Anatomy and Physiology of the Urinary System

Introduction
The Urinary System is a group of organs in the body concerned with filtering out
excess fluid and other substances from the bloodstream. The substances are filtered
out from the body in the form of urine. Urine is a liquid produced by the kidneys,
collected in the bladder and excreted through the urethra. Urine is used to extract
excess minerals or vitamins as well as blood corpuscles from the body. The Urinary
organs include the kidneys, ureters, bladder, and urethra. The Urinary system works
with the other systems of the body to help maintain homeostasis. The kidneys are the
main organs of homeostasis because they maintain the acid base balance and the
water salt balance of the blood.
Functions of the Urinary System
One of the major functions of the Urinary system is the process of excretion. Excretion
is the process of eliminating, from an organism, waste products of metabolism and other
materials that are of no use. The urinary system maintains an appropriate fluid volume
by regulating the amount of water that is excreted in the urine. Other aspects of its
function include regulating the concentrations of various electrolytes in the body fluids
and maintaining normal pH of the blood. Several body organs carry out excretion, but
the kidneys are the most important excretory organ. The primary function of the kidneys
is to maintain a stable internal environment (homeostasis) for optimal cell and tissue
metabolism. They do this by separating urea, mineral salts, toxins, and other waste
products from the blood. They also do the job of conserving water, salts, and
electrolytes. At least one kidney must function properly for life to be maintained. Six
important roles of the kidneys are:

Regulation of plasma ionic composition: Ions such as sodium, potassium, calcium,

magnesium, chloride, bicarbonate, and phosphates are regulated by the amount that
the kidney excretes.

Regulation of plasma osmolarity: The kidneys regulate osmolarity because they have
direct control over how many ions and how much water a person excretes.

Regulation of plasma volume: Your kidneys are so important they even have an effect
on your blood pressure. The kidneys control plasma volume by controlling how much
water a person excretes. The plasma volume has a direct effect on the total blood
volume, which has a direct effect on your blood pressure. Salt(NaCl)will cause osmosis
to happen; the diffusion of water into the blood.

Regulation of plasma hydrogen ion concentration (pH): The kidneys partner up with
the lungs and they together control the pH. The kidneys have a major role because they
control the amount of bicarbonate excreted or held onto. The kidneys help maintain the
blood Ph mainly by excreting hydrogen ions and reabsorbing bicarbonate ions as
needed.
Removal of metabolic waste products and foreign substances from the
plasma: One of the most important things the kidneys excrete is nitrogenous waste. As
the liver breaks down amino acids it also releases ammonia. The liver then quickly
combines that ammonia with carbon dioxide, creating urea which is the primary
nitrogenous end product of metabolism in humans. The liver turns the ammonia into
urea because it is much less toxic. We can also excrete some ammonia, creatinine and
uric acid. The creatinine comes from the metabolic breakdown of creatine phospate (a
high-energy phosphate in muscles). Uric acid comes from the break down of
nucleotides. Uric acid is insoluble and too much uric acid in the blood will build up and
form crystals that can collect in the joints and cause gout.

Secretion of Hormones: The endocrine system has assistance from the kidney's when
releasing hormones. Renin is released by the kidneys. Renin leads to the secretion of
aldosterone which is released from the adrenal cortex. Aldosterone promotes the
kidneys to reabsorb the sodium (Na+) ions. The kidneys also secrete erythropoietin
when the blood doesn't have the capacity to carry oxygen. Erythropoietin stimulates red
blood cell production. The Vitamin D from the skin is also activated with help from the
kidneys. Calcium (Ca+) absorption from the digestive tract is promoted by vitamin D.

Organs in the Urinary System

Kidneys and Their Structure

The kidneys are a pair of bean shaped, reddish brown organs about the size of
your fist.It measures 10-12 cm long. They are covered by the renal capsule, which is a
tough capsule of fibrous connective tissue. Adhering to the surface of each kidney is two
layers of fat to help cushion them. There is a concaved side of the kidney that has a
depression where a renal artery enters, and a renal vein and a ureter exit the kidney.
The kidneys are located at the rear wall of the abdominal cavity just above the waistline,
and are protected by the ribcage. They are considered retroperitoneal, which means
they lie behind the peritoneum. There are three major regions of the kidney, renal
cortex, renal medulla and the renal pelvis. The outer, granulated layer is the renal
cortex. The cortex stretches down in between a radially striated inner layer. The inner
radially striated layer is the renal medulla. This contains pyramid shaped tissue called
the renal pyramids, separated by renal columns. The ureters are continuous with the
renal pelvis and are the very center of the kidney.

