Chapter 26: The

Urinary System

Copyright 2009, John Wiley

Overview of kidney functions
Regulation of blood ionic composition
Regulation of blood pH
Regulation of blood volume
Regulation of blood pressure
Maintenance of blood osmolarity
Production of hormones (calcitrol and erythropoitin)
Regulation of blood glucose level
Excretion of wastes from metabolic reactions and
foreign substances (drugs or toxins)

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Anatomy and histology of the
kidneys
External anatomy
Renal hilium indent where ureter emerges along
with blood vessels, lymphatic vessels and nerves
3 layers of tissue
Renal capsule deep layer continuous with outer coat
of ureter, barrier against trauma, maintains kidney shape
Adipose capsule mass of fatty tissue that protects
kidney from trauma and holds it in place
Renal fascia superficial layer thin layer of connective
tissue that anchors kidney to surrounding structures and
abdominal wall

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Organs of the urinary system in
a female

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Position and coverings of the
kidneys

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Internal anatomy
Renal cortex superficial
Outer cortical zone
Inner juxtamedullary zone
Renal columns portions of cortex that extend between
renal pyramids
Renal medulla inner region
Several cone shaped renal pyramids base faces cortex
and renal papilla points toward hilium
Renal lobe renal pyramid, overlying cortex area,
and of each adjacent renal column

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Anatomy of the kidneys
Parenchyma (functional portion) of kidney
Renal cortex and renal pyramids of medulla
Nephron microscopic functional units of kidney
Urine formed by nephron drains into
Papillary ducts
Minor and major calyces
Renal pelvis
Ureter
Urinary bladder

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Internal anatomy of the
kidneys

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Blood and nerve supply of
the kidneys
Blood supply
Although kidneys constitute less than 0.5% of total body mass,

they receive 20-25% of resting cardiac output

Left and right renal artery enters kidney

Branches into segmental, interlobar, arcuate, interlobular arteries

Each nephron receives one afferent arteriole

Divides into glomerulus capillary ball

Reunite to form efferent arteriole (unique)

Divide to form peritubular capillaries or some have vasa recta

Peritubular venule, interlobar vein and renal vein exits kidney

Renal nerves are part of the sympathetic autonomic nervous

system
Most are vasomotor nerves regulating blood flow

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Blood supply of the kidneys

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The nephron functional
units of kidney
2 parts
Renal corpuscle filters blood plasma
Glomerulus capillary network
Glomerular (Bowmans) capsule double-walled
cup surrounding glomerulus
Renal tubule filtered fluid passes into
Proximal convoluted tubule
Descending and ascending loop of Henle
(nephron loop)
Distal convoluted tubule

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Nephrons
Renal corpuscle and both convoluted tubules in
cortex, loop of Henle extend into medulla
Distal convoluted tubule of several nephrons
empty into single collecting duct
Cortical nephrons 80-85% of nephrons
Renal corpuscle in outer portion of cortex and short loops of
Henle extend only into outer region of medulla
Juxtamedullary nephrons other 25-20%
Renal corpuscle deep in cortex and long loops of Henle extend
deep into medulla
Receive blood from peritubular capillaries and vasa recta
Ascending limb has thick and thin regions
Enable kidney to secrete very dilute or very concentrated urine

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The structure of nephrons and
associated blood vessels

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Histology of nephron and
collecting duct
Glomerular capsule
Visceral layer has podocytes that wrap projections
around single layer of endothelial cells of glomerular
capillaries and form inner wall of capsule
Parietal layer forms outer wall of capsule
Fluid filtered from glomerular capillaries enters capsular
(Bowmans) space

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Histology of a renal
corpuscle

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Renal tubule and collecting duct
Proximal convoluted tubule cells have microvilli with
brush border increases surface area
Juxtaglomerular appraratus helps regulate blood
pressure in kidney
Macula densa cells in final part of ascending loop of Henle
Juxtaglomerular cells cells of afferent and efferent
arterioles contain modified smooth muscle fibers
Last part of distal convoluted tubule and collecting duct
Principal cells receptors for antidiuretic hormone (ADH)
and aldosterone
Intercalated cells role in blood pH homeostasis

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Overview of renal physiology
1. Glomerular filtration
Water and most solutes in blood plasma move across the wall of
the glomerular capillaries into glomerular capsule and then renal
tubule
2. Tubular reabsorption
As filtered fluid moves along tubule and through collecting duct,
about 99% of water and many useful solutes reabsorbed
returned to blood
3. Tubular secretion
As filtered fluid moves along tubule and through collecting duct,
other material secreted into fluid such as wastes, drugs, and
excess ions removes substances from blood
Solutes in the fluid that drains into the renal pelvis remain in the
fluid and are excreted
Excretion of any solute = glomerular filtration + secretion - reabsorption

