What are the four parts of the

urinary system?

What are the 7 functions of the

urinary system?

Kidneys
Ureters
Bladder
Urethra
1. Regulation of water, electrolyte, and acid-base balance
2. Excretion of metabolic wastes, excess water, and excess
electrolytes in urine
3. Excretion of bioactive substances, including many drugs
4. Regulation of arterial blood pressure by secretion of renin
5. Secretion of erythropoietin
6. Conversion of the steroid prohormone vitamin D (produced in
the epidermis) into the active form (1,25-dihydroxycholcalciferol
or calcitrol or vitamin D3)
7. Gluconeogenesis during starvation or fasting

What structures are present at

the hilum of the kidney?

Adipose tissue in the renal

sinus, renal artery and vein,
renal pelvis branching into
major calyces

What does a renal lobe consist

of?

A renal (medullary) pyramid plus

the cortical tissue at its base
and along its sides (the renal
columns or columns of Bertin)

What does a renal lobule

consist of?

A medullary ray plus the

attached cortical tissue

What is the tip of each

medullary pyramid called?

Trace the path of blood flow

through the kidney.

Renal papilla

Renal artery --> Segmental artery --> Interlobar

artery --> Arcuate artery --> Interlobular artery
(cortical radial artery) --> Afferent arteriole -->
Glomerular capillaries --> Efferent arteriole -->
Peritubular capillaries OR Vasa recta --> Stellate
vein --> Interlobular vein --> Arcuate vein -->
Interlobar vein --> Segmental vein --> Renal vein

Glomerulonephritis

What is inflammation within the

glomerulus called?

Caused by humoral immune reactions -->

deposition of circulating antibody-antigen
complexes within the glomerulus OR binding of
circulating antibodies to glomerular antigens or
extraneous antigens depositied in the glomerulus
--> local inflammatory response

What are the two poles of a

renal corpuscle?

Vascular pole
Tubular pole

Describe the outer parietal layer

of the glomerular capsule.

Simple squamous epithelium

supported by a basal lamina
At the tubular pole, this epithelium
changes to the simple cuboidal
epithelium of the PCT.

Describe the visceral layer of

the glomerular capsule.

What are slit diaphragms?

Describe the basement

membrane of the glomerulus.

What are the 3 parts of the

filtration barrier?

Stellate (star-shaped) podocytes with primary

processes curving around lengths of
glomerular capillary; many parallel,
interdigitating pedicels (secondary processes)
extend from each primary process; filtration
slit pores exist between the pedicels and are
covered with slit diaphragms
Modified and specialized occluding or tight
junctions composed of nephrins, other proteins,
glycoproteins, and proteoglycans; projecting
from the cell membrane on either side of the
filtration slit, these polyanionic glycoproteins and
proteoglycans interact to form a series of
openings within the slit diaphragm, with a surface
that is negatively charged

Fusion of capillary- and podocyte-produced basal

laminae
Laminin and fibronectin connect to integrins of both
the podocyte and the endothelial cell membranes
Meshwork of corss-linked type IV collagen and large
proteoglycans restricts passage of large proteins
Polyanionic GAGs restrict filtration of organic anions

1. Fenestrations of the capillary endothelium =

block blood cells and platelets
2. Thick combined basal lamina (glomerular
basement membrane) = restricts large proteins
and some organic anions
3. Filtration slit diaphragms between pedicels =
restrict some small proteins and some organic
anions
1. Physical support of capillaries within the glomerulus

What are the functions of the

mesangium?

2. Contract in response to blood pressure changes, helping to

maintain optimal filtration rate
3. Phagocytosis of protein aggregates adhering to the glomerular
filter, including antibody-antigen complexes
4. Secretion of cytokines, prostaglandins, and other factors
important for immune defense and repair in the glomerulus

Describe the histological

features of the PCT.

Simple cuboidal epithelium; central nuclei;

cells well-stained with numerous
mitochondria (acidophilic, mostly associated
with basal foldings), prominent basal folds,
and lateral interdigitations; apical pits and
vesicles; long apical microvilli (brush border);
lumens often occluded

Which cells hydroxylate vitamin

D?

Proximal tubule cells

hydroxylate vitamin D and
release it to the capillaries.

Which cells produce

erythropoietin?

Fibroblastic interstitial cells in

cortical areas near the proximal
tubules

Describe the histological

features of the thin limbs of the
loop of Henle.

Simple squamous epithelium;

few mitochondria or organelles;
prominent lumens

Describe the histological

features of the thick ascending
limb of the loop of Henle.

Simple cuboidal epithlium; no

microvilli; many mitochondria

Describe the histological

features of the DCT.

Describe the histological

features of the collecting
system.

What is the thickening and loss

of function of the glomerular
basement membrane called?

What is sickle cell nephropathy?

Describe cells of the macula

densa.

