URINARY SYSTEM

General structure and function

• Waste products accumulate in blood (urea,
creatinine, ammonia)
o These are toxic and must be removed to
maintain homeostasis
o Organs remove waste products form the
blood then from the body
• Organs
o Kidney – PRIMARY ORGAN which filters
waste products form the bloodstream;
convert the filtrate into urine
o Ureters
o Urinary bladder
o Urethra
• Upper urinary tract – kidney, ureter
• Lower urinary tract – bladder, urethra

Specific Functions of the Urinary System

• Removing waste products form the blood stream
• Storage and excretion of urine
o The urinary bladder is expandible, muscular sac that can store as much as 1L of urine
• Regulation of erythrocyte production
o As kidney filters blood, it also detects oxygen levels in blood
o Erythropoietin (EPO) – hormone produced by kidney
▪ Released if blood oxygen falls
▪ Stimulated RBC production in Red BM
Functions of kidney
Regulation of:
• Blood volume
• pH: Eliminate H+ ion – less acidic; Conserve bicarbonate – more basic
o blood pH: 7.35-7.45
o CO2: 35-45 mmHg
o Bicarbonate – 22-26mEq/L
o ROME – Respiratory, opposite relationship with bicarbonate; Metabolic, equal relationship with
bicarbonate
• Blood pressure – secretes hormone RENIN – important for the Renin-angiotensin system (RAS); works with
hypotension stimulation
 • Glucose
o Gluconeogenesis – kidneys synthesize glucose from amino acids and other precursors during
prolonged fasting; also, in the liver
• Maintains Osmolality – concentration of solute and solution; Normal: 300 moles/L

Kidney
• Retroperitoneal
o Anterior surface covered with peritoneum
o Posterior surface against posterior abdominal
• Superior pole: T-12
• Inferior pole: L-3
• Right kidney is approx. 2cm lower than left
• Adrenal gland on superior po
• Hilum: concave medial border
• Renal sinus: internal space
o Houses blood vessels, lymphatic vessels, nerves
o Houses renal pelvis, renal calyces
o Also fat
• Surrounding tissues
• Mostly fats to maintain position and protect
• Deep to superficial
o Fibrous capsule (renal capsule)
▪ Dense irregular CT
▪ Covers outer surface
o Perinephric fat (adipose capsule)
▪ Called perirenal fat
▪ Completely surrounds kidney
▪ Cushioning and insulation
o Renal fascia
▪ Dense irregular CT
▪ Anchors kidney to posteriors wall and peritoneum
o Paranephric fat
▪ Between renal fascia and peritoneum
Internal anatomy
• Renal parenchyma – functional part of the kidney that includes the
renal cortex and the renal medulla; it contains nephrons
• Nephrons – functional unit of kidneys
• Renal cortex – lighter part of the kidneys; contains renal corpuscle
(convoluted tubules)
• Renal medulla – darker part of the kidneys; The medulla is divided
into 8 to 10 cone-shaped masses of tissue called renal pyramids; also,
where loops of Henley is located
• Renal pyramids - The base of each pyramid originates at the border
between the cortex and medulla and terminates in the papilla

• Renal pelvis - a funnel-shaped continuation of the upper

end of the ureter where papilla projects into;
o The outer border of the pelvis is divided into
open ended pouches called major calyces
o extend downward and divide into minor calyces,
which collect urine from the tubules of each
papilla
o When this leaves the kidney, it becomes the
ureter

Blood and nerve supply

• Nerve supply: Renal plexus (T10-L2);

• ANS: sympathetic
• Blood supply: provides 20-25% of total cardiac outpu

Nephron – Each kidney in the human contains about 800,000 to

1,000,000 nephrons, each capable of forming urine.
Parts:
1. Glomerulus - contains a network of branching and
anastomosing glomerular capillaries; the total
glomerulus is encased in Bowman’s capsule;
o it contains podocytes which are cells that filters
the glomerular capsule
o creatinine is the common filtered substance
2. Proximal convoluted tubule
o where fluid from glomerulus flows found in the
renal cortex
o non-selective & it contains microvilli part of the
nephron that has the greatest water
absorption; end product is concentrated urine
 3. Loop of Henle (Nephron Loop)
o fluid will flow after the proximal tubule;
it is selective & only allowed water to be
absorbed → concentrated urine.
o It’s deep into the renal medulla and
contains 3 portions:
▪ Descending limb
▪ Thin segment of ascending limb
▪ Think segment of ascending limb
**Ascending limb – less selective than
descending limb; contains the Juxtaglomerular
apparatus
4. Macula Densa
o plays an important role in controlling
nephron function
o monitor the filtration – salt sensors
5. Distal convoluted tubule
o where fluid goes beyond the macula densa
o also found in the renal cortex; it contains principal cells (binding sites of hormone ADH) &
Intercalated cells
6. Collecting tubule – it has 2 parts: the cortical and medullary collecting tubule
7. Collecting duct – empty into the renal pelvis through the tips of the renal papillae