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 Structures and functions of a
nephron
Renal corpuscle Renal tubule and collecting duct

Afferent Glomerular
arteriole capsule

Fluid in Urine
1 Filtration from blood renal tubule (contains
plasma into nephron excreted
substances)
2 Tubular reabsorption 3 Tubular secretion
Efferent from fluid into blood from blood into fluid
arteriole

Blood
(contains
reabsorbed
Peritubular capillaries substances)

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Glomerular filtration
Glomerular filtrate fluid that enters capsular space
Daily volume 150-180 liters more than 99% returned to
blood plasma via tubular reabsorption
Filtration membrane endothelial cells of glomerular
capillaries and podocytes encircling capillaries
Permits filtration of water and small solutes
Prevents filtration of most plasma proteins, blood cells and
platelets
3 barriers to cross glomerular endothelial cells
fenestrations, basal lamina between endothelium and
podocytes and pedicels of podocytes create filtration slits
Volume of fluid filtered is large because of large surface
area, thin and porous membrane, and high glomerular
capillary blood pressure

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The filtration membrane

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 Podocyte of visceral
layer of glomerular
(Bowmans) capsule

Filtration slit
Pedicel

1 Fenestration (pore) of glomerular

endothelial cell: prevents filtration of
blood cells but allows all components
of blood plasma to pass through

2 Basal lamina of glomerulus:

prevents filtration of larger proteins

3 Slit membrane between pedicels:

prevents filtration of medium-sized
proteins

(a) Details of filtration membrane

Pedicel of podocyte Filtration slit

Basal lamina

Lumen of glomerulus

Fenestration (pore) of TEM 78,000x

glomerular endothelial cell

(b) Filtration membrane

Net filtration pressure
Net filtration pressure (NFP) is the total pressure
that promotes filtration
NFP = GBHP CHP BCOP
Glomerular blood hydrostatic pressure is the blood
pressure of the glomerular capillaries forcing water and
solutes through filtration slits
Capsular hydrostatic pressure is the hydrostatic pressure
exerted against the filtration membrane by fluid already in
the capsular space and represents back pressure
Blood colloid osmotic pressure due to presence of proteins
in blood plasma and also opposes filtration

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The pressures that drive
glomerular filtration

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 1 GLOMERULAR BLOOD
2 CAPSULAR HYDROSTATIC
HYDROSTATIC PRESSURE
PRESSURE (CHP) = 15 mmHg
(GBHP) = 55 mmHg

3 BLOOD COLLOID
OSMOTIC PRESSURE
Afferent arteriole (BCOP) = 30 mmHg
Proximal convoluted tubule

Efferent
arteriole NET FILTRATION PRESSURE (NFP)
=GBHP CHP BCOP
= 55 mmHg 15 mmHg 30 mmHg
= 10 mmHg
Glomerular
(Bowman's) Capsular
capsule space
Glomerular filtration

Glomerular filtration rate amount of filtrate

formed in all the renal corpuscles of both
kidneys each minute
Homeostasis requires kidneys maintain a
relatively constant GFR
Too high substances pass too quickly and are not
reabsorbed
Too low nearly all reabsorbed and some waste
products not adequately excreted
GFR directly related to pressures that determine
net filtration pressure

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3 Mechanisms regulating GFR

1. Renal autoregulation
Kidneys themselves maintain constant renal blood flow
and GFR using
Myogenic mechanism occurs when stretching triggers
contraction of smooth muscle cells in afferent arterioles
reduces GFR
Tubuloglomerular mechanism macula densa provides
feedback to glomerulus, inhibits release of NO causing
afferent arterioles to constrict and decreasing GFR

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Tuboglomerular feedback

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Mechanisms regulating GFR

2. Neural regulation
Kidney blood vessels supplied by sympathetic ANS fibers that
release norepinephrine causing vasoconstriction
Moderate stimulation both afferent and efferent arterioles
constrict to same degree and GFR decreases
Greater stimulation constricts afferent arterioles more and
GFR drops
3. Hormonal regulation
Angiotensin II reduces GFR potent vasoconstrictor of both
afferent and efferent arterioles
Atrial natriuretic peptide increases GFR stretching of atria
causes release, increases capillary surface area for filtration

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Tubular reabsorption and
tubular secretion
Reabsorption return of most of the filtered
water and many solutes to the bloodstream
About 99% of filtered water reabsorbed
Proximal convoluted tubule cells make largest
contribution
Both active and passive processes
Secretion transfer of material from blood
into tubular fluid
Helps control blood pH
Helps eliminate substances from the body

