LECTURE 13

KIDNEY AND URINARY SYSTEM Ali Hussein

The renal arteries arise from the abdominal aorta and supply the kidneys
with blood for filtration. One or more renal veins drain each kidney to the
inferior vena cava. The total blood volume circulated through the kidneys is
approximately 300 times a day. The Urine produced in the kidneys is conducted
by the two ureters to the bladder where it is stored until voided via the urethra.
The hilum is the site of entry and exit of the renal blood vessels and ureter. The
renal papillae are multiple medullary loves called pyramids, which are
surrounded by an extension of the renal pelvis called the calyx. The renal
cortex is composed of the fused cortical parts of the lobes sending down
between adjacent medullary lobes. Arcuate (bow-shaped) vessels and
Interlobular (between lobes) vessels supply each nephron with a rich blood
supply. The whole kidney is invested by a tough fibrous capsule, which is
further surrounded by a thick layer of fat to protect each kidney against
trauma.
The nephron is the functional unit of the kidney, consisting of the
RENAL CORPUSCLE, where plasma filtration occurs, and the RENAL
TUBULES, where reabsorption occurs. The wide afferent enters the
BOWMAN’S CAPSULE of the renal corpuscle at the vascular pole and
branches to form a network of capillaries, known as the GLOMERULUS.
The efferent arteriole is smaller in diameter and therefore maintains the
pressure gradient that drives the filtration of blood. The renal tubules make
up the vast bulk of the parenchyma between the corpuscles, and differ in
shape and internal diameter of the tubules.
The plasma filtrate from the glomerular capillaries passes through
3 layers before entering the renal tubules:
The plasma must first pass through the FENSTRATED
CAPILLARIES ENDOTHELUM, which allows anything smaller than an
erythrocyte to pass through the fenestrae. Due of this, the endothelial cells
lining the glomerulus are not usually considered part of the renal filtration
barrier.
The plasma must then pass through the GLOMERULAR
BASEMENT MEMBRANE, a 300nm thick membrane with a
composition of collagen type IV fibres, laminin and proteoglycans rich in
heparin sulphate. The negatively charged basement membrane repels
negatively charged proteins in the blood.
The plasma must further pass through PODOCYTES, flat cells with
primary and secondary processes/pedicels that resemble octopus tentacles,
which cover the endothelium. Each podocyte has several long primary
pedicels that can cover more than one capillary. Secondary pedicels are
latter extensions of these primary pedicels, and these inter-digitations give
rise to regularly spaces filtrations slits 25nm wide, where filtrated plasma
passes through.
Nephrons develop when blind-ending tubules dilate and are
invaginated as they become associated with mesoderm tissue.
These blind-end tubules lined with simple cuboidal epithelium will
develop into the Bowman’s capsule, while the mesoderm tissue will
develop into the glomerulus. The layer of invaginated epithelium
flattens and differentiates into podocytes, while the basal lamina of the glomerular endothelium and
podoyctes fuse to form the glomerular basement membrane. The remaining tissue forms mesangium.
The filtrate passes from the bowman’s capsule to the renal tubule, which is split into many
segments of varying length, structure and, consequently, function:
The PROXIMAL CONVULUTED TUBULE is the longest part of the renal
tubule, where approximated 75% of filtrate is reabsorbed. The simple tall columnar
epithelium has a large brush border of microvilli that increases the surface area for
reabsorption. A high number of mitochondria is present, indicative of the high ATP
requirement for reabsorption. Once filtrate passes across the apical surface of these
cells, it passes through the basolateral membrane to many capillaries, which arise
from the efferent arteriole.
The LOOP OF HENLE arises in the cortex and dips to the medulla and returns
to the cortex once more. The tubule is thin wall until it becomes thick walled during
ascent. A series of straight capillaries, known as Vasa Recta, descend from the
cortex with Loop of Henle, allowing reabsorption to take place.
The DISTAL CONVULUTED TUBULE is found within the cortex and is
involved in the reabsorption of sodium ions from tubule lumen. Its simple cuboidal
epithelium also contains many mitochondria, but a brush border is
absent. The distal convoluted tubule is under Aldosterone control.
The JUXTAGLOMERULAR APPARATUS is a specialisation of
the afferent arteriole and the distal convoluted tubule of the same
nephron, allowing the regulation of blood pressure via the Renin-
Angiotensin system. An area of large closed packed epithelial lining
cells of the Distal Convoluted Tubule, known as the MACULA
DENSA, associate with specialised smooth muscle cells on the
Afferent Arteriole wall, known as JUXTAGLOMERULAR CELLS.
These juxtaglomerular cells are the cells that contain the renin. Other specialised cells include LACIS
CELLS, important in Erythropoietin synthesis and secretion.
A fall in systemic blood pressure is sensed by juxtaglomerular cells and triggers the release of renin
into the circulation. Reduced filtration lowers the concentration of sodium ion in the Distal Convoluted
Tubule and this low Na+ concentration triggers renin secretion. The renin in the bloodstream catalysed
the conversion of Angiotensinogen to Angiotensin I, and the ACE enzyme further catalyses the
conversion of Angiotensin I to Angiotensin II. Angiotensin II is a
potent vasoconstrictor and constricts the blood vessels and promotes
the release of Aldosterone from the adrenal cortex.
The COLLECTING TUBULES are extensions of the Distal
Convoluted Tubule, with several collecting tubules from several
nephrons converging to form one COLLECTING DUCT. These
collecting ducts descend as medullary rays towards the renal medulla,
merging into larger ducts, known as the DUCTS OF BELLINI. These
ducts and tubules are under the control of anti-diuretic hormone
(ADH), causing the reabsorprtion of water into the medullary
interstitium, a tissue surrounding the loop of Henle in the renal
medulla.
The Ducts of Bellini converge and drain the filtrated urine down
towards the RENAL PAPILLA, where it flows into the RENAL
PELVIS, also known as the PELVICALCEAL SPACE. These spaces
are typically lined with urinary transition epithelium, with smooth
muscle wall found in the walls. Once in the renal pelvis, the urine
drains into the ureters.
 The two URETERS are basically two muscular tubes that conduct urine from the kidneys in the
abdomen to the bladder in the pelvic floor. The muscular walls consist of an inner layer of longitudinal
smooth muscle and an outer layer of circular smooth muscle, which convey the urine via peristaltic
action. The lumen of the ureter is lined by transitional epithelium with a lamina propria rich in collagen.
The adventitia of the ureters contains arteries and veins, which provide the rich blood, supply.
The BLADDER is the hollow, muscular, and distensible organ that collects the urine from the ureter.
The wall of the bladder consists of elastic fibres and three layers of smooth muscle; an innermost layer
of longitudinal smooth muscle, an outer layer of circular muscle and an outermost layer of longitudinal
smooth muscle. The adventitia contains arteries, veins and lymphatics.
This transitional epithelium, found in the renal pelvis, ureters and bladder, is only found in the
conducting passages of the urinary system, and has adapted well to the environment. The transitional
epithelium is stratified, forming a number of layers that are at their greatest when the epithelium is not
expanded, and squamous only when expanded. The epithelial cells superficial cytoplasm stains
heavenly, but are indistinct from other transitional epithelium. Much folding and formation of deep
clefts of fusiform vesicles renders the transitional epithelium impermeable to the toxic urine. The lamina
propria of transitional epithelium contains capillaries.