St.

Paul University Philippines - College of Nursing School of Nursing and Allied Health Sciences 2nd Semester 2018-2019
 Learning Objectives
• On completion of the week’s activity, the
students should be able to:

• describe the structures and functions of the

renal system

• describe a nephron
 Learning Objectives
• describe the process of urine formation

• discuss how the kidneys help maintain blood

pressure, fluids and electrolyte balance

• predict the outcomes of disturbed renal

system functions
HUMAN URINARY SYSTEM
 Kidney Anatomy
• Kidneys
– two bean-shaped organs that are located at
the back of the peritoneum (retroperitoneal)
in the superior lumbar region
 Kidney Anatomy
– receive 25% of the total cardiac output per
minute
 Kidney Anatomy
– structural and functional units of the kidneys
are called nephrons
 Kidney Anatomy
• each nephron

– consists of a glomerulus and renal tubule

– subdivisions of the renal tubule
(from the glomerulus) are

 glomerular (Bowman’s) capsule

 proximal convoluted tubule (PCT)
 loop of Henle (LOH)
 distal convoluted tubule (DCT)
 collecting duct (CD)
URINE FORMATION
 Kidney Physiology:
Mechanisms of Urine Formation
– functions of the nephrons:
• filtration
• tubular reabsorption
• tubular secretion
– regulate the volume, composition, pH of the blood, and
eliminate nitrogenous metabolic wastes (urea)
Kidney Physiology: Mechanisms of Urine Formation

Glomerular filtration

– the glomeruli function as filters

– high glomerular blood pressure (55 mm Hg) occurs

because the glomeruli are fed and drained by
arterioles, and the afferent arterioles are larger
in diameter than the efferent arterioles
Kidney Physiology: Mechanisms of Urine Formation

Tubular reabsorption

• needed substances are removed from the filtrate

by the tubule cells

• returned to the peritubular capillary blood

Kidney Physiology: Mechanisms of Urine Formation

– actively reabsorbed substances include

• glucose
• amino acids
• some ions

– PCT cells are most active in reabsorption

• most of the nutrients, 65% of the water and sodium
ions, and the bulk of actively transported ions are
reabsorbed in the PCT
Kidney Physiology: Mechanisms of Urine Formation

– reabsorption of additional sodium ions and

water occurs in the DCT and CD, and is
“hormonally” controlled:

• aldosterone increases the primary reabsorption of

sodium (water follows after) mostly at the DCT

• antidiuretic hormone (ADH) enhances water

reabsorption by the CD, not salt
ANTI-DIURETIC HORMONE
ALDOSTERONE
R-A-A MECHANISM
Kidney Physiology: Mechanisms of Urine Formation

Tubular secretion
– means of adding substances to the filtrate
(from the blood or tubule cells)

– active process that is important in eliminating

drugs, certain wastes, & excess ions & in
maintaining the acid-base balance of the
blood
Kidney Physiology: Mechanisms of Urine Formation

– the “descending” limb of the LOH is

permeable to water, which leaves the filtrate &
enters the medullary interstitium

– the filtrate & medullary fluid at the bend of the

LOH are concentrated (hyperosmolar)
Kidney Physiology: Mechanisms of Urine Formation

– the “ascending” limb of the LOH is NOT

permeable to water:
• Na+ and Cl– move out of the filtrate into the
interstitial space, passively in the thin limb (or
descending limb of the LOH) & actively in the thick limb
(or ascending limb of the LOH)

– the filtrate becomes more dilute

Kidney Physiology: Mechanisms of Urine Formation

– as filtrate flows through the CD in the inner

medulla, urea diffuses into the interstitial
space

– from here, urea (nitogenous waste) re-enters

the thin limb & is recycled
Kidney Physiology: Mechanisms of Urine Formation

– the blood flow in the vasa recta is sluggish, &

the contained blood equilibrates with the
medullary interstitial fluid

– hence, blood entering & exiting the medulla in

the vasa recta is isotonic to blood plasma &
the high solute concentration of the medulla is
maintained
Kidney Physiology: Mechanisms of Urine Formation

– in the absence of ADH, dilute urine is formed

because the dilute filtrate reaching the CD is
simply allowed to pass from the kidneys
Kidney Physiology: Mechanisms of Urine Formation

– as blood levels of ADH rise, the CDs become

more permeable to water, & water moves out
of the filtrate as it flows through the
hyperosmotic medullary areas

– consequently, more concentrated urine is

produced, & in smaller amounts
MICTURATION
 Urine
• Urine
– 95% water
– typically clear, yellow, aromatic, & slightly acidic
– its specific gravity ranges from 1.001 to 1.035
– substances not normally found (or, in large amounts)
in urine include glucose, proteins (none to trace in
cases of exercise), erythrocytes, leukocytes (although
occasionally present), hemoglobin, & bile pigments
 Urine
– daily urinary volume is typically 1.4–1.5L to as
much as 1.8 L, but this depends on the state
of hydration of the body
FLUID and ELECTROLYTE
BALANCE
 Ureters
• Ureters

– muscular tubes running retroperitoneally from

each kidney to the urinary bladder

– conduct urine by peristalsis from the renal

pelvis to the urinary bladder
 Urinary Bladder
• Urinary bladder

– distensible muscular sac that lies posterior to

the pubic symphysis

– functions to store urine

 Urethra
• Urethra
– muscular tube that helps move urine from the
bladder to the body exterior
 Urethra
– in females, the urethra is 3 – 4 cm long
• conducts only urine

– in males, it is 20 cm long
• conducts both urine & semen (“urogenital system”)
 References
• Vanputte, C., Regan, J., & Russo, A. (2019). Seeley’s
Essentials of Anatomy & Physiology (10th Ed.) New York
City, McGraw Hill Education

• Marieb, E.N. (2006). Essentials of Human Anatomy and

Physiology. San Francisco, Pearson.

• Tortora, G. J. (2006). Principles of Anatomy and

Physiology. (11th. Ed.). New Jersey, John Wiley and
Sons, Inc.