The Urinary System

Composition of the Urinary System

Functions of the Kidneys

1) filter blood plasma, separate wastes, return useful materials to the blood, and eliminate the wastes. Toxic nitrogenous wastes - ammonia, urea, uric acid, creatine, and creatinine - cause diarrhea, vomiting, and cardiac arrhythmia, convulsions, coma, and death.

Functions of the Kidneys

1) filter blood plasma, separate wastes, return useful materials to the blood, and eliminate the wastes. 2) regulate blood volume and osmolarity.

Functions of the Kidneys

3) produce hormones 1. renin 2. erythropoietin 3. calcitrol 4) regulate acid-base balance of the body fluids. 5) detoxify superoxides, free radicals, and drugs.

ANATOMY OF THE KIDNEYS

- The kidneys lie along the posterior abdominal wall

- The medial surface of the kidney is concave with a hilum carrying renal nerves and blood vessels.

The renal parenchyma is divided into an outer cortex and inner medulla.

Extensions of the cortex (renal columns) project toward the sinus, dividing the medulla into 6-10 renal pyramids. Each pyramid is conical with a blunt point called the papilla facing the sinus.

The papilla is nestled into a cup called a minor calyx, which collects its urine. Two or three minor calyces merge to form a major calyx. The major calyces merge to form the renal pelvis.

The Nephron
- The kidney contains 1.2 million nephrons, which are the functional units of the kidney. - A nephron consists of : i. blood vessels afferent arteriole glomerulus efferent arteriole ii. renal tubules proximal convoluted tubule loop of Henle distal convoluted tubule

The Nephron

glomerulus efferent arteriole

blood

proximal convoluted tubule

distal convoluted tubule

blood

afferent arteriole

Loop of Henle

The Nephron
- Most components of the nephron are within the cortex.

Nephrons are connected to renal artery/vein and ureter.

The glomerulus is enclosed in a two-layered glomerular (Bowman's) capsule.

Proximal tubule

URINE FORMATION

The kidney produces urine through 4 steps.

Glomerular Filtrate Tubular fluid

Urine

1) Glomerular Filtration

The Filtration Membrane

From the plasma to the capsular space, fluid passes through three barriers.

foot processes

fenestrated epithelium basement membrane

The Filtration Membrane

Almost any molecule smaller than 3 nm can pass freely through the filtration membrane into the capsular space. These include: Water, electrolytes, glucose, amino acids, lipids, vitamins, and nitrogenous wastes Kidney infections and trauma commonly damage the filtration membrane and allow plasma proteins or blood cells to pass through.

Blood cells in urine Plasma proteins

Filtration Pressure
Glomerular filtration follows the same principles that govern filtration in other capillaries.

Glomerular Filtration Rate (GFR)

- is the amount of filtrate formed per minute by the two kidneys combined. - For the average adult male, GFR is about 125 ml/min. - This amounts to a rate of 180 L/day. - An average of 99% of the filtrate is reabsorbed, so that only 1-2 L of urine per day is excreted.

GFR must be precisely controlled.

a. If GFR is too high - increase in urine output - threat of dehydration and electrolyte depletion. b. If GFR is too low - insufficient excretion of wastes. c. The only way to adjust GFR from moment to moment is to change glomerular blood pressure.

Renal Autoregulation - the ability of the kidneys to maintain a relatively stable GFR in spite of the changes (75 - 175 mmHg) in arterial blood pressure.

The nephron has two ways to prevent drastic changes in GFR when blood pressure rises: 1) Constriction of the afferent arteriole to reduce blood flow into the glomerulus 2) Dilation of the efferent arteriole to allow the blood to flow out more easily.

Change in an opposite direction if blood pressure falls

Mechanisms of Renal Autoregulation 1) 2) myogenic response tubuloglomerular feedback

1)

myogenic response

2)

tubuloglomerular feedback

1) Glomerular Filtration 2) Tubular Reabsorption 3) Tubular Secretion 4) Concentrating Urine by Collecting Duct

About 99% of Water and other useful small molecules in the filtrate are normally reabsorbed back into plasma by renal tubules.

Reabsorption in Proximal Convoluted Tubules

- The proximal convoluted tubule (PCT) is formed by one layer of epithelial cells with long apical microvilli.

- PCT reabsorbs about 65% of the glomerular filtrate and return it to the blood.

Routes of Proximal Tubular Reabsorption

1) transcellular route 2) paracellular route

PCT

peritubular capillary

Mechanisms of Proximal Tubular Reabsorption

1) Solvent drag 2) Active transport of sodium. 3) Secondary active transport of glucose, amino acids, and other nutrients. 4) Secondary water reabsorption via osmosis 5) Secondary ion reabsorption via electrostatic attraction 6) Endocytosis of large solutes

Osmosis
Water moves from a compartment of low osmolarity to the compartment of high osmolarity.

low osmolarity
( high H2O conc.) H2 O

high osmolarity
( low H2O conc.)

