URINARY SYSTEM

MRS. J.K.KAPOBE
NDOLA SCHOOL OF NURSING
 INTRODUCTION
• The body is made up of several systems that
remove waste products from the body.
• This waste is generated by cells that produce a
variety of wastes that are toxic to the body if
left to accumulate.
• Body fluids such as lymph, and blood carry
wastes from the tissues that produce them.
• While other structures remove wastes from
blood and transport them to the outside.
• The respiratory system is one of such systems
that removes waste from the body in form of
carbondioxide and the urinary system
removes certain salts and nitrogenous wastes.
ORGANS OF THE URINARY SYSTEM
• The urinary system consists of :
• Two kidneys, which remove substances from
the blood, form urine and help regulate
certain metabolic processes.
• Two ureters, which transport urine from the
kidneys.
• The urinary bladder, which stores urine
• The urethra , which conveys urine to the
outside of the body.
• The formation of urine is the function of the
kidneys, and the rest of the system is
responsible for eliminating the urine.
 THE KIDNEYS
• The kidneys are located on either side of the
vertebral column in a depression high on the
posterior wall of the abdominal cavity.
• The upper and lower boarders of the kidneys
are generally at the levels of the twelfth
thoracic and third lumbar vertebrae.
• In most individuals the left kidney is 1.5-2.0cm
higher than the right one.
• The kidneys are positioned
retroperitoneally.(behind the parietal
peritonium).
• The kidneys are embedded in adipose tissue
that acts as a cushion and is in turn covered by
a fibrous connective tissue membrane called
the renal fascia, which helps hold the kidneys
in place.
• Each kidney has an indentation called the hilus
on its medial side which is deeply concave.
• The lateral surface of each kidney is convex.
• The resulting medial depression leads into a
hollow chamber called the renal sinus.
• The entrance to this sinus is the hilum, and
through it passes blood vessels, nerves,
lymphatic vessels and the ureter.
• The superior end of the ureter expands to
form a funnel –shaped sac called the renal
pelvis.
• The pelvis is divided into two or three tubes
called major calyces and these in turn are
divided into several minor calyces.
• The renal artery is a branch of the abdominal
aorta, and the renal vein returns blood to
the inferior vena cava.
• The ureter carries urine from the kidney to
the urinary bladder.
 INTERNAL STRUCTURE
OF THE KIDNEY
• The lateral and middle areas are tissue layers,
and the medial area at the hilus is a cavity.
• The outer tissue layer is called the renal
cortex; it is made of renal corpuscles and
convoluted tubules.
• These are parts of the nephron.
• The inner tissue layer is the renal medulla,
which is made of loops of Henle and collecting
tubules (also parts of the nephron).
• The renal medulla consists of wedge-shaped
pieces called renal pyramids.
• The tip of each pyramid is its apex or papilla.
• The third area is the renal pelvis; this is not a
layer of tissues, but rather a cavity formed by
the expansion of the ureter within the kidney
at the hilus.
• Funnel shaped extensions of the renal pelvis,
called calyces (singular: calyx), enclose the
papillae of the renal pyramids.
• Urine flows from the renal pyramids into the
calyces, then to the renal pelvis and out into
the ureter.
 THE NEPHRONS
• The nephron is the structural and functional
unit of the kidney.
• Each kidney contains approximately 1 million
nephrons.
• It is in the nephrons, with their associated
blood vessels, that urine is formed.
• Each nephron has two major portions: a renal
corpuscle and a renal tubule.
• Each of these major parts has further
subdivisions.
 RENAL CORPUSCLE

