URINARY SYSTEM

BY EKA BEBASARI
 Materi
• Fungsi ginjal dalam homeostasis
• Struktur ginjal
• Pembentukan urin dan faktor-faktor yang
mempengaruhinya
 INTRODUCTION
• The urinary system consist of:
 kidneys (renes)
 Ureters
 urinary bladder (vesica urinaria)
 urethra
Urinary system and homeostasis
Maintain water and
electrolytes balances

Remove toxic wastes

products

Endocrin and
metabolic function
Blood supply of kidneys
 Nerve Supply of Kidneys
• Many renal nerves originate in renal ganglion
and pass through renal plexus into kidneys
along with renal arteries
• Renal nerves -> part of sympathetic division of
autonomic nervous system
• Most are vasomotor nerves that regulate flow
of blood through kidney by causing
vasodilation or vasoconstriction of renal
arterioles
Nephron Parts of a Nephron
• Nephrons : functional
units of kidneys
• Consists of two parts :
• Renal corpuscle
– where blood
plasma is filtered
• Renal tubule
– into which the
filtered fluid passes
• Renal corpuscle
– where blood
plasma is filtered
– glomerulus
(capillary network)
– glomerular
(Bowman’s)
capsule, a double-
walled epithelial
cup that surrounds
glomerular
capillaries
• Blood plasma is filtered
in glomerular capsule
• filtered fluid passes into
renal tubule, which has 3
main sections
– proximal convoluted
tubule
– loop of Henle
(nephron loop)
– distal convoluted
tubule
 JUXTAMEDULLARY NEPHRON
CORTICAL NEPHRON (80-85%) (15-20%)
Histology of nephron
GLOMERULAR CAPSULE
(Bowman’s) capsule

• Visceral layer
– modified simple squamous
epithelial cells (podocytes)
• Parietal layers
– simple squamous
epithelium, forms outer
wall of capsule
• Fluid filtered from
glomerular capillaries
enters capsular
(Bowman’s) space, space
between two layers of
glomerular capsule
In each nephron, final part of ascending limb of loop
of Henle makes contact with afferent arteriole
columnar tubule cells in this region are crowded
together, known as macula densa

Alongside macula densa, wall of afferent arteriole

(and sometimes efferent arteriole) contains modified
smooth muscle fibers called juxtaglomerular (JG)
cells
• Together with macula densa, constitute juxtaglomerular
apparatus (JGA)
• JGA helps regulate blood pressure within kidneys
RENAL TUBULE AND COLLECTING
DUCT
• Number of nephrons is constant from birth
• Increase in kidney size is due solely to growth of
individual nephrons
• If nephrons are injured or become diseased, new
ones do not form
• Signs of kidney dysfunction usually do not become
apparent until function declines to less than 25% of
normal because remaining functional nephrons
adapt to handle a larger-than normal load
– Eg Surgical removal of one kidney, stimulates
hypertrophy (enlargement) of remaining kidney,
which eventually is able to filter blood at 80% of
rate of two normal kidneys
RENAL PHYSIOLOGY
• Glomerular filtration
• Tubular reabsorption
• Tubular secretion
 Glomerular filtration
• Daily volume of glomerular filtrate in
adults is 150 liters in females and 180
liters in males
• More than 99% of glomerular filtrate
returns to bloodstream via tubular
reabsorption, so only 1–2 liters are
excreted as urine
 Filtration membrane