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Reabsorption routes and transport
mechanisms
Reabsorption routes
Paracellular reabsorption
Between adjacent tubule cells
Tight junction do not completely seal off interstitial fluid from tubule fluid
Passive
Transcellular reabsorption through an individual cell
Transport mechanisms
Reabsorption of Na+ especially important
Primary active transport
Sodium-potassium pumps in basolateral membrane only
Secondary active transport
Symporters, antiporters
Transport maximum (Tm)
Upper limit to how fast it can work
Obligatory vs. facultative water reabsorption

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Reabsorption routes: paracellular
reabsorption and transcellular
reabsorption

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Reabsorption and secretion in
proximal convoluted tubule (PCT)
Largest amount of solute and water reabsorption
Secretes variable amounts of H+, NH4+ and urea
Most solute reabsorption involves Na+
Symporters for glucose, amino acids, lactic acid, water-soluble
vitamins, phosphate and sulfate
Na+ / H+ antiporter causes Na+ to be reabsorbed and H+ to be secreted
Solute reabsorption promotes osmosis creates osmotic gradient
Aquaporin-1 in cells lining PCT and descending limb of loop of Henle
As water leaves tubular fluid, solute concentration increases
Urea and ammonia in blood are filtered at glomerulus and
secreted by proximal convoluted tubule cells

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Reabsorption and secretion in
the proximal convoluted tubule

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Reabsorption in the loop of
Henle
Chemical composition of tubular fluid quite different from
filtrate
Glucose, amino acids and other nutrients reabsorbed

Osmolarity still close to that of blood

Reabsorption of water and solutes balanced

For the first time reabsorption of water is NOT automatically

coupled to reabsorption of solutes
Independent regulation of both volume and osmolarity of
body fluids
Na+-K+-2Cl- symporters function in Na+ and Cl- reabsorption
promotes reabsorption of cations
Little or no water is reabsorbed in ascending limb
osmolarity decreases

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Na+K+-2Cl- symporter in the
thick ascending limb of the loop
of Henle

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Reabsorption and secretion in the late
distale convoluted tubule and
collecting duct
Reabsorption on the early distal convoluted tubule
Na+-Cl- symporters reabsorb Na+ and Cl-
Major site where parathyroid hormone stimulates
reabsorption of Ca+ depending on bodys needs
Reabsorption and secretion in the late distal
convoluted tubule and collecting duct
90-95% of filtered solutes and fluid have been returned by
now
Principal cells reabsorb Na+ and secrete K+
Intercalated cells reabsorb K+ and HCO3- and secrete H+
Amount of water reabsorption and solute reabsorption and
secretion depends on bodys needs

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Hormonal regulation of tubular
reabsorption and secretion
Angiotensin II - when blood volume and blood pressure
decrease
Decreases GFR, enhances reabsorption of Na+, Cl- and water
in PCT
Aldosterone - when blood volume and blood pressure
decrease
Stimulates principal cells in collecting duct to reabsorb more
Na+ and Cl- and secrete more K+
Parathyroid hormone
Stimulates cells in DCT to reabsorb more Ca2+

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Regulation of facultative water
reabsorption by ADH
Antidiuretic hormone (ADH
or vasopressin)
Increases water
permeability of cells by
inserting aquaporin-2 in last
part of DCT and collecting
duct
Atrial natriuretic peptide
(ANP)
Large increase in blood
volume promotes release of
ANP
Decreases blood volume
and pressure by inhibiting
reabsorption of Na+ and
water in PCT and collecting
duct, suppress secretion of
ADH and aldosterone

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Production of dilute and
concentrated urine
Even though your fluid intake can be highly
variable, total fluid volume in your body
remains stable
Depends in large part on the kidneys to
regulate the rate of water loss in urine
ADH controls whether dilute or concentrated
urine is formed
Absent or low ADH = dilute urine
Higher levels = more concentrated urine through
increased water reabsorption

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Formation of dilute urine
Glomerular filtrate has same osmolarity as blood
300 mOsm/liter
Fluid leaving PCT is isotonic to plasma
When dilute urine is being formed, the osmolarity
of fluid increases as it goes down the descending
loop of Henle, decreases as it goes up the
ascending limb, and decreases still more as it
flows through the rest of the nephron and
collecting duct

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Formation of dilute urine
Osmolarity of interstitial fluid of
renal medulla becomes
greater, more water is
reabsorbed from tubular fluid
so fluid become more
concentrated
Water cannot leave in thick
portion of ascending limb but
solutes leave making fluid
more dilute than blood plasma
Additional solutes but not
much water leaves in DCT
Low ADH makes late DCT and
collecting duct have low water
permeability