• A renal capsule is composed of a tangled

cluster of blood capillaries called a
glomerulus.
• A thin –walled, saclike structure called
glomerular capsule (Bowman’s capsule)
surrounds the glomerulus.
• The glomerulus is a capillary network that
arises from an afferent arteriole and empties
into an efferent arteriole.
• The diameter of the efferent arteriole is
smaller than that of the afferent arteriole,
which helps maintain a fairly high blood
pressure in the glomerulus.
• The glomerular capsule (Bowman’s capsule),
which is an expansion at the proximal end of a
renal tubule, receives fluid filtered at the
glomerulus.
• The inner layer of Bowman’s capsule is made
of podocytes; the name means “foot cells,”
and the “feet” of the podocytes are on the
surface of the glomerular capillaries.
• The arrangement of podocytes creates pores,
spaces between adjacent “feet,” which make
this layer very permeable.
• The outer layer of Bowman’s capsule has no
pores and is not permeable.
• The renal tubule leads away from the
glomerular capsule and coils into a part of the
nephron called the proximal convoluted
tubule.
• The proximal convoluted tubule dips towards
the renal pelvis, where it becomes the
descending limb of the nephron (Loop of
Henle).
• The tube then curves backwards towards its
renal corpuscle and forms the ascending limb
of nephron loop.
• The ascending limb returns to the region of
the renal corpuscle, where it coils tightly again
and is called the distal convoluted tubule.
• Distal convoluted tubules from several
nephrons merge in the renal cortex to form a
collecting duct, which in turn passes into the
renal medulla and enlarges as other distal
convoluted tubules join it.
• The resulting tube empties its contents into a
minor calyx through an opening in a renal
papilla.
THE NEPHRONE
 Structure of the Bladder

