Urinary tract physiology

Suyasning HI phastiko@yahoo.com

Composition of the Urinary System

Out line
1) Urine Formation 2) Urine Storage and Elimination

The Nephron

glomerulus
efferent arteriole
blood

proximal convoluted tubule

distal convoluted tubule

blood

afferent arteriole

Loop of Henle

URINE FORMATION

The kidney produces urine through 4 steps.

Glomerular Filtrate Tubular fluid

Urine

Blood cells in urine Plasma proteins

Glomerular Filtration Rate (GFR)

- is the amount of filtrate formed per minute by the two kidneys combined. - For the average adult male, GFR is about 125 ml/min. - This amounts to a rate of 180 L/day. - An average of 99% of the filtrate is reabsorbed, so that only 1-2 L of urine per day is excreted.

GFR must be precisely controlled.

a. If GFR is too high - increase in urine output - threat of dehydration and electrolyte depletion.

b. If GFR is too low - insufficient excretion of wastes.

c. The only way to adjust GFR from moment to moment is to change glomerular blood pressure.

Renal Autoregulation
- the ability of the kidneys to maintain a relatively stable GFR in spite of the changes (75 - 175 mmHg) in arterial blood pressure.

The nephron has two ways to prevent drastic changes in GFR when blood pressure rises: 1) Constriction of the afferent arteriole to reduce blood flow into the glomerulus 2) Dilation of the efferent arteriole to allow the blood to flow out more easily.

Change in an opposite direction if blood pressure falls

Mechanisms of Renal Autoregulation

1)
2)

myogenic response
tubuloglomerular feedback

1)

myogenic response

2)

tubuloglomerular feedback

1) Glomerular Filtration 2) Tubular Reabsorption 3) Tubular Secretion 4) Concentrating Urine by Collecting Duct

About 99% of Water and other useful small molecules in the filtrate are normally reabsorbed back into plasma by renal tubules.

Reabsorption in Proximal Convoluted Tubules

- The proximal convoluted tubule (PCT) is formed by one layer of epithelial cells with long apical microvilli.

- PCT reabsorbs about 65% of the glomerular filtrate and return it to the blood.

Routes of Proximal Tubular Reabsorption

1) transcellular route 2) paracellular route

PCT

peritubular capillary

Mechanisms of Proximal Tubular Reabsorption

1) Solvent drag 2) Active transport of sodium. 3) Secondary active transport of glucose, amino acids, and other nutrients. 4) Secondary water reabsorption via osmosis 5) Secondary ion reabsorption via electrostatic attraction 6) Endocytosis of large solutes

Osmosis
Water moves from a compartment of low osmolarity to the compartment of high osmolarity.

low osmolarity
( high H2O conc.)

H2O

high osmolarity
( low H2O conc.)

1) Solvent drag
Proteins stay - driven by high colloid osmotic pressure (COP) in the peritubular capillaries - Water is reabsorbed by osmosis and carries all other solutes along. - Both routes are involved. H2O

Proteins

2) Active transport of sodium

Sodium pumps (Na-K ATPase) in basolateral membranes transport sodium out of the cells against its concentration gradient using ATP.

Na+
K+ capillary PCT cell

Na+

Tubular lumen

There are also pumps for other ions

Ca++

Ca++

capillary

PCT cell

Tubular lumen

3) Secondary active transport of glucose, amino acids, and other nutrients

- Various cotransporters can carry both Na+ and other solutes. For example, the sodiumdependent glucose transporter (SDGT) can carry both Na+ and glucose.

Na+
K+ Na+

Glucose capillary PCT cell

3) Secondary active transport of glucose, amino acids, and other nutrients

Amino acids and many other nutrients are reabsorbed by their specific cotransporters with sodium.

Na+
K+ Na+

amino acids capillary PCT cell

4) Secondary water reabsorption via osmosis

Sodium reabsorption makes both intracellular and extracellular fluid hypertonic to the tubular fluid. Water follows sodium into the peritubular capillaries.

Na+

Na+

H2O
capillary

PCT cell

Tubular lumen

5) Secondary ion reabsorption via electrostatic attraction

Negative ions tend to follow the positive sodium ions by electrostatic attraction.