1. Renal pyramid
2. Interlobar artery

3. Renal artery

4. Renal vein

5. Renal hylum

6. Renal pelvis

7. Ureter

8. Minor calyx

9. Renal capsule

10. Inferior renal capsule

11. Superior renal capsule

12. Interlobar vein

13. Nephron

14. Minor calyx

15. Major calyx

16. Renal papilla

17. Renal column

Renal Vein

The renal veins are veins that drain the kidney. They connect the kidney to the inferior
vena cava. Because the inferior vena cava is on the right half of the body, the left renal
vein is generally the longer of the two. Unlike the right renal vein, the left renal vein
often receives the left gonadal vein (left testicular vein in males, left ovarian vein in
females). It frequently receives the left suprarenal vein as well.

Renal Artery

The renal arteries normally arise off the abdominal aorta and supply the kidneys with
blood. The arterial supply of the kidneys are variable and there may be one or more
renal arteries supplying each kidney. Due to the position of the aorta, the inferior vena
cava and the kidneys in the body, the right renal artery is normally longer than the left
renal artery. The right renal artery normally crosses posteriorly to the inferior vena cava.
The renal arteries carry a large portion of the total blood flow to the kidneys. Up to a
third of the total cardiac output can pass through the renal arteries to be filtered by the
kidneys.

Ureters

The ureters are two tubes that drain urine from the kidneys to the bladder. Each ureter
is a muscular tube about 10 inches (25 cm) long. Muscles in the walls of the ureters
send the urine in small spurts into the bladder, (a collapsible sac found on the forward
part of the cavity of the bony pelvis that allows temporary storage of urine). After the
urine enters the bladder from the ureters, small folds in the bladder mucosa act like
valves preventing backward flow of the urine. The outlet of the bladder is controlled by a
sphincter muscle. A full bladder stimulates sensory nerves in the bladder wall that relax
the sphincter and allow release of the urine. However, relaxation of the sphincter is also
in part a learned response under voluntary control. The released urine enters the
urethra.

Urinary Bladder

The urinary bladder is a hollow, muscular and distendible or elastic organ that sits on
the pelvic floor (superior to the prostate in males). On its anterior border lies the pubic
symphysis and, on its posterior border, the vagina (in females) and rectum (in males).
The urinary bladder can hold approximately 17 to 18 ounces (500 to 530 ml) of urine,
however the desire to micturate is usually experienced when it contains about 150 to
200 ml. When the bladder fills with urine (about half full), stretch receptors send nerve
impulses to the spinal cord, which then sends a reflex nerve impulse back to the
sphincter (muscular valve) at the neck of the bladder, causing it to relax and allow the
flow of urine into the urethra. The Internal urethral sphincter is involuntary. The ureters
enter the bladder diagonally from its dorsolateral floor in an area called the trigone. The
trigone is a triangular shaped area on the postero-inferior wall of the bladder. The
urethra exits at the lowest point of the triangle of the trigone. The urine in the bladder
also helps regulate body temperature. If the bladder becomes completely void of fluid, it
causes the patient to chill.

Urethra

The urethra is a muscular tube that connects the bladder with the outside of the body.
The function of the urethra is to remove urine from the body. It measures about 1.5
inches (3.8 cm) in a woman but up to 8 inches (20 cm) in a man. Because the urethra is
so much shorter in a woman it makes it much easier for a woman to get harmful
bacteria in her bladder this is commonly called a bladder infection or a UTI. The most
common bacteria of a UTI is E-coli from the large intestines that have been excreted in
fecal matter.

Female urethra

In the human female, the urethra is about 1-2 inches long and opens in the vulva
between the clitoris and the vaginal opening.

Men have a longer urethra than women. This means that women tend to be more
susceptible to infections of the bladder (cystitis) and the urinary tract.
Male urethra

In the human male, the urethra is about 8 inches long and opens at the end of the head
of the penis.

The length of a male's urethra, and the fact it contains a number of bends, makes
catheterisation more difficult.

The urethral sphincter is a collective name for the muscles used to control the flow of
urine from the urinary bladder. These muscles surround the urethra, so that when they
contract, the urethra is closed.

 There are two distinct areas of muscle: the internal sphincter, at the bladder neck
and
 the external, or distal, sphincter.

Human males have much stronger sphincter muscles than females, meaning that they
can retain a large amount of urine for twice as long, as much as 800mL, i.e. "hold it".