• The bladder is located on the floor of the pelvic

cavity.
• It is pear shaped but becomes oval as it fills with
urine.
• It has a capacity of about 600mls and rises into
the abdominal cavity when full.
• The bladder is a musculomembranous sac
consisting of 4 layers which are serous, muscular,
sub-mucus and mucus discussed as below.
• 1. Serous
• the outer "serous" layer is a partial layer
derived from the peritoneum, consists of two
types: parietal peritoneum and fibrous
connective tissue.
Muscular
• the detrusor muscle is the muscle of the
urinary bladder wall.
• It consists of three layers of smooth
(involuntary) muscle fibers.
• Most of the fibers of the external layer are
arranged longitudinally.
• Those of the middle layer are mostly arranged
in a circular configuration.
• The muscle fibers of the internal layer have a
longitudinal arrangement
• Sub-mucous
• This is a thin layer of areolar tissue that
loosely connects the muscular layer with the
mucous layer, intimately attached to the
mucous layer.
• Mucous
• the innermost layer of the wall of the urinary bladder is
the mucous membrane (also called the "mucosa").
• It contains transitional epithelium tissue that can
stretch.
• Because it is only loosely attached to the (strong and
substantial) muscular layer, the mucosa falls into many
folds known as rugae
• The features observable on the inside of the bladder
are the ureter orifices, the trigone, and the internal
orifice of the urethra.
• The trigone is a smooth triangular region
between the openings of the two ureters and
the urethra.
• It does not present any rugae even when the
bladder is empty.
THE BLADDER MUSCLES
 FORMATION OF URINE
• Waste products protein metabolism are
excreted , electrolyte balance is maintained
and the acid base balance is influenced by the
excretion of hydrogen ions.
• There are three phases in the formation of
urine which are:
• Simple filtration
• Selective reabsoption
• Secretion
 Glomerular Filtration /Simple
filtration
• blood from the renal artery enters the smaller
afferent arteriole which then turns into even
smaller capillaries of the glomerulus.
• As the blood vessels travel this course the vessels
get narrower and narrower.
• This results in an increase in blood pressure.
• This high pressure forces a plasma-like fluid to
filter from the blood in the glomerulus through a
semi permeable membrane into the Bowman's
capsule.
• This fluid is called the filtrate.
• It consists of water, glucose, amino acids,
some salts, and urea.
• The filtrate does not contain plasma proteins
because they are too large to pass through the
pores of the capillary membrane so they
remain in the blood.
• Waste products are dissolved in blood plasma
so they pass into the renal filtrate.
• Useful materials such as nutrients and
minerals are also dissolved in plasma and are
also present in renal filtrate.
• Therefore, renal filtrate is very much like
blood plasma; except that there is far less
protein and no blood cells are present.
• The glomerular filtration rate (GFR) is the
volume of filtrate that both kidneys can filter
per minute and this is a measurement of how
well the kidneys are processing wastes.
• GFR varies with age but in a normal healthy
adult it is about 120-130mls /minute or
180litresin 24hrs.
• The GFR determines the stage of chronic renal
disease
 Tubular reabsorption
• This process includes the reabsorption of
useful substances from the filtrate within the
renal tubules into the capillaries around the
tubules.
• These substances are water, glucose, amino
acids, vitamins, bicarbonate ions, and the
chloride salts of calcium, magnesium, sodium
and potassium.
• Some constituents of the filtrate like glucose
and amino acids don’t pass out in urine as
they are completely reabsorbed, unless they
are in great quantities
• Reabsorption starts in the proximal tubules
and continues through the loop of Henle, to
the distal tubule and then to the collecting
tubules.
• In some cases reabsorption is regulated by hormones
like:
• Parathyroid hormone from the parathyroid gland plus
calcitonin from the thyroid gland regulates reabsorption of
calcium and phosphate from the distal convoluted tubule
• Antidiuretic hormone from posterior pituitary lobe
increases the permeability of the distal convoluted tubule
and the collecting tubule there by increasing the
reabsorption of water.
• Aldosterone from adrenal cortex increases
reabsorption of Na+ and water and secretion of k+
.The process is regulated by negative feedback.
• Atrial Natriuretic peptide (ANP), secreted by atria
of the heart in response to stretching of the atrial wall
.This reduces the reabsorption of NA+ and water from
proximal convoluted tubule and collecting duct.
• Tubular secretion -is the opposite of
reabsorption.
• This mechanism also changes the composition
of urine.
• Some substances are actively secreted into the
tubules.
• Substances secreted into the urine include
ammonia, hydrogen ions, potassium and some
drugs.
 The process of micturition
• Micturition (Urination) is the process by which
urine is expelled from the bladder.
• It is controlled by the central nervous system
in the brain and spinal cord.
• It involves the contraction of the detrusor
muscle, and pressure from surrounding
structures.
• Urination also involves the relaxation of the
external urethral sphincter which surrounds
the urethra about 3 centimeters from the
bladder, and is composed of voluntary
muscular tissue.
• Urination is usually stimulated by the
distention of the bladder as it fills with urine.
• When the walls of the bladder contract, nerve
receptors are stimulated, and the urination
reflex is triggered.
• The urination reflex causes the internal
urethral sphincter to open and the external
urethral sphincter to relax.
• This relaxation allows the bladder to empty.
The bladder can hold about 600 ml of urine.
• The desire to urinate may not occur until the
bladder contains 250-300 ml
• There is a complex interaction between will-
powered (somatic) and non will-powered
(autonomic) nervous systems.
• In the will-powered nervous system, there is the
parasympathetic and the sympathetic systems.
• During the bladder filling phase, the sympathetic
nervous system dominates, while the
parasympathetic system dominates during the
emptying phase.
 FORMATION OF URINE
• There are 3 phases that are involved in urine
formation which are:
• Simple filtration
• Selective reabsorption
• Secretion
• The process of urine formation begins when
the glomerular capillaries filter plasma, a
process called glomerular filtration.
• In glomerular filtration, blood pressure forces
plasma, dissolved substances, and small proteins
out of the glomeruli and into Bowman’s capsules.
• This fluid is no longer plasma but is called renal
filtrate.
• The blood pressure in the glomeruli, compared
with that in other capillaries, is relatively high,
about 60 mmHg.
• The pressure in Bowman’s capsule is very low,
and its inner, podocyte layer is very permeable,
so that approximately 20% to 25% of the blood
that enters glomeruli becomes renal filtrate in
Bowman’s capsules.
• The blood cells and larger proteins are too large
to be forced out of the glomeruli, so they remain
in the blood.
• Waste products are dissolved in blood plasma, so
they pass into the renal filtrate.
• Useful materials such as nutrients and
minerals are also dissolved in plasma and are
also present in renal filtrate.
• Filtration is not selective with respect to
usefulness; it is selective only with respect to
size.
• Therefore, renal filtrate is very much like
blood plasma, except that there is far less
protein and no blood cells are present.
• The glomerular filtration rate (GFR) is the
amount of renal filtrate formed by the kidneys
in 1 minute, and averages 100 to 125 mL per
minute.
• GFR may be altered if the rate of blood flow
through the kidney changes.
• If blood flow increases, the GFR increases, and
more filtrate is formed.
• If blood flow decreases (as may happen
following a severe hemorrhage), the GFR
decreases, less filtrate is formed, and urinary
output decreases.
 TUBULAR REABSORPTION

