribute to the slit diaphragm Thin desc limb (tDLH) and thin asc limb (tALH)

Nephrotic syndrome (finnish type) - Less complex

- Few mitochondria, little cell membrane amplification
 Genetic absence of NEPHRIN
 Severe proteinuria Thick asc limb (TAL)

Juxtaglomerular apparatus (JGA) - Terminates at macula densa

- Tall interdigitations & numerous mitochondria
1) Extraglomerular mesangial cells - Extensively invaginated BL membranes
2) Macula densa - Makes the medullary interstitium HYEPROSMOTIC
- patch of specialized tubule epith cells at the
transition of TAL and distal tubule Classic distal tubule
3) Granular cells
- aka. Juxtaglomerular or epitheloid cells - Distal convoluted tubule (DCT)
- specialized smooth ms cells that produce, store and  Macula densa to connecting tubule
release RENIN  Cells are similar in stx to those of TAL
- INDIRECTLY modulates Na balance & systemic - Connecting tubule (CNT)
blood pressure  Ends at initial collecting tubule
 3 cell types:
The tubule components of the nephron include the
a. CNT cells – produce & release
proximal tubule, loop of Henle, distal tubule, and
KALLIKREIN (serine protease; modulates
collecting duct
channels & transporters)
BY: PATRICK LIM & GREGORIO GERONIMO S. SALAZAR 2
 b. Intercalated cells – lack central cilium Loop of Henle (tDLH, tALH, TAL)
- A-intercalated: secretes H, reabsorbs
K - forms concentrated or diluted urine
- B-intercalated: seceretes HCO3 - by pumping NaCl int the intertitium of medulla without
appreciable water flow = HYPERTONIC
st
Initial collecting tubule (ICT, upto 1 confluence) and - TAL cells: secretes TAMM-HORSFALL
cortical collecting tubule (CCT, after the confluence) GLYCOPROTEIN (THP) or aka. UROMODULIN
o 30 – 50 mg/day into the urine, along with
- Identical albumin: <20 mg/day (accounts for most
- Composed of intercalated and principal cells CHON normally present in urine)
- Intercalated cells (same as above)
- Principal cells Distal tubule and Collecting duct system
 About 2/3 of the cell
 Fewer mitochondria - Fine control of water & salt excretion
 (+) central cilium on apical surface - Hormones exert their effects on electrolyte & water
 Reabsorbs Na and Cl excretion (aldosterone, arginine vasopressin)
 Secretes K
The JGA is a region where each thick ascending limb
contacts its glomerulus
Medullary collecting duct (MCD)
2 regulatory roles of JGA:
- Lined by 1 cell type
- Increases in cell height toward the papilla
1.Tubuloglomerular feedback
- DUCT OF BELLINI/PAPILLARY COLLECTING
- Fluid and NaCl INCREASES = GFR falls
DUCT - at the extreme end, cells are extremely tall
2. DECREASE stretch in arteriole walls sensed by
Baroreceptors = INCREASE release of RENIN by
The tightness of tubule epithelia increases from the
granular cells
proximal to the medullary collecting tubule
- Systemic arterial blood pressure
- Tight junction permeability – either tight or leaky
Sympathetic nerve fibers to the kidney regulate renal
- Tightness increases from prox tubule to the collecting
blood flow, glomerular filtration, and tubule reabsorption
duct
- Leaky prox tubule – shallow, few strands of
Innervation to kidneys – entirely sympathetic; they lack
membrane proteins
parasympathetic nerve fibers
- Tight collecting tubule – deep, multiple strands of
membrane proteins Originates from the CELIAC PLEXUS and follow the
- Tight junctions consisting of only 1 strand ARTERIAL vessels into the kidney
o Low electrical resistance
o High solute permeability NOREPINEPHRINE & DOPAMINE – released by the sympa
- Several strands
o High electrical resistance 3 major effects of sympathetic stimulation:
o Low permeability
- Gap junctions – provide low-resistance pathways b/w 1) Catecholamines – vasoconstriction
some neighbouring tubule cells; lateral; ELECTRICAL 2) Catecholamines – enhances Na reabsorption bye
COUPLING found in Prox tubule cells but NOT prox tubule cells
among heterogenous cells (connecting & collecting 3) Stimulates RENIN secretion – sympa fibers near the
tubules) granular cells of JGA

MAIN ELEMENTS OF RENAL FUNCTION Baroreceptors – stimulated by increased perfusion pressure

