Anatomy & Physiology - Lecture

STUDENT ACTIVITY SHEET BS NURSING / FIRST YEAR

Session # 22

LESSON TITLE: URINARY SYSTEM AND FLUID BALANCE Materials:

LEARNING OUTCOMES: Book, pen and notebook
Upon completion of this lesson, you can:
1. Describe the structural and functional characteristics of urinary
system and its organ composition;
2. Illustrate the blood supply through kidneys;
3. Recognize the major processes in urine production,
regulation of concentration and volume, and movement out of
the body;
4. Recall the hormonal mechanisms regulating the urinary system;
5. Enumerate the body fluid compartments;
6. Identify the three factors that control the pH and its mechanisms; Reference:
and,
7. Identify the different disorders and diseases associated with the VanPutte, C., Regan, J., & Russo, A. (2019). Seeley’s
urinary system and its description. essentials of anatomy & physiology (10th ed.).
New York, NY: McGraw-Hill Education.

LESSON REVIEW/PREVIEW
Take a review from the previous chapter by responding to the statement posted based on your own understanding.
Use the space provided. If not enough, you may write at the back portion of this page. Right after, you can proceed
comparing your responses from the Main Lesson in the previous chapter. Enjoy!

Illustrate the process of digestion, absorption & transport of carbohydrates, lipids,

and proteins in the digestive system.
Carbohydrates
In the mouth, salivary amylase starts the digestion of carbohydrates. The carbohydrates are subsequently
transported to the stomach, where they are digested until the meal is thoroughly combined with acid, inactivating salivary
amylase. Pancreatic amylase continues carbohydrate breakdown in the duodenum, and absorption begins. Glucose,
galactose, and fructose are monosaccharides that are taken up by intestinal epithelial cells. This process is also employed
for galactose transport, while facilitated diffusion is used for fructose transport. Insulin influences the rate of glucose transport
into most types of cells, and it can increase tenfold in the presence of insulin. Glucose penetrates most cells slowly without
insulin.

Lipids
Emulsification, or the transformation of big lipid droplets into much smaller droplets, is the first stage in lipid
digestion. These, as well as other lipids, are contained within a protein covering. Chylomicrons are packed lipid-protein
complexes, also known as lipoproteins. Chylomicrons exit epithelial cells and go to the lacteals, which are lymphatic
capillaries in the intestinal villi. The lipids in chylomicrons are carried to the liver, where they are stored, transformed into
other molecules, or burned for energy. They're also delivered to adipose tissue, where they're stored until they're needed
elsewhere in the body as an energy source.

Proteins
Amino acid chains make up proteins. They're in almost all of the plant and animal items we consume. Pepsin is a
digestive enzyme that breaks down proteins into shorter amino acid chains known as polypeptides. Amino acids are actively
delivered into all of the body's cells. Growth hormone and insulin promote this transport. The majority of amino acids are
utilized to make new proteins; however, some are metabolized and a part of the energy released is used to make ATP.
Excess amino acids cannot be stored by the body. Instead, they're partially degraded and utilized to make glycogen or lipids,
which can be stored. The human body can only store a certain quantity of information.

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MAIN LESSON
You must read & study the concepts and refer to figures/tables in Chapter 18 of the book.

Urinary System – major excretory system; controls the composition & volume of body fluids. (See figure 18.1,
page 496)

Functions:
▪ Excretion of waste products ▪ Regulation of extracellular fluid pH
▪ Regulation of blood volume and pressure ▪ Regulation of red blood cell synthesis
▪ Regulation of the concentration of solutes in the ▪ Regulation of vitamin D synthesis
blood

Kidneys – bean-shaped organs located retroperitoneally & on each side of the vertebral column; the major excretory
organ of urinary system (See figures 18.2 & 18.3, pages 497-498)
▪ divided into two major regions, outer cortex & inner medulla, which surrounds renal sinus
▪ Renal Capsule – layer of connective tissue that surrounds each kidney; around is a thick layer of adipose
tissue that protects the kidney from mechanical shock
▪ Hilum – medial area where renal artery & nerves enter & renal veins, ureter, & lymphatic vessels exit the
kidney
▪ Renal Sinus – cavity which contains blood vessels part of system for collecting urine, & adipose tissue
▪ Renal Pyramids – cone-shaped; bases are located at boundary between two regions & the tips project
towards the center of kidney
▪ Calyx – funnel-shaped structure that surrounds the tip of each pyramid
▪ Renal Pelvis – a larger funnel formed from joining of all the calyces
▪ Ureter – a small tube from narrowed renal pelvis which exits the kidney & connects to urinary
bladder