• Tubular reabsorption takes place from the

renal tubules into the peritubular capillaries.
• In a 24-hour period, the kidneys form 150 to
180 liters of filtrate, and normal urinary
output in that time is 1 to 2 liters.
• Therefore, it becomes apparent that most of
the renal filtrate does not become urine.
• Approximately 99% of the filtrate is
reabsorbed back into the blood in the
peritubular capillaries.
• Only about 1% of the filtrate will enter the
renal pelvis as urine.
• Most reabsorption and secretion (about 65%)
take place in the proximal convoluted tubules,
whose cells have microvilli that greatly
increase their surface area.
• The distal convoluted tubules and collecting
tubules are also important sites for the
reabsorption of water
 Mechanisms of Reabsorption
1. Active transport—the cells of the renal tubule
use ATP to transport most of the useful
materials from the filtrate to the blood.
• These useful materials include glucose, amino
acids, vitamins, and positive ions.
• For many of these substances, the renal
tubules have a threshold level of reabsorption.
• This means that there is a limit to how much
the tubules can remove from the filtrate.
• All parts of the renal tubule are surrounded by
• peritubular capillaries, which arise from the
efferent arteriole.
• The peritubular capillaries will receive the
materials reabsorbed by the renal tubules.
 BLOOD VESSELS OF THE KIDNEY

• The pathway of blood flow through the kidney

is an essential part of the process of urine
formation.
• Blood from the abdominal aorta enters the
renal artery, which branches extensively
within the kidney into smaller arteries
• The smallest arteries give rise to afferent
arterioles in the renal cortex
• From the afferent arterioles, blood flows
• into the glomeruli (capillaries), to efferent
arterioles, to peritubular capillaries, to veins
within the kidney, to the renal vein, and finally
to the inferior vena cava.
• Remember that in this pathway there are two
sets of capillaries, and recall that it is in
capillaries that exchanges take place between
the blood and surrounding tissues.
• Therefore, in the kidneys there are two sites of
exchange.
• The exchanges that take place between the
nephrons and the capillaries of the kidneys
will form urine from blood plasma.
 FORMATION OF URINE (summary)

• The formation of urine involves three major

processes. The first is glomerular filtration,
which takes place in the renal corpuscles.
• The second and third are tubular reabsorption
and tubular secretion, which take place in the
renal tubules.
 GLOMERULAR FILTRATION
• Filtration is the process in which blood
pressure forces plasma and dissolved material
out of capillaries.
• In glomerular filtration, blood pressure forces
plasma, dissolved substances, and small
proteins out of the glomeruli and into
Bowman’s capsules.
• This fluid is no longer plasma but is called
renal filtrate.
• The blood pressure in the glomeruli,
compared with that in other capillaries, is
relatively high, about 60 mmHg.
• The pressure in Bowman’s capsule is very low,
and its inner, podocyte layer is very
permeable, so that approximately 20% to 25%
of the blood that enters glomeruli becomes
renal filtrate in Bowman’s capsules.
• The blood cells and larger proteins are too
large to be forced out of the glomeruli, so they
remain in the blood.
• Waste products are dissolved in blood plasma,
so they pass into the renal filtrate.
• Useful materials such as nutrients and
minerals are also dissolved in plasma and are
also present in renal filtrate.
• Filtration is not selective with respect to
usefulness; it is selective only with respect to size.
• Therefore, renal filtrate is very much like blood
plasma, except that there is far less protein and
no blood cells are present.
• The glomerular filtration rate (GFR) is the amount
of renal filtrate formed by the kidneys in 1
minute, and averages 100 to 125 mL per minute.