The nephron forms an ultrafiltrate of the blood plasma and Chemoreceptors – stimulated by ischemia & abnormal ion
then selectively reabsorbs the tubule fluid or secretes composition of the interstitial fluid in the RENAL PELVIS
solutes into it
- High levels of K and H ions
Starling forces
The kidneys, as endocrine organs, produce renin, 1,25-
- governs the flow of fluid across the capillary walls in dihydroxyvitamin D, erythropoietin, prostaglandins, and
the glomerulus and result in net filtration bradykinin
- flows in the BOWMAN’S SPACE and not in the
Prox tubule – convert 25-hydrocyvitamin D to active
interstitium
metabolite, 1,25-diydroxyvitamin D (controls Ca and
Renal tubule – recover most of the fluid & solutes filtered at phosphorus in intestines, kidneys and bones)
the glomerulus
Fibroblast-like cells – found in cortex & outer medulla secrete
Proximal tubule – largest fraction of glomerular filtrate EPO (dev’t of RBC)

- reabsorbs: NaCl, NaHCO3, filtered nutrients (glucose, Prostaglandins & Kinins – control circulation within the
AA), divalent ions, and water kidney; VASODILATORS
- secretes: NH4, variety of endogenous and exogenous
Tubule cells – secerete Angiotensin, Bradykinin, cAMP & ATP
solutes in the lumen
into the lumen; modulate downstream nephron function

BY: PATRICK LIM & GREGORIO GERONIMO S. SALAZAR 3

THE URETERS AND BLADDER Bladder filling activates stretch receptors, initiation of
micturition reflex, a spinal reflex under control of higher
The ureters propel urine from the renal pelvis to the central nervous system centers
bladder by peristaltic waves conducted along a syncytium
of smooth-muscle cells Bladder tone – bladder volume + internal (intervesical)
pressure
Ureter
Cystometrogram – record of the relationship b/w volume &
- loops OVER the TOP of common iliac artery & vein on pressure
the SAME SIDE of the body
- enters at the LOWER POSTERIOR portion of bladder Increasing bladder volume 0 to ~50 mL: moderately steep
(ureterovesical junction) increase in pressure
- pass OBLIQUELY to its muscular wall
- open into the bladder lumen at 1 to 2 cm ABOVE and ~300 mL: almost no pressure increase
LATERAL to the orifice of the urethra
- lumen: transitional epithelium >400 mL: produce steep increments of PASSIVE pressure
- inner LONGITUDINAL, outer CIRCULAR of smooth ms
Cortical & suprapontine centers: INHIBIT micturition reflex
(syncytium and thus an example of UNITARY smooth
ms Pontine Micturation Center (PMC): coordinates; controls the
- Gap junctions: 2 to 6 cm/s bladder and sphincters
- Action potential: triggered by chemical or mechanical
stimuli (stretch) Storage phase
- Contraction: Ca-calmodulin activated MLCK
- PKA phosphorylates MLCK: lowering the affinity of - ~150 mL: first urge for bladder emptying
MLCK for Ca-Calmodulin - 400-500 mL: senses fullness
- cAMP: relaxing effect in smooth ms
- peristaltic waves: originate from electrical pacemakers Voiding phase
in the proximal portion of renal pelvis
- sympathetic input: modulated ureteral contractility - Voluntary relaxation of EXTERNAL sphincter, followed
 NE acts on a-adrenergic – excitatory by INTERNAL sphincter
- Pontine centers INHIBIT parasympathetic neurons that
 NE on B-adrenergic – inhibitory
innervate the detrusor ms: micturition reflex continues
- Parasympathetic input: enhances ureteral contractility
via Ach - Bladder contracts = expel urine!
- Cortical centers: INHIBIT internal sphincter
 DIRECTLY stimulating muscarinic receptors
- Entire urinary system is normally STERILE
 Postganglionic sympathetic fibers to release NE,
which stimulate a-adrenoreceptors

Parasympathetic, sympathetic, and somatic fibers

innervate the urinary bladder and its sphincters

Urinary bladder

- Body: main portion that collects urine

- Neck: funnel-shaped extension that connects w/
urethra
- Detrusor muscle: 3 poorly defined smooth ms
- Lower tip of trigone: opens up to POST urethra
- Internal sphincter: smooth ms interspersed with elastic
tissue in the wall of post urethra
- External sphincter: voluntary, mainly slow-twitched
striated ms fibers
- Humans: lack gap junctions (absence of electrotonic
coupling between cells)
- Smooth ms: multiunit (1:1 ratio b/w nerve endings &
smooth ms cells)
- Bladder & sphincters: sympa, para & somatic NS
 Sympathetic innervation T10-L2
(intermediolateral cell column)
- Superior hypogastric plexus
 Parasympathetic innervation S2-S4
(intermediolateral cell column)
- Pelvic splanchnic nerves
- Synapse: body & neck of bladder
 Somatic innervation S2-S4 (motor neurons)
- Pudendal nerve: voluntary skeletal ms of
EXTERNAL sphincter

BY: PATRICK LIM & GREGORIO GERONIMO S. SALAZAR 4