• Cortical Nephrons
o Near peripheral edge of cortex
o Short nephron loops
o Have peritubular capillaries
• Juxtamedullary nephrons
o Near corticomedullary border
o Long nephron loops
o Have vasa recta

Urine formation
• Three processes
• Filtration
o Renal corpuscle: forms filtrate; filters 115-125ml/min; 180L/day
o From blood to tubule
• Reabsorption
o Mostly PCT
o Water and salt: rest of nephron
o From tubule to blood
• Secretion
o From blood to tubule
Filtration membrane

Drainage of urine

Nephrons → collecting ducts (filtration) → papillary duct (urine) → minor calyx → major calyx → renal pelvis →
ureter → bladder → urethra

Parts of Nephron – Detailed (Refer to nephron pic)

Proximal convoluted tubule
• Begins at tubular pole of the renal corpuscle.
• Cells: simple cuboidal epithelium
o actively reabsorb from the filtrate:
o almost all nutrients (glucose and amino acids)
o electrolytes
o plasma proteins
o Osmosis: reabsorption of 60% to 65% of the water in filtrate.
o Have microvilli
• Solutes and water:
o moved into blood plasma via the peritubular capillaries
o when substance is still needed, it will send it back to capillary bed, but when it isn’t needed, it will go
to the loop of Henle

Nephron Loop (Loop of Henle)

• originates at end of proximal convoluted tubule
• projects toward and/or into the medulla.
• Each loop has two limbs.
o descending limb: from cortex toward and/or into the medulla
o ascending limb: returns back to the renal cortex

Distal convoluted tubule

• begins at the end of the thick ascending limb of the nephron loop
o adjacent to the afferent arteriole (important physiologically)
o Juxtaglomerular apparatus.
• Primary function:
o Secretion
o From blood plasma to filtrate.
o secretes ions
▪ potassium (K+)
 ▪ acid (H+)
• Reabsorption of water also occurs if only ample amount of NaCl is present :
o influenced by two hormones
o Aldosterone
o antidiuretic hormone (ADH)

Collecting ducts
• function in a well-hydrated person
o transport the tubular fluid into the papillary duct and then the minor calyx
• function in a dehydrated person:
o water conservation
o more concentrated urine is produced

Urinary tract

Ureters
• long, fibromuscular tubes
• conduct urine from the kidneys to the urinary
bladder.
• average 25 centimeters in length
• retroperitoneal
• ureters originate at the renal pelvis
• extend inferiorly to enter the posterolateral wall of
the base of the urinary bladder.
• wall is composed of three concentric tunics.
o mucosa
o muscularis
o adventitia

Urinary bladder
• expandable, muscular container
• made of transitional epithelial cells
• serves as a reservoir for urine
• positioned immediately superior and posterior to the pubic symphysis.
• in females:
o the urinary bladder is in contact with the uterus posterosuperiorly and with the vagina
posteroinferiorly.
• in males:
o it is in contact with the rectum posterosuperiorly and is immediately superior to the prostate gland.
• is a retroperitoneal organ.
• when empty, it exhibits an upside-down pyramidal shape.
• Filling with urine distends it superiorly until it assumes an oval shape
• Trigone
o posteroinferior triangular area of the urinary bladder wall
o formed by imaginary lines – connect the two posterior ureteral openings and the anterior urethral
opening
o The trigone remains immovable as the urinary bladder fills and evacuates
 o functions as a funnel which directs urine into the urethra as the bladder wall contracts
o has four tunics:
▪ Mucosa
▪ Submucosa
▪ Muscularis: called the detrusor muscle
▪ Adventitia
o Internal urethral sphincter made up of smooth muscle controlled by the ANS

Micturition (urination)
• The expulsion of urine from the bladder.
• Initiated by a complex sequence of events called the micturition reflex.
• The bladder is supplied by both parasympathetic and sympathetic nerve fibers of the autonomic nervous
system

