THE

URINARY
SYSTEM
Cefer S. Sales,
MD

Urinary System

Kidneys
Ureters
UB
Urethra

Functions

Formation of urine
Urine elimination
Excretion of waste products

REGULATION OF BLOOD VOLUME

ELECTROLYTES
ACID-BASE BALANCE
TISSUE FLUID

KIDNEYS

Location : retroperitoneal

Renal fascia : covering

Hilus : medial indentation
Cushion : fat tissue

Internal Structure

Renal cortex
Renal medulla

Renal pyramids

Renal pelvis

Calyx/calyces

The Nephron
Structural and functional unit of the kidney

Renal corpusle
Glomerulus
Bowmans capsule

Renal tubule
Proximal convoluted tubule
Loop of Henle
Distal convoluted tubule
Collecting tubule papillary duct calyx of renal pelvis

Blood Vessels of the Kidney

abdominal aortarenal arterysmaller
arteriesafferent arteriolesglomeruli
(capillaries)efferent arteriolesperitubular
capillariessmaller veins renal vein IVC

Two Sets of Capillaries : sites of exchange

URINE FORMATION
Glomerular Filtration

Renal corpuscles
From glomerulus to Bowmans capsule
High BP in the glomerulus forces plasma, dissolved
materials and small proteins out of the blood and into
Bowmans capsule
Filtrate
Filtration is only selective to size
Blood cells and large proteins remain in the blood

Glomerular Filtration Rate

(GFR)

100-125ml/min

inc. blood flow inc. GFR

dec. blood flow dec. GFR

Tubular Reabsorption

Renal tubules
From filtrate in the renal tubule to the blood in the
peritubular capillaries
99% filtrate reabsorbed
1% becomes urine

Transport Mechanisms and Substances

Involved:

Active transport

Passive transport

most negative ions follow positive ions

Osmosis

glucose, amino acids, vitamins, positive ions

threshold level

water follows absorption of minerals ex. Na

Pinocytosis

small proteins engulfed by proximal tubule cells

Tubular Secretion

Renal tubules
From the blood in the peritubular capillaries to the
filtrate in the renal tubule
Creatinine and other waste urine

HORMONES THAT INFLUENCE

REABSORPTION OF WATER

Aldosterone

ANP

Atria

ADH

Adrenal cortex

Posterior pituitary

PTH

Parathyroid glands

KIDNEYS and ACID-BASE

BALANCE

Kidneys have the greatest capacity to

compensate for normal and abnormal pH
changes
Too acidic body fluids

excrete H+ ions into filtrate

return HCO3- ions to the blood

Too alkaline body fluids

return H+ ions to the blood

excrete HCO3- ions to the filtrate

OTHER KIDNEY
FUNCTIONS

Renin Angiotensin System

Juxtaglomerular cells RENIN

Angiotensin II potent vasoconstrictor

Erythropoietin secretion

Response to hypoxia
Stimulation of the red bone marrow to increase
rate of RBC production

Vitamin D activation

Conversion of inactive to active form (calcitriol)

Increase absorption of calcium and phosphate in small

intestine

ELIMINATION OF URINE
URETERS

Retroperitoneal from the hilus to lower posterior

side of UB
Peristalsis of smooth muscle propels urine
toward UB
Filled bladder compresses lower ends of ureters
to prevent backflow

URINARY BLADDER

Below peritoneum
Behind pubis bones

Mucosa

no rugae, does not expand, bounded by openings of ureters

and urethra

Detrusor smooth muscle

transitional epithelium folded into rugae, expands

Trigone : triangular area of the floor

Female : below the uterus

Male : above the prostate gland

contracts to expel urine

Internal urethral sphincter

involuntary, formed by detrusor around the opening of the

urethra

URETHRA

takes urine from the bladder to the exterior

Female : 1-1.5 inches long, anterior to vagina
Male : 7-8 inches long, passes through the prostate gland
and penis
Parts of the Urinary Bladder (Male)

Prostatic urethra
surrounded by the prostate gland
Membranous urethra
surrounded by external urethral sphincter
voluntary, made up of skeletal muscle
Cavernous urethra
spongy/penile
longest

URINATION REFLEX

Stimulus : stretching of the detrusor muscle

by accumulating urine
>800ml urine : maximum
200-400ml : causes sufficient stretching

sensory impulses sacral spinal cordmotor impulses

(parasympathetic) detrusor muscle contraction internal
sphincter relaxes external sphincter relaxes (voluntary
control)

CHARACTERISTICS OF
URINE

Amount
Color
Specific Gravity
pH
Constituents
Nitrogenous Wastes

READ

Renal Failure
Hemodialysis
Kidney Stones
UTI
Blood Tests and Kidney Function

Fluid - Electrolytes and

Acid-Base
Balance

Water : 55-75%
Electrolytes : ions in body fluids, mostly
minerals
Water Compartments :

ICF
ECF

Water Intake

Water Output

Fluids
Foods
Metabolic water
Urine
Sweat
Exhaled air
Feces

See Fig. 19-2

Regulation of Water Intake and

Output

Hypothalamus : osmoreceptors
Dehydration : thirst
ADH : increase water reabsorption
Aldosterone : increase reabsorption of Na+
ions and water
ANP : loss of Na+ ions and water

ELECTROLYTES

Chemicals that dissolve in water and dissociate into ions

mostly organic
cations
: positive, Na+ & K+
anions
: negative, Cl- & HCO3Electrolytes in Body Fluids
ICF
: K+, HPO4-2, protein anions abundant
Plasma
: Na+, Cl-, protein anions significant
Tissue fluid
: same as plasma, protein anions
insignificant

ACID BASE BALANCE

Normal pH ranges

Blood : 7.35-7.45
ICF : 6.8-7.0
Tissue fluid : as in blood

Normal pH maintained by :

Buffer systems
Respirations
Kidneys

BUFFER SYSTEMS

Weak acid and a weak base

React with strong acids and bases to change
them to substances that do not greatly affect
pH
Reaction is fast
Least capacity to prevent pH changes

Bicarbonate buffer system

Phosphate buffer system
Protein buffer system

RESPIRATORY MECHANISMS

Regulates amount of CO2 in body fluids

May be a cause or help correct pH imbalance from
some other cause

Respiratory Acidosis

Due to decreased rate or efficiency of respiration

Respiratory Alkalosis

Far less common

Due to more rapid breathing

RESPIRATORY COMPENSATION
for METABOLIC pH CHANGES

Changes in pH caused by other than respiratory disorder

metabolic imbalance

Metabolic Acidosis

Respiratory system prevent the drastic change

DM, diarrhea/vomiting

Metabolic Alkalosis

not common, overuse of antacid medications

vomiting of stomach contents only

RENAL MECHANISM

greatest capacity to buffer pH changes

take several hours to days to be effective

Acidosis

K excrete H+ ions and retain Na+ ions and HC03- ions

Alkalosis

K retain H+ ions and excrete Na+ ions and HC03 ions