Шээсний эрхтэн - Urinary system

The urinary system consists of the paired kidneys and ureters, the bladder, and the urethra. This
system’s primary role is to ensure optimal properties of the blood, which the kidneys continuously
monitor. This general role of the kidneys involves a complex combination of renal functions:

Regulation of the balance between water and electrolytes (inorganic ions) and the acid-base balance;

Excretion of metabolic wastes along with excess water and electrolytes in urine, the kidneys’ excretory
product which passes through the ureters for temporary storage in the bladder before its release to the
exterior by the urethra;

Excretion of many bioactive substances, including many drugs;

Secretion of renin, a protease important for regulation of blood pressure by cleaving circulating
angiotensinogen to angiotensin I;

Secretion of erythropoietin, a glycoprotein growth factor that stimulates erythrocyte production in red
marrow when the blood O2 level is low;

Conversion of the steroid prohormone vitamin D, initially produced in the skin, to the active form (1,25-
dihydroxyvitamin D3 or calcitriol); and

Gluconeogenesis during starvation or periods of prolonged fasting, making glucose from amino acids to
supplement this process in the liver.

Kidney

Each kidney has a thick outer cortex, surrounding a medulla that is divided into 8-12 renal pyramids;
each pyramid and its associated cortical tissue comprises a renal lobe.

The apical papilla of each renal pyramid inserts into a minor calyx,a subdivision of two or three major
calyces extending from the renal pelvis.

The ureter carries urine from the renal pelvis and exits the renal hilum, where the renal artery and vein
are also located.

Renal Vasculature

Renal arteries branch to form smaller arteries between the renal lobes, with interlobular arteries
entering the cortex to form the microvasculature; venous branches parallel the arterial supply.

In the cortex afferent arterioles enter capillary clusters called glomeruli, which are drained by efferent
arterioles, instead of venules, an arrangement that allows higher hydrostatic pressure in the capillaries.

The efferent arterioles from cortical glomeruli branch diffusely as peritubular capillaries, while those
from juxtamedullary glomeruli branch as long microvascular loops called vasa recta in the medulla

Nephrons

Functional units of the kidney are the nephrons, numbering about 1 million, each with a renal corpuscle
and a long renal tubule, and a system of collecting ducts.
 The renal corpuscle has a simple squamous parietal layer of the glomerular (Bowman) capsule,
continuous with the proximal tubule, and a specialized visceral layer of podocytes surrounding the
glomerular capillaries.

Podocytes extend large primary processes that curve around a capillary and extend short,
interdigitating secondary processes or pedicels, between which are narrow spaces called slit pores.

The elevated pressure in the capillaries forces water and small solutes of blood plasma through the
glomerular filter into the capsular (or urinary) space inside the glomerular capsule.

In each glomerulus the filter has three parts: the finely fenestrated capillary endothelium; the thick (330
nm) fused basal laminae of type IV collagen and other proteins produced by the endothelial cells and
podocytes; and the slit pores between the pedicels, covered by thin filtration slit diaphragms.

From the renal corpuscle, filtrate enters the long nephron tubule that extends through both the cortex
and medulla, with epithelial cells for both reabsorption and secretion of substances into the filtrate.

The first tubular part, the proximal convoluted tubule (PCT), is mainly cortical, has simple cuboidal cells
with long microvilli in the lumen, abundant mitochondria, and large, interdigitating basolateral folds.

In the PCT, all glucose and other organic nutrients, all small proteins and peptides (which are degraded
to amino acids), and much water and electrolytes are reabsorbed from the filtrate and transferred to the
peritubular capillaries.

From the PCT filtrate flows into the loop of Henle, located in the medulla, which has squamous thin
descending and ascending limbs; the latter extends as a thick ascending limb (TAL) back into the cortex.

In the cortex the TAL (also known as the distal straight tubule) contacts the arterioles at the vascular
pole of its parent renal corpuscle and there thickens focally as the macula densa.

Tall epithelial cells of the macula densa and specialized smooth muscle cells in the adjacent afferent
arteriole called juxtaglomerular cells, which secrete renin, comprise a juxtaglomerular apparatus (JGA)
that is an important regulator of blood pressure.

Beyond the macula densa, the tubule continues as the distal convoluted tubule (DCT), where electrolyte
levels of the filtrate are adjusted further and which lead to short connecting tubules.

Connecting tubules from several nephrons join to form the cortical collecting ducts, of simple cuboidal
epithelium, which enter the medulla in parallel with the loops of Henle and vasa recta and become
larger with more columnar cells.

Urinary Tract

Principal cells of the collecting ducts are pale-staining, with relatively few mitochondria and distinct cell
membranes that are rich in aquaporins (water channels) for passive water reabsorption.

The largest collecting ducts deliver filtrate into the minor calyces, where it undergoes no further
modification and is called urine.

The calyces, renal pelvis, ureters, and urinary bladder are lined by urothelium, or transitional
epithelium, which protects underlying cells from hypertonic, potentially toxic effects of urine.
 Large, bulbous superficial cells of the urothelium, called umbrella cells, have apical membranes
consisting of hinged regions with dense plaques of uroplakin proteins that protect the cytoplasm.

As the urinary bladder fills its highly folded mucosa unfolds, the urothelium gets somewhat thinner by
cell movements, and the hinged membrane plaques of umbrella cells partially unfold.

The urethra drains the bladder and in both genders is lined initially by urothelium, followed (in males)
by alternating stratified columnar and pseudostratified columnar epithelium and distally by stratified
squamous epithelium.

In males the urethra has three regions: the prostatic urethra in the prostate gland; the short
membranous urethra passing through the urogenital diaphragm, and the long penile urethra.