Renal/Urinary System

KIDNEY
The kidney is divided into three major regions: the hilum, cortex, and medulla (Fig 1-8-1).

Hilum
The hilum is located medially and serves as the point of entrance and exit for the renal artery, renal vein, and ureter. The renal pelvis, the expanded upper portion of the ureter, divides into twoor three major calyces upon entrance into the kidney. These, in turn, divideinto eight minor calyces.Branches of the renal artery, vein, and nerve supply each part of the kidney.

Cortex
The cortex forms the outer zone of the kidney as well as several renal columns, which penetrate the entire depth of the kidney.

Medulla
The medulla appears as a series of medullary pyramids. The apex of each pyramid directs the urinary stream into a minor calyx. KAPLAN MEDICAL 65

US WILE Step 1: Anatomy

Cortex MedullaryRaysofCortex

Hilium Ureter

Glomerulus

Minor Calyces Renal Pelvis Renal Medullary Pyramid

Medulla

Renal Columns (of Bertin) Major Calyx

Figure 1-8-1. Organization of the Kidney

URINIFEROUS TUBULES
The uriniferous tubules consist of two functionally related portions called the nephron and the collecting tubule.

Nephron
The nephron consists of a renal corpuscle, proximal convoluted tubule, loop of Henle, and distal convoluted tubule (Fig 1-8-2).

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Distal Convoluted Tubule

Bowmans
Ca
ule

Proximal

P? nvoluted Tubule

Figure 1-8-2. Nephron Diagram

Renal Corpuscle
The renal corpuscle consists of a tuft of capillaries, or glomerulus, surrounded by a double-walled epithelial capsule called Bowman's capsule (Fig 1-8-3).

KAPLAN MEDICAL 67Type IV Collagen

USMLE Step 1: Anatomy Glomerulus The glomerulus is composed of several anastomotic capillary loops interposed between an afferent and an efferent arteriole. The endothelium of the glomerulus is thin and fenestrated. Plasma filtration (ultrafiltration) occurs in the glomerulus.
Bowman's Capsule Bowman's capsule consists of an inner visceral layer and an outer parietal layer (Fig 1-8-3). The space between these layers, the urinary space, is continuous with

The visceral layer is composed of podocytes resting on a basal lamina, which is fused with the basal lamina of the capillary endothelium (Figs I-8-4,1-8-5, and 1-8-6). The parietal layer is composed of a simple squamous epithelium that is continuous with the proximal convoluted tubule epithelial lining.
Afferent Efferent Arteriole Arteriole

Parietal
Layer

visceral Layer (Podocytes)

0
Magnification of Above

Capillary (Fenestrated)

ersta4Wb

Basal Lamina: rocesses pr* Heparan Sulfate (j -) ^Urinary Space Figure 1-8-3. Bowman's Capsule Diagram

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Figure 1-8-4. Scanning Electron Micrograph Demonstrating Podocytes With Their Processes (arrows)

Urinary Bowman's) ^J[ Space

Podocyte Foot Processes

Figure 1-8-5. Transmission Electron Micrograph Demonstrating Podocytes

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Figure I-8-6. Electron Micrograph Demonstrating Relationship Between Basal Lamina, Podocyte, and Endothelial Cell

Proximal Convoluted Tubule

The proximal convoluted tubule is the longest and most convoluted segment of the nephron. Its cells possess an apical brush border that provides a much greater surface area for reabsorption and secretion. Most of the components of the glomerular filtrate are reabsorbed in the proximal tubule.

LoopofHenle The loop of Henle is a hairpin loop of the nephron that extends into the medulla and consists of thick and thin segments.

Distal Convoluted Tubule

The distal convoluted tubule is lined by cuboidal cells that reabsorb sodium and chloride from the tubular filtrate.

Collecting Tubules Collecting tubules consist of arched and straight segments made up of cells that range from cuboidal to columnar. In response to vasopressin (also known as antidiuretic hormone, or ADH) secreted by the neurohypophysis, collecting tubules become permeable to water and, thus, are important in the kidney's role in water conservation and urine concentration.
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VASCULAR SUPPLY
^Renal artery Interlobar arteries Arcuate arteries Interlobular arteries ^-Afferent arterioles *-Glomeruli *-Efferent arterioles -Peritubular plexus Vasa recta

Vasa Recta
The arteriolae rectae and the corresponding venae rectae with their respective capillary networks comprise the vasa recta, which supplies the medulla. The endothelium of the venae rectae is fenestrated and plays an important role in maintaining the osmotic gradient required for concentrating urine in the kidney fuBules.

JUXTAGLOMERULAR APPARATUS
The juxtaglomerular apparatus consists of juxtaglomerular cells, polkissen cells, and the macula densa (Fig 1-8-3).
Proximal Tubule

Glomerular Capillary Loops Glomerular Capillary Endothelium Glomerular Epithelium

Polkissen Cells Efferent Arteriole Distal Tubule Basement Membrane of Bowman's Capsule Red Blood Cells

Glomerular Basement Membrane Epithelium of Bowman's Capsule Juxtaglomerular Cells Afferent Arteriole Macula Densa Cells

Figure 1-8-7. Renal Corpuscle and Juxtaglomerular Apparatus

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Juxtaglomerular Cells
The juxtaglomerular cells are myoepithelial cells in the afferent arteriole. They secrete an enzyme called renin, which enters the bloodstream and converts the circulating polypeptide angiotensinogen into angiotensin I. AngiotensinJ-is-eooygrted to angiotensin II, a potent vasoconstrictor that stimulates aldosterone secretion from the adrenal cortex. Aldosterone increases sodium and water reabsorption in the distal portion of the nephron.

Polkissen Cells
Polkissen cells are located between the afferent and efferent arterioles at the vascular pole of the glomerulus, adjacent to the macula densa. Their function is unknown.

Macula Densa
Cells of the distal tubule near the afferent arteriole are taller and more slender than elsewhere in the distal tubule. They constitute the macula densa. The macula densa is thought to sense sodium concentration in the tubular fluid.