Nephrons

A nephron is the basic structural and functional unit of the kidney. The name nephron
comes from the Greek word (nephros) meaning kidney. Its chief function is to regulate
water and soluble substances by filtering the blood, reabsorbing what is needed and
excreting the rest as urine. Nephrons eliminate wastes from the body, regulate blood
volume and pressure, control levels of electrolytes and metabolites, and regulate blood
pH. Its functions are vital to life and are regulated by the endocrine system by hormones
such as antidiuretic hormone, aldosterone, and parathyroid hormone.

Each nephron has its own supply of blood from two capillary regions from the renal
artery. Each nephron is composed of an initial filtering component (the renal corpuscle)
and a tubule specialized for reabsorption and secretion (the renal tubule). The renal
corpuscle filters out large solutes from the blood, delivering water and small solutes to
the renal tubule for modification.

Glomerulus

The glomerulus is a capillary tuft that receives its blood supply from an afferent arteriole
of the renal circulation. The glomerular blood pressure provides the driving force for fluid
and solutes to be filtered out of the blood and into the space made by Bowman's
capsule. The remainder of the blood not filtered into the glomerulus passes into the
narrower efferent arteriole. It then moves into the vasa recta, which are collecting
capillaries intertwined with the convoluted tubules through the interstitial space, where
the reabsorbed substances will also enter. This then combines with efferent venules
from other nephrons into the renal vein, and rejoins with the main bloodstream.

Afferent/Efferent Arterioles

The afferent arteriole supplies blood to the glomerulus. A group of specialized cells
known as juxtaglomerular cells are located around the afferent arteriole where it
enters the renal corpuscle. The efferent arteriole drains the glomerulus. Between the
two arterioles lies specialized cells called the macula densa. The juxtaglomerular cells
and the macula densa collectively form the juxtaglomerular apparatus. It is in the
juxtaglomerular apparatus cells that the enzyme renin is formed and stored. Renin is
released in response to decreased blood pressure in the afferent arterioles, decreased
sodium chloride in the distal convoluted tubule and sympathetic nerve stimulation of
receptors (beta-adrenic) on the juxtaglomerular cells. Renin is needed to form
Angiotensin I and Angiotensin II which stimulate the secretion of aldosterone by the
adrenal cortex.
Bowman’s Capsule

The Bowman's capsule (or capsula glomeruli, glomerular capsule) is a cup-like sac at
the beginning of the tubular component of a nephron in the mammalian kidney that
performs the first step in the filtration of blood to form urine. A glomerulus is enclosed in
the sac. Fluids from blood in the glomerulus are collected in the Bowman's capsule
(i.e., glomerular filtrate) and further processed along the nephron to form urine. This
process is known as ultrafiltration.

Proximal Convoluted Tubule (PCT)

The proximal tubule can be anatomically divided into two segments: the proximal
convoluted tubule and the proximal straight tubule. The proximal convoluted tubule can
be divided further into S1 and S2 segments based on the histological appearance of it's
cells. Following this naming convention, the proximal straight tubule is commonly called
the S3 segment. The proximal convoluted tubule has one layer of cuboidal cells in the
lumen. This is the only place in the nephron that contains cuboidal cells. These cells are
covered with millions of microvilli. The microvilli serve to increase surface area for
reabsorption.
Loop of Henle
In the kidney, the loop of Henle (or Henle's loop or ansa nephroni) is the portion of
thenephron that leads from the proximal straight tubule to the distal convoluted tubule.
The loop has a hairpin bend in the renal medulla. The main function of this structure is
to create a concentration gradient in the medulla of the kidney. By means of
a countercurrent multipliersystem, which utilizes sodium pumps, it creates an area of
high sodium concentration deep in the medulla, near the collecting duct. Water present
in the filtrate in the collecting duct flows through aquaporin channels out of the collecting
duct, moving passively down its concentration gradient. This process reabsorbs water
and creates a concentrated urine for excretion.

Distal Convoluted Tubule (DCT)

The distal convoluted tubule is similar to the proximal convoluted tubule in structure and
function. Cells lining the tubule have numerous mitochondria, enabling active transport
to take place by the energy supplied by ATP. Much of the ion transport taking place in
the distal convoluted tubule is regulated by the endocrine system. In the presence of
parathyroid hormone, the distal convoluted tubule reabsorbs more calcium and excretes
more phosphate. When aldosterone is present, more sodium is reabsorbed and more
potassium excreted. Atrial natriuretic peptide causes the distal convoluted tubule to
excrete more sodium. In addition, the tubule also secretes hydrogen and ammonium to
regulate pH. After traveling the length of the distal convoluted tubule, only 3% of water
remains, and the remaining salt content is negligible. 97.9% of the water in the
glomerular filtrate enters the convoluted tubules and collecting ducts by osmosis
Formation of Urine
Urine is formed in three steps: Filtration, Reabsorption, and Secretion.

