Chapter 20 Urinary System

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Location of Kidneys is Retroperitoneally

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Kidney structure

Composed of 2 layers: Outer: cortex & Inner : medulla Lateral surface is convex, medial surface deeply concave Medial side leads into a renal sinus where the entrance is termed the hilum where blood vessels, nerves, lymphatics and the ureter enter/exit Superior end of the ureter expands to form a funnel shaped sac called the renal pelvis i) further subdivided into major calyces and further into minor calyces ii) renal papillae project into each minor calyx from the renal medulla The renal medulla is composed of conical masses called renal pyramids The renal cortex forms a shell around the medulla, its tissue dips into the medulla between the renal pyramids, forming the renal columns Cortex has its own protective covering called the capsule

Kidneys

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Renal Blood Vessels

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Functions of the Kidneys

Main function is to regulate the volume, composition and pH of body fluids Removes wastes which contain nitrogenous and sulfur containing products of protein metabolism Control the rate of RBC production via erythropoietin Regulates blood pressure by secreting renin Regulates absorption of calcium ions by activating Vitamin D

Renal Blood Vessels

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Renal Blood Vessels

Renal arteries supply the kidneys carry about 15 to 30% of the total cardiac output daily artery enters the kidney via the hilum and begins to branch into smaller branches called interlobar arteries which pass between the pyramids Become the arcuate arteries and then the interlobular arteries and eventually end as the afferent arterioles which will lead to the nephron, the functional unit of the kidney Blood will return to the IVC via the renal veins

The Nephron
Each kidney contains about 1 million functional nephrons (at birth) Each consists of a renal corpuscle and a renal tubule Each corpuscle consists of: i) a filtering unit called a glomerulus ii) a sac-like structure called a glomerular capsule (Bowmans) The afferent arteriole will give rise to the glomerular capillaries and blood will exit the apparatus via the efferent arteriole Filtration of fluid from the glomerular capillaries is the first step in urine formation Capsule composed of a single layer of squamous epithelium for quick filtering of filtrate Trailing from the capsule is a proximal convoluted tubule (PCT) then the loop of Henle then the (DCT) distal convoluted tubule and finally the collecting tubule : This is the pathway that urine exits the nephron and eventually leads to the renal pelvis

Glomerular Capsule

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Nephron and Associated Blood Vessels

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Renal Cortex and Renal Medulla

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Juxtaglomerular Apparatus

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The macula densa & Juxtaglomerular Apparatus

Near its origin, the DCT passes between the efferent and afferent arterioles by touching them At this point, the epithelial cells of the DCT are tall and tight- these comprise the macula densa
Means next to the glomerulus Composed of large vascular smooth muscle cells Together with the macula densa, this apparatus helps regulate the secretion of renin

Types of Nephrons

cortical nephrons 80% of nephrons juxtamedullary nephrons regulate water balance

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Blood Supply of Nephron

The capillary loop of the vasa recta is closely associated with the nephron loop of the juxtamedullary nephron

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Summary of Blood Flow Through Kidney and Nephron

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Urine Formation
Glomerular Filtration substances move from blood to glomerular capsule Tubular Reabsorption substances move from renal tubules into blood of peritubular capillaries glucose, water, urea, proteins, creatine amino, lactic, citric, and uric acids phosphate, sulfate, calcium, potassium, and sodium ions

Tubular Secretion substances move from blood of peritubular capillaries into renal tubules drugs and ions

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Glomerular Filtration
Glomerular filtrate passes through the fenestrae of the capillary endothelium

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Glomerular Filtration Rate

Net Filtration Pressure = force favoring filtration forces opposing filtration (glomerular capillary ( capsular hydrostatic pressure hydrostatic pressure) and glomerular capillary osmotic pressure )

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Tubular Reabsorption

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Effect of ADH on Renal Tubules

without ADH, DCT and collecting duct are impermeable to water with ADH, DCT and collecting duct become permeable to water with ADH, water is reabsorbed by osmosis into hypertonic medullary interstitial fluid

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Urea and Uric Acid Excretion

Urea product of amino acid catabolism plasma concentration reflects the amount or protein in diet enters renal tubules through glomerular filtration 50% reabsorbed rest is excreted
Uric Acid product of nucleic acid metabolism enters renal tubules through glomerular filtration 100% reabsorbed 10% secreted and excreted

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Elimination of Urine
nephrons collecting ducts renal papillae minor and major calyces renal pelvis ureters urinary bladder urethra outside world
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Ureters
25 cm long extend downward posterior to the parietal peritoneum parallel to vertebral column in pelvic cavity, join urinary bladder wall of ureter mucous coat muscular coat fibrous coat

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Location of Male and Female Urinary Bladders

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Urinary Bladder
Longitudinal section and posterior view of male urinary bladder

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Cross Section of Urethra

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Male and Female Urethras

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Micturition
bladder distends and stretch receptors stimulated micturition center activated in sacral portion of spinal cord parasympathetic nerve impulses cause detrusor muscle to contract need to urinate is sensed voluntary contraction of external urethral sphincter prevents urination when decision is made to urinate, external urethral sphincter relaxes, detrusor muscle contracts, and urine is expelled
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Clinical Application
Glomerulonephritis common inflammation of glomeruli may be acute or chronic acute glomerulonephritis usually occurs as an immune reaction to a Streptococcus infection antigen-antibody complexes deposited in glomeruli and cause inflammation most patients recover from acute glomerulonephritis chronic glomerulonephritis is a progressive disease and often involves diseases other than that caused by Streptococcus sp. renal failure may result from chronic glomerulonephritis
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Crescenteric Glomerulonephritis