Urine Flow: ti$s &f ()*+l $y(+mi/ 0 1+ly1)s 0 ()*+l $)l2is 0 3()t)( 0 3(i*+(y 4l+//)(

Nephron – a functional unit of the kidney and each consists of: (See figures 18.4 & 18.5, pages 499-500)
1. Renal Corpuscle – housed the filtration portion of nephrons
o Bowman Capsule – enlarged end of nephron which is intended to form a double-walled
chamber; cavities open into proximal convoluted tubule which carries fluid away from the capsule
inner layer consists of podocytes, specialized cells wrapped around the glomerular
✔ capillaries
✔ contains the filtration membrane which consists of endothelium of glomerular
capillaries, podocytes, and the basement membrane
✔ filtrate – a fluid that is forced across the filtration membrane
o Glomerulus – a tuft of capillaries that lies within the indentation of Bowman capsule
✔ Afferent Arteriole – supplies the blood for filtration
✔ Efferent Arteriole – transports the filtered blood away from glomerulus

Juxtaglomerular Apparatus – a vital regulatory structure located next to glomerulus; responsible

for the secretion of enzyme renin; consists of:
✔ Juxtaglomerular Cells – cuff of specialized smooth muscle cells at the point
where the afferent arteriole enters the renal corpuscle
✔ Macula Densa – group of specialized cells at the part of distal convoluted tubule that
lies between the afferent & efferent arterioles
2. Proximal Convoluted Tubule – primary site for reabsorption of solutes & water
3. Loop of Henle
o Descending Limb – extends toward the renal sinus; critical site for water reabsorption by
osmosis
o Ascending Limb – extends toward the cortex; the filtered fluid flows going to distal
convoluted tubule

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 4. Distal Convoluted Tubule – empties fluid into a single collecting duct, in which multiple ducts
empty into a single papillary duct

Types of Nephrons: (See figure 18.5, page 500)

1. Juxtamedullary Nephrons – next to medulla that is approximately 15% of nephrons
2. Cortical Nephrons – do not extend deep into medulla

Blood Supply through Kidneys: (See figure 18.6, page 501)

Renal Arteries ► Interlobar Arteries ► Arcuate Arteries ► Interlobular Arteries ► Afferent Arteriole ►
Glomerulus ► Efferent Arteriole ► Peritubular Capillaries, including Vasa Recta ►
Interlobular Veins ► Arcuate Veins ► Interlobar Veins ► Renal Vein

Major Processes in Urine Production: (See process figure 18.7, page 503)
1. Filtration – movement of materials across the filtration membrane into the Bowman capsule to form filtrate
its driving force is the blood pressure
✔ Filtration Pressure – a pressure gradient which forces the fluid from glomerular capillary
✔ across filtration membrane into the Bowman capsule to form filtrate (See process figure 18.8,
page 503); influenced by three factors:
▪ glomerular capillary blood pressure – normally higher than blood pressure in most
capillaries (increased glomerular capillary blood pressure = increased filtration
pressure)
▪ blood protein concentration – encourages the movement of water by osmosis back
into glomerular capillaries that reduces overall filtration pressure
(decreased blood protein concentration = increased overall filtration process)
▪ pressure in Bowman capsule – resist the movement of fluid into
(decreased pressure in Bowman capsule = increased overall filtration process)

calculated by: Glomerular Capillary Pressure – Capsular Pressure – Colloidal Osmotic

Pressure
where:
o Glomerular Capillary Pressure is the blood pressure in glomerular capillary
o Capsular Pressure is due to pressure of filtrate already inside the Bowman
capsule
o Colloid Osmotic Pressure is the pressure inside the glomerular capillary

2. Tubular Reabsorption – solutes are reabsorbed across the wall of nephrons into the interstitial fluid
(See process figures 18.9-18.13, pages 505-508)

Solutes & water reabsorbed from proximal convoluted tubule enter the peritubular capillaries (65% of
filtrate volume)
▼
To descending limb, reabsorbed water & solutes then to the vasa recta (15% of filtrate volume)
▼
To ascending limb which dilutes the filtrate by removing solutes
▼
Solutes diffuse out of the nephron (Na+ via active transport; K+ & Cl- via cotransport)
▼
Highly concentrated filtrate is converted to dilute solution as it travels
▼
Enters the interstitial fluid of medulla & help concentration of solutes high
▼
To distal convoluted tubule & collecting duct which remove water & additional solutes (19% of filtrate
volume)
(Na+ & Cl- are the principal reabsorbed solutes)
▼
Leaving only 1% of original filtrate volume as urine