Urethra
• Fibromuscular tube
o exits the urinary bladder through the urethral opening
o at anteroinferior surface
• conducts urine to the exterior of the body.
• Tunica mucosa: is a protective mucous membrane
o houses clusters of mucin-producing cells called urethral glands.
• Tunica muscularis: primarily smooth muscle fibers
o help propel urine to the outside of the body.
• Two urethral sphincters:
o Internal urethral sphincter
▪ restrict the release of urine until the pressure within the urinary bladder is high enough
▪ made of involuntary smooth mm
▪ a circular thickening of the detrusor muscle
▪ controlled by ANS
o External urethral sphincter
 ▪ and voluntary activities needed to release the urine are activated.
▪ Formed by skeletal mm fibers of the urogenital diaphragm (voluntary)
▪ Controlled by somatic NS
▪ This is the mm children learn to control to be “toilet-trained”

Female urethra
• Has a single function:
o to transport urine from the urinary bladder
to the vestibule, an external space
immediately internal to the labia minora
o 3 to 5 centimeters long, and opens to the
outside of the body at the external urethral
orifice located in the female perineum

Male urethra
• Urinary and reproductive functions –
passageway for both urine and semen
• Approximately 18 to 20 centimeters long.
• Partitioned into three segments:
o prostatic urethra is approximately 3 to 4
centimeters long and is the most dilatable
portion of the urethra; extends through the
prostate gland, immediately inferior to the male bladder,
where multiple small prostatic ducts enter it
o membranous urethra – shortest and least dilatable
portion; extends from the inferior surface of the prostate
gland through the urogenital diaphragm
o spongy urethra is the longest part (15 centimeters)
encased within a cylinder of erectile tissue in the penis
called the corpus spongiosum; extends to the external
urethral orifice

Aging and the Urinary System

• Changes in the size and functioning of the kidneys begin at 30.

• Gradual reduction in kidney size.
• Reduced blood flow to the kidneys.
• Decrease in the number of functional nephrons.
• Reabsorption and secretion are reduced.
• Diminished ability to filter and cleanse the blood.
• Less aldosterone or antidiuretic hormone.
• Ability to control blood volume and blood pressure is reduced.
• Bladder decreases in size.
• More frequent urination.
• Control of the urethral sphincters—and micturition—may be
lost.
 Upper UTI Lower UTI
Pyelonephritis Common infection:
- Caused by bacterial infection Cystitis - inflammation of the bladder, usually caused by a
- Chronic → kidney inflammation bladder infection; common in women; can get better by
- Systemic symptoms such as fever, malaise, chills, themselves
and painful costo-vertebral
- (+) murphy’s percussion Urethritis - inflammation of the urethra, the tube that
- Nocturnal pain at night carries pee from the bladder out of the body

Kidney stones – stone formation in papilla Symptoms

Ureteral stones (more painful) - Urinary frequency and urgency
** (N) – urinate > 2hrs
- LBP
- Hematuria (blood)
- Pyuria (pus)
- pain during sexual intercourse dyspareunia for female;
Priapism for male
Renal failure Prostatitis – enlarged prostate that caused prostatic
- Increased BUN urethra to narrow; w/ nocturia, LBP, arthralgia, myalgia
- Creatinine
- Na retention and hyperkalemia

URINARY INCONTINENCE – inability to retain urine; involuntary leaking of urine

Stress - Sudden release of urine due to an increase intra- - WEAK PELVIC FLOOR MUSCLE
incontinence abdominal pressure (coughing, ab exercise, - Damaged pudendal nerve
pregnant) - Kegels exercises (pigil-wiwi)
- Common to menopausal and stress individuals

Urge - due to overactive bladder (hypertonicity) - nawiwiwi na pero biglang parang

incontinence - sensation of fullness of bladder Nawala (sensory instability)
- hypersensitivity of bladder - train pt. to follow normal
- common to child, and UMNL frequency of voiding (> 2hrs)
- damaged detrusor muscle
Overflow - bladder continuously leaks due to overdistension - catheterization
incontinence of bladder (swelling and becoming large by
pressure from inside)
- urinate nang urinate
- with neurogenic bladder
- common to SCI and LMNL
Function - Normal bladder but has incapacity of urination - Time-voiding
incontinence - Common to Alzheimer’s disease, dementia,
stroke, and people with environmental barriers