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Urinary System

The major function of this system is the elimination of excess water, salts,

and waste products.

Above 170 bpm, your thinking is reduced to the primitive fight or flight

response. Running (or charging) is at its peak performance. The vast

majority of people also tend to lose control of their bladder and bowels at

this stage because even those functions consume resources that the body

prefers to save for fighting or running.

Although renal function declines substantially with age, it usually remains

sufficient for removing bodily wastes. Nevertheless, reduced renal function

decreases the elderly person's ability to respond to various physiological and

pathological stresses. In general, aging is associated with an increased

incidence of kidney problems. There is a decline in the number of nephrons

by about 30-40% between ages 25 and 85. Nephrons are the basic functional

units of the kidneys and are made up of a renal corpuscle and renal tubules.

There is also a reduction in filtration rate due to cumulative damage to the

system and to reduction in blood flow to the kidneys.

Urine is formed by the kidneys through three processes: filtration,

reabsorption and secretion. The ultimate source of urine is blood, and a large

amount of blood is transported to the kidneys for filtration by way of the

renal arteries. Renal blood flow progressively decreases from 1200

mL/minute at age 30 to 40 years to 600 mL/minute at age 80. A decrease in


the glomerular filtration rate, or the rate at which blood is forced through

and filtered by the renal corpuscle in the kidneys, is the most important

functional defect caused by aging.

Since the kidneys receive up to 25% of the resting cardiac output through

the renal arteries, a large portion of total blood volume is filtered through the

renal corpuscle each day. At this rate, it wouldn’t take long to totally deplete

the body’s entire blood volume. Since this is obviously not a common

problem, the body must have some way to recover a majority of that filtered

blood. The process that returns necessary items from the filtrate back into

the blood is called reabsorption.

Reabsorption is responsible for returning 99% of filtrate back to the

circulatory system. Reduced nephron sensitivity which occurs with age,

however, results in less reabsorption of water, so urination becomes more

frequent while daily fluid requirements increase. At the same time, there is

usually a loss of thirst which compounds the problem. The muscles that help

regulate the release of urine become weaker which leads to problems with

incontinence and often involves slow leakage of urine. This is usually a more

common problem in women. In males, urinary retention might develop due

to chronic inflammation of the prostate gland. Swelling of the gland prevents

the flow of urine as it puts pressure on the urethra.

Maintaining Water-Salt Balance


It is the job of the kidneys to maintain the water-salt balance of the blood.

They also maintain blood volume as well as blood pressure. Simple examples

of ways that this balance can be changed include ingestion of water,

dehydration, blood loss and salt ingestion.

Reabsorption of water

Direct control of water excretion in the kidneys is exercised by the anti-

diuretic hormone (ADH), released by the posterior lobe of the pituitary gland.

ADH causes the insertion of water channels into the membranes of cells

lining the collecting ducts, allowing water reabsorption to occur. Without

ADH, little water is reabsorbed in the collecting ducts and dilute urine is

excreted. There are several factors that influence the secretion of ADH. The

first of these happen when the blood plasma gets too concentrated. When

this occurs, special receptors in the hypothalamus release ADH. When blood

pressure falls, stretch receptors in the aorta and carotid arteries stimulate

ADH secretion to increase volume of the blood.

Reabsorption of Salt

The Kidneys also regulate the salt balance in the blood by controlling the

excretion and the reabsorption of various ions. As noted above, ADH plays a

role in increasing water reabsorption in the kidneys, thus helping to dilute

bodily fluids. The kidneys also have a regulated mechanism for reabsorbing

sodium in the distal nephron. This mechanism is controlled by aldosterone, a

steroid hormone produced by the adrenal cortex. Aldosterone promotes the


excretion of potassium ions and the reabsorption of sodium ions. The release

of Aldosterone is initiated by the kidneys. The juxtaglomerular apparatus is a

renal structure consisting of the macula densa, mesangial cells, and

juxtaglomerular cells. Juxtaglomerular cells (JG cells, also known as granular

cells) are the site of renin secretion. Renin is an enzyme that converts

angiotensinogen (a large plasma protein produced by the liver) into

Angiotensin I and eventually into Angiotensin II which stimulates the adrenal

cortex to produce aldosterone. The reabsorption of sodium ions is followed

by the reapsorption of water. This causes blood pressure as well as blood

volume to increase.

Atrial natriuretic hormone (ANH) is released by the atria of the heart when

cardiac cells are streatched due to increased blood volume. ANH inhibits the

secretion of renin by the juxtaglomerular apparatus and the secretion of the

aldosterone by the adrenal cortex. This promotes the excretion of sodium.

When sodium is excreted so is water. This causes blood pressure and volume

to decrease.

Stress urinary incontinence (SUI), also known as effort incontinence, is due

essentially to insufficient strength of the pelvic floor muscles. It is the loss of

small amounts of urine associated with coughing, laughing, sneezing,

exercising or other movements that increase intra-abdominal pressure and

thus increase pressure on the bladder. The urethra is supported by fascia of


the pelvic floor. If this support is insufficient, the urethra can move

downward at times of increased abdominal pressure, allowing urine to pass.

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Above 170 bpm, your thinking is reduced to the primitive fight or flight

response. Running (or charging) is at its peak performance. The vast

majority of people also tend to lose control of their bladder and bowels at

this stage because even those functions consume resources that the body

prefers to save for fighting or running.