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3. Tubular Secretion- solutes are secreted across the wall of the nephron into the filtrate; can either be through:
Active Mechanism – actively transported into the nephron (H+, K+, creatinine, histamine, &
✔ penicillin)
✔ Passive Mechanism – diffuses into the lumen of nephron (ammonia secretion)

Regulation of Urine Concentration and Volume:

✔ 5 4&/y fl3i/ 1&*1)*t(+ti&* 6 5 7+t)( ()+4s&($ti&* 6 concentrated urine (eliminates 5 solute &
conserves water)
✔ 8 4&/y fl3i/ 1&*1)*t(+ti&* 6 8 7+t)( ()+4s&($ti&* 6 diluted urine (eliminates 5 water &
conserves solutes)
✔ 5 4l&&/ 2&l3m) 6 5 4l&&/ $()ss3() 6 large volume of urine
✔ 8 4l&&/ 2&l3m) 6 8 4l&&/ $()ss3() 6 small volume of urine

Hormonal Mechanisms: (See homeostasis figure 18.17, page 511)

1. Renin-Angiotensin-Aldosterone (RAA) Mechanism (Discussed in Chapter 13. See figure
18.14, page 509)
2. Anti-Diuretic Hormone (ADH) Mechanism (Discussed in Chapter 10. See figure 18.15, page 510)
3. Atrial Natriuretic Hormone (ANH) Mechanism (Discussed in Chapter 10. See figure 18.16,
page 510)

Urinary Bladder – hollow, muscular container that stores urine; can hold to a maximum of about 1000mL
▪ Trigone – a triangle-shaped portion of urinary bladder located between the opening of ureters & urethra
▪ Internal Urethral Sphincter – smooth muscles that prevents urine leakage from the urinary
bladder
▪ External Urethral Sphincter – skeletal muscle; allows a person to voluntarily start or stop the flow
of urine out

Micturition Reflex – activated by stretch of urinary bladder wall; an automatic reflex but can be inhibited or
stimulated by higher centers in brain (See process figure 18.19, page 513)
Urine Movement: 9)*+l :)l2is 0 ;()t)(s 0;(i*+(y <l+//)(
▼
Reaches a volume (few hundred mL), increases bladder pressure
▼
Activates Stretch Receptors leading to Micturition Reflex
▼
Conduction of action potential to spinal cord through pelvic nerves
▼
Parasympathetic response causes urinary bladder to contract
▼
Decreases somatic motor nerves to external urethral sphincter causing it to relax
▼
Urine flows out

Body Fluid Compartments:

▪ Intracellular Fluid Compartment – includes the fluid inside all the cells of the body
▪ Extracellular Fluid Compartment – includes all the fluid outside the cells (interstitial fluid, plasma
within blood vessels, fluid in lymphatic vessels)
o also includes specialized fluids such as aqueous & vitreous humor of the eye, CSF, synovial fluid,
serous fluid in body cavities, fluid secreted by glands, renal filtrate, & urine in bladder

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pH – concentration of H+ normal value: 7.35 – 7.45); controlled by three factors: (See figure 18.22, page 519)
1. Buffers – chemicals that resist a change in the pH of a solution; contain salts of either weak acids or weak
bases
✔ bind to H+ when H+ increases or release H+ when H+ decreases
3- -
✔ major buffers in body fluids are proteins, PO4 buffer system, and the HCO3 buffer
system
2. Respiratory System- responds rapidly to a change in pH since neurons in respiratory center of the
brain are sensitive to CO2 levels & pH
✔ 5 =>2 levels & low pH = elevated rate & depth of respiration to eliminate CO2 & pH rises back
8 =>2 levels & high pH = reduced rate & depth of respiration to conserve CO2 & pH goes
✔ down
3. Kidneys – the nephrons secrete H+ into the urine & can directly regulate the pH of body fluids
✔ 8 4l&&/ $H 6 5 s)1()ti&* &f H+ i* /ist+l 1&*2&l3t)/ t343l)s @ 5 ()+4s&($ti&* &f H=>3- A 5
4l&&/ $H
✔ 5 4l&&/ $H 6 8 s)1()ti&* &f H+ i* /ist+l 1&*2&l3t)/ t343l)s @ 5 l&ss &f H=>3- i* 3(i*) A 8
4l&&/ $H