1) Solvent drag
Proteins stay - driven by high colloid osmotic pressure (COP) in the peritubular capillaries - Water is reabsorbed by osmosis and carries all other solutes along. - Both routes are involved. H2O

Proteins

2) Active transport of sodium

Sodium pumps (Na-K ATPase) in basolateral membranes transport sodium out of the cells against its concentration gradient using ATP.

Na+ K+ capillary PCT cell

Na+

Tubular lumen

There are also pumps for other ions

Ca++

Ca++

capillary

PCT cell

Tubular lumen

3) Secondary active transport of glucose, amino acids, and other nutrients - Various cotransporters can carry both Na+ and other solutes. For example, the sodiumdependent glucose transporter (SDGT) can carry both Na+ and glucose. Na+ K+ Na+

Glucose capillary PCT cell

3) Secondary active transport of glucose, amino acids, and other nutrients Amino acids and many other nutrients are reabsorbed by their specific cotransporters with sodium.

Na+ K+ Na+

amino acids capillary PCT cell

4) Secondary water reabsorption via osmosis

Sodium reabsorption makes both intracellular and extracellular fluid hypertonic to the tubular fluid. Water follows sodium into the peritubular capillaries.

Na+

Na+ H2O

capillary

PCT cell

Tubular lumen

5) Secondary ion reabsorption via electrostatic attraction

Negative ions tend to follow the positive sodium ions by electrostatic attraction.

Na

Na+ Cl-

capillary

PCT cell

Tubular lumen

6) Endocytosis of large solutes

The glomerulus filters a small amount of protein from the blood. The PCT reclaims it by endocytosis, hydrolzes it to amino acids, and releases these to the ECF by facilitated diffusion.

amino acids

protein

capillary

PCT cell

Tubular lumen

The Transport Maximum - There is a limit to the amount of solute that the renal tubule can reabsorb because there are limited numbers of transport proteins in the plasma membranes. - If all the transporters are occupied as solute molecules pass through, some solute will remain in the tubular fluid and appear in the urine. Example of diabetes

Na+

Glucose

high glucose in blood

high glucose in filtrate Exceeds Tm for glucose

Glucose in urine

Reabsorption in the Nephron Loop

- The primary purpose is to establish a high extracellular osmotic concentration. - The thick ascending limb reabsorbs solutes but is impermeable to water. Thus, the tubular fluid becomes very diluted while extracellular fluid becomes very concentrated with solutes.

mOsm/L

The high osmolarity enables the collecting duct to concentrate the urine later.

Reabsorption in Distal Convoluted Tubules

- Fluid arriving in the DCT still contains about 20% of the water and 10% of the salts of the glomerular filtrate. - A distinguishing feature of these parts of the renal tubule is that they are subject to hormonal control.

Aldosterone a. secreted from adrenal gland in response to a Na+ or a K+ in blood b. to increase Na+ absorption and K+ secretion in the DCT and cortical portion of the collecting duct. c. helps to maintain blood volume and pressure.

Atrial Natriuretic Factor - secreted by the atrial myocardium in response to high blood pressure. - It inhibits sodium and water reabsorption, increases the output of both in the urine, and thus reduces blood volume and pressure.

1) Glomerular Filtration 2) Tubular Reabsorption 3) Tubular Secretion 4) Concentrating Urine by Collecting Duct

Tubular Secretion
- Renal tubule extracts chemicals from the blood and secretes them into the tubular fluid. - serves the purposes of waste removal and acid-base balance.

H+

H+

capillary

PCT cell

Tubular lumen

1) Glomerular Filtration 2) Tubular Reabsorption 3) Tubular Secretion 4) Concentrating Urine by Collecting Duct

1. The collecting duct (CD) begins in the cortex, where it receives tubular fluid from numerous nephrons. 2. CD reabsorbs water.

Cortex

collecting duct

urine

1. Driving force The high osmolarity of extracellular fluid generated by NaCl and urea, provides the driving force for water reabsorption. 2. Regulation The medullary portion of the CD is not permeable to NaCl but permeable to water, depending on ADH.
mOsm/L

Cortex medulla

urine

Control of Urine Concentration depends on the body's state of hydration. a. In a state of full hydration, antidiuretic hormone (ADH) is not secreted and the CD permeability to water is low, leaving the water to be excreted. b. In a state of dehydration, ADH is secreted; the CD permeability to water increases. With the increased reabsorption of water by osmosis, the urine becomes more concentrated.