Loss of Plasma Proteins in Urine Causes Edema

Net Filtration Pressure
 Glomerular Filtration Rate
• Amount of filtrate formed in all renal corpuscles of
both kidneys each minute
• Averages : 125 mL/min in males and 105 mL/min in
females
• Regulation of GFR
– Autoregulation
– Neural regulation
– Hormonal regulation
 Renal Autoregulation of GFR
• Myogenic mechanism
–  blood pressure stretches walls of afferent
arterioles  smooth muscle fibers in wall of the
afferent arteriole contract  narrows arteriole’s
lumen  renal blood flow decreases  reducing
GFR to previous level
• Tubuloglomerular feedback
Tubuloglomerular feedback
 Neural Regulation of GFR
• sympathetic ANS fibers : Norepinephrine
• Vasoconstriction, activation of α1 receptors, plentiful in
smooth muscle fibers of afferent arterioles
• At rest, sympathetic stimulation is moderately low, both
afferent and efferent arterioles constrict to the same
degree. Blood flow into and out of the glomerulus is
restricted to the same extent, which decreases GFR only
slightly
• With greater sympathetic stimulation, however, as
occurs during exercise or hemorrhage, vasoconstriction
of the afferent arterioles predominates
 Hormonal Regulation of GFR
• Angiotensin II reduces GFR
– very potent vasoconstrictor that narrows both
afferent and efferent arterioles and reduces renal
blood flow -> GFR 
• Atrial natriuretic peptide (ANP) increases GFR
– Secrete by cells in atria of the heart
– causing relaxation of the glomerular mesangial
cells -> increases capillary surface area available
for filtration -> GFR 
 TUBULAR REABSORPTION
• Reabsorption : return of most of filtered water and
many of filtered solutes to bloodstream
– Normally, about 99% of filtered water is
reabsorbed
• Proximal convoluted tubule cells make largest
contribution
• Solutes reabsorbed by both active and passive
processes include glucose, amino acids, urea, and
ions [Na (sodium), K (potassium), Ca2 (calcium), Cl
(chloride), HCO3 (bicarbonate), and HPO4 2
(phosphate)]
 TUBULAR SECRETION
• Transfer of materials from blood and tubule cells into tubular fluid
• Secreted substances include hydrogen ions (H), K, ammonium ions
(NH4), creatinine, and certain drugs such as penicillin
• Important outcomes:
– secretion of H helps control blood pH
– secretion of other substances helps eliminate them from body
• Certain substances pass from blood into urine and may be detected
by urinalysis
– important to test athletes for drugs such as anabolic steroids,
plasma expanders, erythropoietin, hCG, and amphetamines
– also used to detect presence of alcohol or illegal drugs eg
marijuana, cocaine, and heroin
Reabsorption routes:
• Paracellular reabsorption
– water and solutes in
tubular fluid return to
bloodstream by moving
between tubule cells
• Transcellular reabsorption
– solutes and water in
tubular fluid return to
bloodstream by passing
through a tubule cell
• Reabsorption of glucose
by Na-glucose symporters
in cells of the proximal
convoluted tubule (PCT)
• Normally, all filtered
glucose is reabsorbed in
the PCT
 Actions of Na/H antiporters in
proximal convoluted tubule cells
• Reabsorption of sodium
ions (Na) and secretion of
hydrogen ions (H) via
secondary active
transport through apical
membrane
• Reabsorption of
bicarbonate ions (HCO3)
via facilitated diffusion
through basolateral
membrane
• Na/H antiporters promote
transcellular reabsorption
of Na and secretion of H
• Passive reabsorption of
Cl, K, Ca2, Mg2, urea,
and water in the
second half of proximal
convoluted tubule
• Electrochemical
gradients promote
passive reabsorption of
solutes via both
paracellular and
transcellular routes
• Na–K–2Cl symporter in
thick ascending limb of
loop of Henle
• Cells in thick ascending
limb have symporters
that simultaneously
reabsorb one Na, one
K, and two Cl
• Reabsorption of Na and
secretion of K by
principal cells in last
part of distal convoluted
tubule and in collecting
duct
• In apical membrane of
principal cells, Na
leakage channels allow
entry of Na while K
leakage channels allow
exit of K into the tubular
fluid
Hormonal Regulation of Tubular Reabsorption
and Tubular Secretion
Renin–Angiotensin–Aldosterone System