Buffer
pH
System Respiratory Metabolic Manifestations
level
Failures
excess in acidic substances
unable to eliminate (lactic acid & ketone bodies)
below ✔ CNS malfunctions
Acidosis adequate amounts of due to increased metabolism &
7.35 ✔ disoriented
CO2 decreased ability eliminate H+
in the urine
✔ hyperexcitability of nervous
system
results from rapid elimination
results from ✔ spasms & tetanic contractions
above of H+ (severe vomiting) or
Alkalosis hyperventilation as ✔ extreme nervousness &
7.45 when excess aldosterone is
response to stress convulsions
secreted by adrenal cortex
✔ cause of death: tetany of
respiratory muscles

Diseases and Disorders of Urinary System:

Condition Description
Cystitis inflammation of urinary bladder which usually results from bacterial infection
Kidney Stone / consists mainly of calcium oxylate that can cause excruciating & debilitating discomfort in lateral
Renal Calculus abdominal region
For the listed conditions below, refer to Table 18.3, page 520 of the book for description:
▪ Glomerulonephritis
▪ Acute Glomerulonephritis
▪ Chronic Glomerulonephritis
▪ Acute Renal Failure
▪ Chronic Renal Failure

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CHECK FOR UNDERSTANDING

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given
to the correct answer and another one (1) point for the correct ratio. Superimpositions or erasures in your
answer/ratio is not allowed. You are given 20 minutes for this activity.

1. Which of the following are considered functions of the urinary system? (Select all that apply)
a. Vitamin D synthesis d. Absorption of digested molecules
b. Regulation of white blood cell synthesis e. Regulation of blood volume and pressure
c. Excretion
ANSWER: A, C, E
RATIO: Options A, C, and E are the functions of the urinary system. Option D or the absorption of digested molecules
Is under the digestive system while Option B is under the body’s immune system.

2. The urinary system is composed of:

a. Two kidneys, two urethrae, a ureter, and a urinary bladder
b. Two kidneys, a ureter, a urinary bladder, and a urethra
c. Two kidneys, two ureters, a urinary bladder, and a urethra
d. Two kidneys, two ureters, two urethrae, and a urinary bladder
ANSWER: C
RATIO: The kidneys, renal pelvis, ureters, bladder, and urethra are all organs of the urinary system. The body turns nutrients into
energy by absorbing them from meals.

3. Which of the following is a connective tissue that surrounds the kidneys?

a. Hilum c. Calyx
b. Renal capsule d. Renal pyramid
ANSWER: B
RATIO: The thin membranous sheath that surrounds the outer surface of each kidney is known as the renal capsule. The capsule is
made up of strong fibers, primarily collagen and elastin (fibrous proteins), that support the kidney mass while also protecting critical
tissue from damage.

4. This is known to be the functional units of the kidneys:

a. Renal papilla c. Juxtaglomerular apparatus
b. Glomerulus d. Nephrons
ANSWER: D
RATIO: The nephron is the kidney's fundamental structural and functional unit. The word nephron is derived from the Greek word
nephrons, which means kidney. Its main job is to keep water and soluble compounds in check by filtering the blood, reabsorbing what's
required, and excreting the excess as urine.

5. Which of the following statements is true?

a. Filtration is the movement of materials across the wall of the nephron into Bowman’s capsule to form
a filtrate.
b. In reabsorption, the solutes are reabsorbed across the filtration membrane into the interstitial fluid by
transport processes, such as active transport and cotransport.
c. In secretion, solutes are secreted across the wall of the nephron into the filtrate.
d. All statements need further evaluation.
ANSWER: C
RATIO: Option D which states in secretion, solutes are secreted across the wall of the nephron into the filtrate is true.

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6. The ascending limb of the loop of Henle functions to:
a. dilute the filtrate by removing solutes.
b. remove water and additional solutes.
c. help regulate aldosterone secretion.
d. increase the rate of active transport of Na+ in the distal tubules and collecting ducts.
ANSWER: D
RATIO: The primary functions of the ascending limb of the loop of Henle is to increase the rate of active transport of
Na+ in the distal tubules and collecting ducts.

7. Approximately L of filtrate enters the nephrons each day; of that volume % is reabsorbed
in the proximal tubule.
a. 80 L and 35% c. 240 L and 85%
b. 180 L and 65% d. 280 L and 99%
ANSWER: B
RATIO: With up to 180 liters of fluid flowing through the kidney's nephrons every day, it's clear that the majority of that fluid and its
contents must be reabsorbed. The proximal convoluted tubule, loop of Henle, distal convoluted tubule, and, to a lesser extent, the
collecting ducts are all involved in reabsorption.