Filtration

Blood enters the afferent arteriole and flows into the glomerulus. Blood in the
glomerulus has both filterable blood components and non-filterable blood components.
Filterable blood components move toward the inside of the glomerulus while non-
filterable blood components bypass the filtration process by exiting through the efferent
arteriole. Filterable Blood components now take on plasma like form called glomerular
filtrate. A few of the filterable blood components are water, nitrogenous waste, nutrients
and salts (ions). Nonfilterable blood components include formed elements such as
blood cells and platelets along with plasma proteins. The glomerular filtrate is not the
same consistency as urine, as much of it is reabsorbed into the blood as the filtrate
passes through the tubules of the nephron.

Reabsorption

Within the peritubular capillary network, molecules and ions are reabsorbed back into
the blood. Sodium Chloride reabsorbed into the system increases the osmolarity of
blood in comparison to the glomerular filtrate. This reabsorption process allows water
(H2O) to pass from the glomerular filtrate back into the circulatory system.
Glucose and various amino acids also are reabsorbed into the circulatory system.
These nutrients have carrier molecules that claim the glomerular molecule and release
it back into the circulatory system. If all of the carrier molecules are used up, excess
glucose or amino acids are set free into the urine. A complication of diabetes is the
inability of the body to reabsorb glucose. If too much glucose appears in the glomerular
filtrate it increases the osmolarity of the filtrate, causing water to be released into the
urine rather than reabsorbed by the circulatory system. Frequent urination and
unexplained thirst are warning signs of diabetes, due to water not being reabsorbed.

Glomerular filtrate has now been separated into two forms: Reabsorbed Filtrate and
Non-reabsorbed Filtrate. Non-reabsorbed filtrate is now known as tubular fluid as it
passes through the collecting duct to be processed into urine.

Secretion

Some substances are removed from blood through the peritubular capillary network into
the distal convoluted tubule or collecting duct. These substances are Hydrogen ions,
creatinine, and drugs. Urine is a collection of substances that have not been reabsorbed
during glomerular filtration or tubular reabsorbtion.

There are hormones that affects reabsorption these are aldosterone, atrial natriuretic
hormone, anti-diuretic hormone and parathyroid hormone.

 Anti-diuretic hormone – Increases reabsorption of water ions from the titrate to

the blood

 Parathyroid hormone – Increases reabsorption of Ca+ ions from filtrate to the

blood and excretion of phosphate ions into filtrate.

 Aldosterone – Increases reabsorption of Na+ ions from filtrate to the blood and
excretion of K+ ions into the filtrate. Water is reabsorbed following the
reabsorption of sodium.

 Atrial natriuretic hormone – Decreases the reabsorption of Na+ ions which

remain in the filtrate. More sodium and water are eliminated in urine.
Maintaining Water-Salt Balance
It is the job of the kidneys to maintain the water-salt balance of the blood. They
also maintain blood volume as well as blood pressure. Simple examples of ways that
this balance can be changed include ingestion of water, dehydration, blood loss and salt
ingestion.

Reabsorption of water

Direct control of water excretion in the kidneys is exercised by the anti-diuretic hormone
(ADH), released by the posterior lobe of the pituitary gland. ADH causes the insertion of
water channels into the membranes of cells lining the collecting ducts, allowing water
reabsorption to occur. Without ADH, little water is reabsorbed in the collecting ducts and
dilute urine is excreted. There are several factors that influence the secretion of ADH.
The first of these happen when the blood plasma gets too concentrated. When this
occurs, special receptors in the hypothalamus release ADH. When blood pressure falls,
stretch receptors in the aorta and carotid arteries stimulate ADH secretion to increase
volume of the blood.

Reabsorption of Salt

The Kidneys also regulate the salt balance in the blood by controlling the excretion and
the reabsorption of various ions. As noted above, ADH plays a role in increasing water
reabsorption in the kidneys, thus helping to dilute bodily fluids. The kidneys also have a
regulated mechanism for reabsorbing sodium in the distal nephron. This mechanism is
controlled by aldosterone, a steroid hormone produced by the adrenal cortex.
Aldosterone promotes the excretion of potassium ions and the reabsorption of sodium
ions. The release of Aldosterone is initiated by the kidneys. The juxtaglomerular
apparatus is a renal structure consisting of the macula densa, mesangial cells, and
juxtaglomerular cells. Juxtaglomerular cells (JG cells, also known as granular cells) are
the site of renin secretion. Renin is an enzyme that converts angiotensinogen (a large
plasma protein produced by the liver) into Angiotensin I and eventually into Angiotensin
II which stimulates the adrenal cortex to produce aldosterone. The reabsorption of
sodium ions is followed by the reapsorption of water. This causes blood pressure as
well as blood volume to increase.