Na

Na+ Cl-

capillary

PCT cell

Tubular lumen

6) Endocytosis of large solutes

The glomerulus filters a small amount of protein from the blood. The PCT reclaims it by endocytosis, hydrolzes it to amino acids, and releases these to the ECF by facilitated diffusion.

amino acids

protein

capillary

PCT cell

Tubular lumen

The Transport Maximum - There is a limit to the amount of solute that the renal tubule can reabsorb because there are limited numbers of transport proteins in the plasma membranes. - If all the transporters are occupied as solute molecules pass through, some solute will remain in the tubular fluid and appear in the urine. Example of diabetes

Na+

Glucose

high glucose in blood

high glucose in filtrate

Exceeds Tm for glucose

Glucose in urine

Reabsorption in the Nephron Loop

- The primary purpose is to establish a high extracellular osmotic concentration.

- The thick ascending limb reabsorbs solutes but is impermeable to water. Thus, the tubular fluid becomes very diluted while extracellular fluid becomes very concentrated with solutes.

mOsm/L

The high osmolarity enables the collecting duct to concentrate the urine later.

Reabsorption in Distal Convoluted Tubules

- Fluid arriving in the DCT still contains about 20% of the water and 10% of the salts of the glomerular filtrate. - A distinguishing feature of these parts of the renal tubule is that they are subject to hormonal control.

Aldosterone a. secreted from adrenal gland in response to a Na+ or a K+ in blood b. to increase Na+ absorption and K+ secretion in the DCT and cortical portion of the collecting duct.

c. helps to maintain blood volume and pressure.

Atrial Natriuretic Factor - secreted by the atrial myocardium in response to high blood pressure. - It inhibits sodium and water reabsorption, increases the output of both in the urine, and thus reduces blood volume and pressure.

1) Glomerular Filtration 2) Tubular Reabsorption 3) Tubular Secretion 4) Concentrating Urine by Collecting Duct

Tubular Secretion
- Renal tubule extracts chemicals from the blood and secretes them into the tubular fluid. - serves the purposes of waste removal and acid-base balance.

H+

H+

capillary

PCT cell

Tubular lumen

1) Glomerular Filtration 2) Tubular Reabsorption 3) Tubular Secretion 4) Concentrating Urine by Collecting Duct

1. The collecting duct (CD) begins in the cortex, where it receives tubular fluid from numerous nephrons. 2. CD reabsorbs water.

Cortex

collecting duct

urine

1. Driving force
The high osmolarity of extracellular fluid generated by NaCl and urea, provides the driving force for water reabsorption.

Cortex medulla

2. Regulation
The medullary portion of the CD is not permeable to NaCl but permeable to water, depending on ADH.
mOsm/L

urine

Control of Urine Concentration depends on the body's state of hydration. a. In a state of full hydration, antidiuretic hormone (ADH) is not secreted and the CD permeability to water is low, leaving the water to be excreted. b. In a state of dehydration, ADH is secreted; the CD permeability to water increases. With the increased reabsorption of water by osmosis, the urine becomes more concentrated.

Cortex medulla

mOsm/L

urine

No more reabsorption after tubular fluid leaving CD

Cortex
medulla

urine urine

Urine Properties

Composition and Properties of Urine

Fresh urine is clear, containing no blood cells and little proteins. If cloudy, it could indicate the presence of bacteria, semen, blood, or menstrual fluid.

Substance Urea Uric acid Creatinine Potassium Chloride Sodium Protein

Blood Plasma (total amount) 4.8 g 0.15 g 0.03 g 0.5 g 10.7 g 9.7 g 200 g

Urine (amount per day) 25 g 0.8 g 1.6 g 2.0 g 6.3 g 4.6 g 0.1 g

HCO3Glucose

4.6 g 3g

0g 0g

Urine Volume
An average adult produces 1-2 L of urine per day.
a. Excessive urine output is called polyuria. b. Scanty urine output is oliguria. An output of less than 400 mL/day is insufficient to excrete toxic wastes.

Urine Storage and Elimination

The Ureters
The ureters are muscular tubes leading from the renal pelvis to the lower bladder.

Urine Movement
Hydrostatic pressure forces urine through nephron Peristalsis moves urine through ureters from region of renal pelvis to urinary bladder. Occur from once every few seconds to once every 2-3 minutes Parasympathetic stimulation: increase frequency Sympathetic stimulation: decrease frequency Ureters enter bladder obliquely through trigone. Pressure in bladder compresses ureter and prevents backflow

The Urinary Bladder

- is a muscular sac on the floor of the pelvic cavity. - is highly distensible and expands superiorly.