8. Antidiuretic hormone (ADH) regulates the amount of water reabsorbed by the distal tubules and collecting
ducts. When ADH levels increase, the permeability of the distal tubules and collecting ducts to water decreases,
and less water is reabsorbed from the filtrate. This statement is:
a. Definitely true c. Partially true
b. Definitely false d. Partially false
ANSWER: B
RATIO: ADH regulates the amount of water reabsorbed by the distal convoluted tubules and collecting ducts.
When ADH levels increase, the permeability of the distal convoluted tubules and collecting ducts to water increases, and more water is
reabsorbed from the filtrate.

9. Starting from the glomerular capsule, the correct order of the renal tubule regions is:
a. proximal convoluted tubule, distal convoluted tubule, loop of Henle
b. distal convoluted tubule, loop of Henle, proximal convoluted tubule
c. loop of Henle, proximal convoluted tubule, distal convoluted tubule
d. proximal convoluted tubule, loop of Henle, distal convoluted tubule
e. distal convoluted tubule, proximal convoluted tubule, loop of Henle.
ANSWER: D
RATIO: The correct order of the renal tubule region is from the proximal convoluted tubule to the loop of Henle and
In the distal convoluted tubule.

10. Pepper, who is drinking beer at a party, falls and hits her head on the ground. Her friend Orah dials “911”
because Pepper is unconscious, depressed ventilation (shallow and slow respirations), rapid heart rate, and is
profusely bleeding from both ears. Which primary acid-base imbalance is Pepper at risk for if medical attention
is not provided?
a. Metabolic Acidosis c. Respiratory Acidosis
b. Metabolic Alkalosis d. Respiratory Alkalosis
ANSWER: D
RATIO: Respiratory Alkalosis is a condition characterized by a low amount of carbon dioxide in the blood caused by excessive
breathing. The most common cause of respiratory alkalosis is hyperventilation. Overbreathing is another term for hyperventilation.

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RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers. You can now ask questions and debate among yourselves. Write
the correct answer and correct/additional ratio in the space provided.

1. ANSWER:
RATIO:

2. ANSWER:
RATIO: _

3. ANSWER:
RATIO:

4. ANSWER:
RATIO:

5. ANSWER:
RATIO:

6. ANSWER:
RATIO:

7. ANSWER:
RATIO:

8. ANSWER:
RATIO:

9. ANSWER:
RATIO:

10. ANSWER:
RATIO:

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LESSON WRAP-UP

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to
help you track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Activity: LEARNING SHEETS

This technique will help you engage by providing a question sheet that guides & stimulates the learning. You will
answer the questions per column, as fast as you can. It will be great to time yourself as you answer on the space
provided. Have fun!

FIND-OUT QUESTIONS:

1. Another term for kidney stones, which form when urine becomes extremely concentrated.
Answer: Renal Calculi
2. The smooth triangular region of the bladder base that is outlined by the openings of the two ureters and the urethra.
Answer: Trigone
3. About two-thirds of body fluid is found within living cells; this fluid is called the .
Answer: Intracellular fluid
4. The process of filtration occurring in a specific structure in a nephron is called .
Answer: Glomerular Filtration
5. The percentage of filtrate eventually reabsorbed into the bloodstream is closest to .
Answer: 99%

LARGER QUESTIONS: (These can only be answered if the FIND-OUT QUESTIONS are completed.)

1. Illustrate the blood flow through the kidney.

The renal artery is the blood vessel that supplies blood to your kidney. Until the blood reaches the nephrons, this big blood
artery branches into smaller and smaller blood vessels. Your blood is filtered in the nephron by the glomeruli, which are small blood
vessels, and then flows out of your kidney through the renal vein.

2. The kidneys can help maintain a rising blood pH by excreting ions and reabsorbing
ions by the tubule cells.
Answer: bicarbonate , bicarbonate

3. Describe the functions of buffer systems in the body.

A buffer is a chemical agent that helps keep the pH of a solution roughly constant, even when acids or bases are added.
Buffering is crucial in living systems because it allows them to maintain homeostasis, or a relatively consistent internal environment.

CHALLENGE QUESTION:
1. What will happen to the urinary system of a person with incontinence in urethral control? Describe and explain the
mechanism.

The bladder can't contain as much urine as the body produces, or it can't drain entirely, resulting in urinary leakage in tiny
quantities. Patients may suffer “dribbling” or a continuous trickling of urine from the urethra if they need to pee often. The
muscles in the urinary system must work harder to retain urine until you are ready to pee when the muscles that support the
urinary tract are weak. Urinary incontinence or leakage can result from the additional tension or strain on the bladder and
urethra.

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