Atrial natriuretic hormone (ANH) is released by the atria of the heart when cardiac
cells are streatched due to increased blood volume. ANH inhibits the secretion of renin
by the juxtaglomerular apparatus and the secretion of the aldosterone by the adrenal
cortex. This promotes the excretion of sodium. When sodium is excreted so is water.
This causes blood pressure and volume to decrease.

Hypernatremia

An increase in plasma sodium levels above normal is hypernatremia. Sodium is the

primary solute in the extracellular fluid. Sodium levels have a major role in osmolarity
regulation. For excitable cells the electrochemical gradient for sodium across the
plasma membrane is critical for life. Water retention and an increased blood pressure
usually are signs of hypernatremia. If the plasma sodium levels are below normal it is
called hyponatremia. Signs of this are low plasma volume and hypotension.

Diuretics

A diuretic (colloquially called a water pill) is any drug that elevates the rate of bodily
urine excretion (diuresis). Diuretics also decrease the extracellular fluid (ECF) volume,
and are primarily used to produce a negative extracellular fluid balance. Caffeine,
cranberry juice and alcohol are all weak diuretics. In medicine, diuretics are used to
treat heart failure, liver cirrhosis, hypertension and certain kidney diseases. Diuretics
alleviate the symptoms of these diseases by causing sodium and water loss through the
urine. As urine is produced by the kidney, sodium and water – which cause edema
related to the disease – move into the blood to replace the volume lost as urine, thereby
reducing the pathological edema. Some diuretics, such as acetazolamide, help to make
the urine more alkaline and are helpful in increasing excretion of substances such as
aspirin in cases of overdose or poisoning. The antihypertensive actions of some
diuretics (thiazides and loop diuretics in particular) are independent of their diuretic
effect. That is, the reduction in blood pressure is not due to decreased blood volume
resulting from increased urine production, but occurs through other mechanisms and at
lower doses than that required to produce diuresis. Indapamide was specifically
designed with this is mind, and has a larger therapeutic window for hypertension
(without pronounced diuresis) than most other diuretics. Chemically, diuretics are a
diverse group of compounds that either stimulate or inhibit various hormones that
naturally occur in the body to regulate urine production by the kidneys. Alcohol produces
diuresis through modulation of the vasopressin system.

Acid-base homeostasis
Acid-base homeostasis is the part of human homeostasis concerning the proper
balance between acids andbases, in other words, the pH. The body is very sensitive to
its pH level, so strong mechanisms exist to maintain it. Outside the acceptable range of
pH, proteins are denatured and digested, enzymes lose their ability to function,
and death may occur.

Mechanism
The body's acid-base balance is tightly regulated. Several buffering agents that
reversibly bind hydrogen ions and impede any change in pH exist. Extracellular buffers
include bicarbonate and ammonia, whereas proteins andphosphate act
as intracellular buffers. The bicarbonate buffering system is especially key, as carbon
dioxide(CO2) can be shifted through carbonic acid (H2CO3) to hydrogen ions
and bicarbonate (HCO3-) as shown below.
Acid-base imbalances that overcome the buffer system can be compensated in the
short term by changing the rate of ventilation. This alters the concentration of carbon
dioxide in the blood, shifting the above reaction according to Le Chatelier's principle,
which in turn alters the pH. For instance, if the blood pH drops too low ( acidemia), the
body will compensate by increasing breathing, expelling CO 2, and shifting the above
reaction to the right such that less hydrogen ions are free; thus the pH will rise back to
normal. For alkalemia, the opposite occurs.

The kidneys are slower to compensate, but renal physiology has several powerful
mechanisms to control pH by the excretion of excess acid or base. In responses to
acidosis, tubular cells reabsorb more bicarbonate from the tubular fluid, collecting
duct cells secrete more hydrogen and generate more bicarbonate,
and ammoniagenesis leads to increased formation of the NH3 buffer. In responses to
alkalosis, the kidney may excrete more bicarbonate by decreasing hydrogen ion
secretion from the tubular epithelial cells, and lowering rates of glutamine metabolism
and ammonia excretion.