The openings of the two ureters and the urethra mark a triangular area called the trigone on the bladder floor.

The Urethra - conveys urine from the urinary bladder to the outside of the body.

Females 3-4 cm
greater risk of urinary tract infections

male ~18 cm

The male urethra has three regions: 1) prostatic urethra 2) membranous urethra 3) penile urethra.

Difficulty in voiding urine with enlarged prostate

In both sexes: - internal urethral sphincter- under involuntary control. - external urethral sphincter - under voluntary control

internal urethral sphincter

external urethral sphincter

Neural Control of Micturition

Micturition Reflex

Innervation of the Sympathetic nerve bladder Parasympathetic nerve

supply L1 L2 supply
S2 S3 S4

L3
Sympathetic chain Hypogastric ganglion Hypogastric nerve

Pelvic nerve

Somatic nerve supply S2

S3 S4 Urethra
Pudendal nerve

External sphincter

Sympathetic nerve supply and Internal urethral sphincter apparently play no role in micturition. They prevent reflux of semen into the bladder during ejaculation.

Parasympathetic nerve supply Sensory fibers in the pelvic nerve carry impulses from stretch receptors present on the wall of the urinary bladder to the spinal centre of micturition. Stimulation of parasympathetic efferent fibers causes contraction of detrusor muscle leading to emptying of urinary bladder.

Somatic nerve supply This maintains the tonic contractions of the skeletal muscle fibers of the external sphincter, so that this sphincter is contracted always. During micturition this nerve is inhibited, causing relaxation of the external sphincter and voiding of urine.

What is micturition?

Spinal cord reflex activity.

* facilitated or inhibited by higher centers * voluntary facilitation or inhibition

Voiding Urine in infants micturition reflex

When the bladder contains about 200 ml of urine, stretch receptors in the wall send impulses to the spinal cord. Parasympathetic signals return to stimulate contraction of the bladder and relaxation of the internal urethral sphincter.

Spinal cord

2. Once voluntary control has developed, emptying of the bladder Once voluntary control by has developed,center emptying ofpons. the This is controlled predominantly a micturition in the bladder is controlled by a micturition center this center receives signals predominantly from stretch receptors and integrates in the pons. This center signals from stretch information with cortical input receives concerning the appropriateness of receptors information cortical urinating at and the integrates moment. this It sends back with impulses toinput stimulate concerning appropriateness of urinating at the relaxation of the the external sphincter. moment. It sends back impulses to stimulate relaxation of the external sphincter.

Voiding Urine in adults

Voluntary control

Urine Volume
Normal volume - 1 to 2 L/day Polyuria > 2L/day Oliguria < 500 mL/day Anuria - 0 to 100 mL/day

ISTILAH-ISTILAH YANG BERHUBUNGAN DENGAN PRODUKSI DAN EKSRESI URIN.

UN-URIE OLIGOURIE POLYURIE DYSURIE POLAKISURIE INKONTINENSIA URINAE

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KELAINAN MIKSI
1. KK ATONIK AKIBAT KERUSA KAN SARAF SENSORIK. - KARENA BENTURAN PD KECELAKAAN
- TABES DORSALIS : KK TABETIK

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2. REFLEX BERKEMIH TERJADI, TETAPI TIDAK DIKENLIKAN OLEH OTAK

BEBERAPA HARI-MINGGU, REFLEX MIKSI TERTEKAN DISEBUT SYOK SPINAL. KATETERISASI TERUS DILAKUKAN, SUATU SAAT REFLEX MIKSI AKAN TIMBUL.

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3. OLEH KARENA HAMBATAN DARI OTAK TIDAK ADA, MIKSI MENJADI KESERINGAN

INI OLEH KARENA KERUSAKAN PARSIAL MED. SPINALIS/ BATANG OTAK YG MENGGANGGU SEMUA SINYAL PENGHAMBAT.

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Diuretics
Effects
urine output blood volume

Uses
hypertension and congestive heart failure

Mechanisms of action
GFR tubular reabsorption

SUMMARY
1) Urine Formation 2) Urine Storage and Elimination

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