Simple cuboidal epithelium; cells flatter

and smaller than in PCT; short microvilli
and basolateral folds but no brush
border; emptier lumens; more nuclei
seen in a section than in PCT (due to
smaller cell size); fewer mitochondria
than PCT, so less acidophilic
Principal cells = most abundant, cuboidal to
columnar; basolateral foldings; few organelles
and sparse microvilli with a primary cilium; palestaining, distinct cell membranes
Intercalated cells = few and scattered; slightly
darker staining; more abundant mitochondria
and projecting apical folds

Diabetic glomerulosclerosis
Produced as part of the systemic
microvascular sclerosis in diabetes mellitus
Leading cause of irreversible end-stage kidney
disease in the United States
Treatment requires transplant or artificial
hemodialysis
One of the most common problems caused
by sickle cell disease
Occurs when the affected erythrocytes sickle
in the vasa recta because of the low oxygen
tension there
Nephropathy results from renal infarcts,
usually within the renal papillae or pyramids

Columnar and closely packed; apical

nuclei, basal Golgi complexes, and a
more elaborate and varied system
of ion channels and transporters
than other DCT cells

Describe juxtaglomerular (JG)

cells.

What is the third cell type,

besides macula densa cells and
JG cells, that is part of the
juxtaglomerular apparatus?

Modified smooth muscle cells of the

tunica media of the afferent arteriole
where it contacts the macula densa
Secretory phenotype including more
rounded nuclei, rough ER, Golgi
complexes, and zymogen granules with
renin

Lacis cells = extraglomerular

mesangial cells that have many of
the same supportive, contractile,
and defensive functions as
mesangial cells within the
glomerulus

How do macula densa cells

respond to high GFR and high
luminal Na+ and Clconcentrations?

Release ATP, adenosine, and other

vasoactive compounds that trigger
constriction of the afferent
arteriole, lowering the glomerular
pressure and decreasing the GFR

Describe the interstitium of the

medulla.

Contains sparse myofibroblastlike cells in a matrix very rich in

hydrophilic hyaluronate

What is lithotripsy?

A procedure that uses focused

ultrasonic shock waves to
disintegrate kidney stones; can
cause significant renal damage

Define pyelonephritis.

Inflammation of the renal pelvis and

calyces caused by bacterial infections of
the urinary tract
Bacteria often move from one or more
minor calyx into the associated renal
papilla, causing accumulation of
neutrophils in the collecting ducts

What type of epithelium do the

calyces, renal pelvis, ureter, and
bladder have?

Stratified transitional epithelium

or urothelium

What are the 3 layers of

urothelium?

1. Single layer of small basal cells resting on a very

thin basement membrane
2. Intermediate region containing from one to
several layers of more columnar cells
3. Superficial layer of very large, bulbous cells
(umbrella cells) that are occasionally bi- or
multinucleated and are highly differentiated to
protect underlying cells against the cytotoxic effects
of hypertonic urine

Describe the apical membranes

of umbrella cells. What special
protein do they contain?

Asymmetric unit membranes where regions of the outer

lipid layer appear twice as thick as the inner leaflet;
these regions are composed of lipid rafts containing
mostly integral membrane proteins called uroplakins
that assemble into paracrystalline arrays of stiffened
plaques; these membranous plaques are impermeable
to water and protect the cytoplasm and underlying cells
from the hyperosmotic effects of urine; plaques are
hinged together by narrow regions of typical membrane

How does the urothelium

change when the bladder goes
from full to empty and vice
versa?

Full --> Empty

Mucosa folds extensively; individual umbrella cells decrease their
apical surface area by folding their membranes at the hinge
regions and internalizing the folded plaques in discoidal vesicles
Empty --> Full
Mucosa unfolds; discoidal vesicles rejoin the apical membranes of
umbrella cells, increasing their surface area as the cell shape
changes from round to flat; urothelium thins out as intermediate
cells are pushed and pulled laterally to accomodate the increased
volume of urine

What surrounds urothelium?

What is the muscle layer of the

bladder called?

Folded lamina propria

Submucosa
Dense sheath of interwoven
smooth muscle layers
Adventitia

Detrusor muscle

Cystitis

What is inflammation of the

bladder mucosa called?

What can chronic cystitis cause?

How do the ureters and the

urethra appear in cross section?

Can be caused by UTI,

immunodeficiency, urinary
catheterization, radiation, or
chemotherapy
Unstable urothelium with benign
urothelial changes involving
hyperplasia or metaplasia; bladder
cancer is usally some sort of
transitional cell carcinoma arising from
unstable urothelium

The prominent longitudinal folds of

these tubes appear as numerous
large projections into the lumen
such that the lumen border is thick
and wavy or squiggly

What are the three segments of

the male urethra?

Describe the prostatic urethra

Describe the membranous

urethra

Describe the spongy urethra

Describe the female urethra

1. Prostatic urethra
2. Membranous urethra
3. Spongy urethra

3-4 cm, extends through

prostate gland, lined by
urothelium

Short segment, passes through

an external sphincter of striated
muscle and is lined by stratified
columnar and pseudostratified
epithelium
About 15 cm long, enclosed within the
erectile tissue of the penis; lined with
stratified columnar and
pseudostratified columnar epithelium
with stratified squamous epithelium
distally
4-5 cm long, lined initially with
transitional epithelium, then by
stratified squamous epithelium and
some areas of pseudostratified
columnar epithelium; middle part is
surrounded by the external striated
muscle sphincter

What is infection of the urethra

called?

Urethritis
Often leads to cystitis in women
due to short urethra

What bacteria is usually the

culprit in a UTI?

Coliform bacteria or Chlamydia

What is pain or difficulty during

urination called?

Dysuria