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Formation of concentrated urine
Urine can be up to 4 times more concentrated than
blood plasma
Ability of ADH depends on presence of osmotic
gradient in interstitial fluid of renal medulla
3 major solutes contribute Na+, Cl-, and urea
2 main factors build and maintain gradient
Differences in solute and water permeability in
different sections of loop of Henle and collecting
ducts
Countercurrent flow of fluid though descending and
ascending loop of Henle and blood through
ascending and descending limbs of vasa recta

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Countercurrent multiplication
Process by which a progressively increasing osmotic gradient is
formed as a result of countercurrent flow
Long loops of Henle of juxtamedullary nephrons function as
countercurrent multiplier
Symporters in thick ascending limb of loop of Henle cause buildup
of Na+ and Cl- in renal medulla, cells impermeable to water
Countercurrent flow establishes gradient as reabsorbed Na + and
Cl- become increasingly concentrated
Cells in collecting duct reabsorb more water and urea
Urea recycling causes a buildup of urea in the renal medulla
Long loop of Henle establishes gradient by countercurrent
multiplication

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Countercurrent exchange

Process by which solutes and water are passively

exchanged between blood of the vasa recta and
interstitial fluid of the renal medulla as a result of
countercurrent flow
Vasa recta is a countercurrent exchanger
Osmolarity of blood leaving vasa recta is only
slightly higher than blood entering
Provides oxygen and nutrients to medulla without
washing out or diminishing gradient
Vasa recta maintains gradient by countercurrent
exchange

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Mechanism of urine
concentration in long-loop
juxtamedullary nephrons

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 Vasa
recta

Loop of
Henle

Juxtamedullary nephron
and its blood supply Glomerular (Bowmans) capsule
together H2O
Glomerulus Na+CI
Afferent Blood flow
arteriole Distal convoluted tubule
Presense of Na+-K+-2CI
symporters
Interstitial Flow of tubular fluid
200
H2O fluid in
Efferent H2O
300 renal cortex
arteriole
H2O 300 320
Proximal Collecting
convoluted duct
tubule 300 300
300
H2O 100 320 3 Principal cells in H2 O
collecting duct
Na+CI reabsorb more Na+CI
H2 O water when ADH
Interstitial fluid 400
400 380 200 is present
in renal medulla 400
500
H2O
600
H2O

580 400 H2 O
600 Na+CI
600
Osmotic 1 Symporters in thick
gradient ascending limb cause 700
buildup of Na+ and Cl H2 O 800
800 780 600
H2 O
800
H2O Urea 900
4 Urea recycling Na+CI
causes buildup H2O
1000 980 800 1000 of urea in the 1000
renal medulla
1100
H2 O
1200 1200 1200 Papillary 1200
2 Countercurrent flow
through loop of Henle duct
establishes an osmotic Loop of Henle
gradient 1200 Concentrated urine

(a) Reabsorption of Na+CI and water in a long-loop juxtamedullary nephron (b) Recycling of salts and urea in the vasa recta
Summary of filtration, reabsorption,
and secretion in the nephron and
collecting duct

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Evaluation of kidney function

Urinalysis
Analysis of the volume and physical, chemical
and microscopic properties of urine
Water accounts for 95% of total urine volume
Typical solutes are filtered and secreted
substances that are not reabsorbed
If disease alters metabolism or kidney function,
traces if substances normally not present or
normal constituents in abnormal amounts may
appear
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Evaluation of kidney function
Blood tests
Blood urea nitrogen (BUN) measures blood nitrogen that
is part of the urea resulting from catabolism and
deamination of amino acids
Plasma creatinine results from catabolism of creatine
phosphate in skeletal muscle measure of renal function
Renal plasma clearance
More useful in diagnosis of kidney problems than above
Volume of blood cleared of a substance per unit time
High renal plasma clearance indicates efficient excretion of
a substance into urine
PAH administered to measure renal plasma flow

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Urine transportation, storage,
and elimination
Ureters
Each of 2 ureters transports urine from renal
pelvis of one kidney to the bladder
Peristaltic waves, hydrostatic pressure and gravity
move urine
No anatomical valve at the opening of the ureter
into bladder when bladder fills it compresses the
opening and prevents backflow

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Ireters, urinary bladder, and
urethra in a female

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Urinary bladder and urethra

Urinary bladder
Hollow, distensible muscular organ
Capacity averages 700-800mL
Micturition discharge of urine from bladder
Combination of voluntary and involuntary muscle contractions
When volume increases stretch receptors send signals to
micturition center in spinal cord triggering spinal reflex
micturition reflex
In early childhood we learn to initiate and stop it voluntarily
Urethra
Small tube leading from internal urethral orifice in floor of
bladder to exterior of the body
In males discharges semen as well as urine

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Comparison between female
and male urethras

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End of Chapter 26

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