Cortex medulla

mOsm/L

urine

No more reabsorption after tubular fluid leaving CD

Cortex medulla

urine urine

Urine Properties

Composition and Properties of Urine Fresh urine is clear, containing no blood cells and little proteins. If cloudy, it could indicate the presence of bacteria, semen, blood, or menstrual fluid.

Substance Urea Uric acid Creatinine Potassium Chloride Sodium Protein HCO3Glucose

Blood Plasma (total amount) 4.8 g 0.15 g 0.03 g 0.5 g 10.7 g 9.7 g 200 g 4.6 g 3g

Urine (amount per day) 25 g 0.8 g 1.6 g 2.0 g 6.3 g 4.6 g 0.1 g 0g 0g

Urine Volume
An average adult produces 1-2 L of urine per day. a. Excessive urine output is called polyuria. b. Scanty urine output is oliguria. An output of less than 400 mL/day is insufficient to excrete toxic wastes.

Diabetes
- is chronic polyuria resulting from various metabolic disorders, including Diabetes mellitus and Diabetes insipidus

Diabetes mellitus - caused by either 1) deficiency of insulin (Type I) or 2) deficiency of insulin receptors (Type II). - Diabetes mellitus features high glucose in the blood (hyperglycemia) glycogen

pancreatic F cell
insulin receptors

insulin

cell glucose cell

blood

high glucose - When glucose in tubular fluid exceeds the transport maximum (180 mg/100 ml), it appears in urine (glycosuria). - Glucose in tubular fluid hinders water reabsorption by osmosis, causing polyuria.

high glucose in filtrate

Retain H2O by osmosis

high urine volume

Diabetes insipidus - is caused by inadequeate ADH secretion. - Due to the shortage of ADH, water reabsorption in CD is compromised, leading to polyuria. urine

Diuresis
refers to excretion of large amount of urine.

Natriuresis
refers to enhanced urinary excretion of sodium

Diuretics - are chemicals that increase urine volume. They are used for treating hypertension and congestive heart failure because they reduce overall fluid volume. - work by either increasing glomerular filtration or reducing tubular reabsorption. Caffeine falls into the former category; alcohol into the latter (alcohol suppresses the release of ADH).

Many diuretics produce osmotic diuresis by inhibiting sodium reabsorption

Renal Function Tests

Renal Clearance
a. the volume of blood plasma from which a particular waste is removed in 1 minute. b. can be measured indirectly by measuring the waste concentration in blood and urine, and the urine volume.

2. Glomerular Filtration Rate

a. Measuring GFR requires a substance that is not secreted or reabsorbed at all. Inulin, a polymer of fructose, is suitable. b. Inulin filtered by the glomeruli remains in the renal tubule and appears in the urine; none is reabsorbed, and the tubule does not secrete it. For this solute, GFR is equal to the renal clearance.

Hemodialysis
artificially clearing wastes from the blood

1) Dialysis machine
- efficient - inconvenient

2) Continuous ambulatory peritoneal dialysis (CAPD)

- The peritoneal membrane is a natural dialysis membrane - convenient - less efficient

Dialysis fluid

Urine Storage and Elimination

The Ureters
The ureters are muscular tubes leading from the renal pelvis to the lower bladder.

The Urinary Bladder

- is a muscular sac on the floor of the pelvic cavity. - is highly distensible and expands superiorly.

The openings of the two ureters and the urethra mark a triangular area called the trigone on the bladder floor.

The Urethra - conveys urine from the urinary bladder to the outside of the body.

Females 3-4 cm
greater risk of urinary tract infections

male ~18 cm

The male urethra has three regions: 1) prostatic urethra 2) membranous urethra 3) penile urethra.

Difficulty in voiding urine with enlarged prostate

In both sexes: - internal urethral sphincter- under involuntary control. - external urethral sphincter - under voluntary control

internal urethral sphincter external urethral sphincter

Voiding Urine in infants micturition reflex

When the bladder contains about 200 ml of urine, stretch receptors in the wall send impulses to the spinal cord. Parasympathetic signals return to stimulate contraction of the bladder and relaxation of the internal urethral sphincter.

Spinal cord

2. Once voluntary control has developed, emptying of the bladder Once voluntary control has developed, emptying of the is controlled predominantly by a micturition center in the pons. This bladder is controlled from stretch receptors and integrates center receives signals predominantly by a micturition center this in the with This center concerning the from stretch informationpons. cortical input receives signals appropriateness of receptors the moment. It sends back impulses to stimulate urinating at and integrates this information with cortical input concerning external sphincter. relaxation of the the appropriateness of urinating at the moment. It sends back impulses to stimulate relaxation of the external sphincter.

Voiding Urine in adults

Voluntary control

SUMMARY 1) General Introduction 2) Anatomy of Urinary System 3) Urine Formation 4) Urine Storage and Elimination