Antidiuretic Hormone

Atrial Natriuretic Peptide

• inhibit reabsorption of Na & water in proximal convoluted tubule

and collecting duct
• suppresses the secretion of aldosterone and ADH

Parathyroid Hormone

• stimulates cells in early distal convoluted tubules to reabsorb

more Ca2 into blood
• inhibits phosphate reabsorption in proximal convoluted tubules,
promoting phosphate excretion
Renin–Angiotensin–Aldosterone
System
 Antidiuretic Hormone/Vasopressin
• Stimulates insertion of vesicles containing aquaporin
(water channel protein) into apical membranes via
exocytosis  water permeability of principal cell’s
apical membrane (distal convoluted tubule and
throughout collecting duct) increases  water
molecules move more rapidly from tubular fluid into
cells  then move rapidly into blood
• Kidneys can produce as little as 400–500 mL of very
concentrated urine/day when ADH concentration is
maximal (eg during severe dehydration)
• When ADH level declines, aquaporin channels are
removed from apical membrane via endocytosis,
kidneys produce a large volume of dilute urine
• When osmolarity or osmotic
pressure of plasma and interstitial
fluid /water concentration , by
as little as 1%, osmoreceptors in
hypothalamus detect the change
–  in blood volume, as occurs in
hemorrhaging or severe
dehydration
• nerve impulses stimulate secretion
of more ADH into blood, and
principal cells become more
permeable to water
• water reabsorption , plasma
osmolarity  to normal
• absence of ADH -> diabetes
insipidus
– excrete up to 20 liters of very
dilute urine daily
Formation of Dilute Urine
• Heavy brown lines ->
impermeability to water
• heavy blue lines ->
impermeable to water in
absence of ADH
• light blue areas around
nephron -> interstitial
fluid
• When ADH is absent, the
osmolarity of urine can
be as low as 65
mOsm/liter
– When ADH level is low,
urine is dilute and has an
osmolarity less than the
osmolarity of blood
 Formation of Concentrated Urine
• When water intake is low or water loss is high (such
as during heavy sweating) kidneys must conserve
water while still eliminating wastes and excess ions
• Under influence of ADH, kidneys produce a small
volume of highly concentrated urine
• Urine can be four times more concentrated (up to
1200 mOsm/liter) than blood plasma or glomerular
filtrate (300 mOsm/liter)
• ability of ADH to cause excretion of concentrated
urine depends on presence of osmotic gradient of
solutes in interstitial fluid of renal medulla
• solute concentration of interstitial fluid in kidney
increases from about 300 mOsm/liter in renal cortex
to about 1200 mOsm/liter deep in renal medulla
• 3 major solutes that contribute to this high osmolarity
: Na, Cl, urea
• 2 main factors contribute to building and maintaining
this osmotic gradient:
– (1) differences in solute and water permeability and
reabsorption in different sections of long loops of Henle
and collecting ducts
– (2) countercurrent flow of fluid through tube-shaped
structures in the renal medulla
• Countercurrent flow : flow of fluid in opposite
directions
• This occurs when fluid flowing in one tube runs
counter (opposite) to fluid flowing in a nearby
parallel tube
• Examples of countercurrent flow
– flow of tubular fluid through descending and
ascending limbs of loop of Henle
– flow of blood through ascending and descending
parts of vasa recta
Countercurrent mechanism
 Countercurrent Multiplication
• process by which a progressively increasing osmotic
gradient is formed in interstitial fluid of renal medulla
as a result of countercurrent flow
• descending limb of loop of Henle carries tubular fluid
from renal cortex deep into medulla, and ascending
limb carries it in opposite direction
• Since countercurrent flow through descending and
ascending limbs of long loop of Henle establishes
osmotic gradient in renal medulla, long loop of Henle is
said to function as a countercurrent multiplier
• kidneys use this osmotic gradient to excrete
concentrated urine
 Countercurrent Exchange
• Process by which solutes and water are passively
exchanged between blood of vasa recta and
interstitial fluid of renal medulla as a result of
countercurrent flow
• long loop of Henle establishes the osmotic gradient
in the renal medulla by countercurrent
multiplication, but the vasa recta maintains the
osmotic gradient in the renal medulla by
countercurrent exchange.
 Renal plasma clearance
• volume of blood that is “cleaned” or cleared of a
substance per unit of time, usually expressed in
units of milliliters per minute
• High renal plasma clearance indicates efficient
excretion of a substance in the urine
• low clearance indicates inefficient excretion.
• For example, the clearance of glucose normally is
zero because it is completely reabsorbed,
therefore, glucose is not excreted at all.
• Knowing a drug’s clearance is essential for
determining the correct dosage
 Plasma clearance
• Inulin
• Glucosa
• Creatinin
• Urea
• PAH
THANK YOU