NCM 104 GU-Nsg.
Paul Christian P. Santos
Renal System
ANATOMY & PHYSIOLOGY
The Kidneys
-maintain the volume and composition of
body fluid by filtration of the blood and
selective reabsorption or secretion of filtered
solutes.
-retroperitoneal organs
-situated on the posterior wall of the
abdomen on each side of the vertebral
column, at about the level of the twelfth rib.
-left kidney is lightly higher in the abdomen
than the right, due to the presence of the liver
pushing the right kidney down.
- take their blood supply directly from the
aorta via the renal arteries; blood is returned
to the inferior vena cava via the renal veins.
FUNCTIONS
1) Controls fluid and electrolyte balance(Na &
K)
2) Urine formation
3) Excrete end products of body metabolism
(urea, uric acid, creatinine)
4) Secrete renin & eryhtropoietin
5) Manufacture & activation of vitamin D for
normal calcium balance
STRUCTURE
Cortex -pale outer region
Medulla-darker inner region
has 8-18 conical regions, called the renal
pyramids
*cortex and the medulla are made up of nephrons
Renal Pyramids
-base of each pyramid starts at the
corticomedullary border
-apex of each pyramid ends in the renal
papilla which merges to form the renal
pelvis and then on to form the ureter.
Renal Pelvis
-is divided into two or three spaces
major calyces subdiv. to
minor calyces
*walls of the calyces, pelvis and ureters are lined with
smooth muscle that can contract to force urine
towards the bladder by peristalsis.
The renal corpuscle is made up of the glomerulus (a
capillary network) and Bowman's capsule (the end of
the tubule
Nephrons
-these are the functional units of the kidney,
and each kidney contains about 1.3 million
-responsible for “ultrafiltration” of the blood
and reabsorption or excretion of products in
the subsequent filtrate
-made up of:
1} glomerulus
-filtering unit- 125ml/min
of filtrate is formed by the kidneys as
blood is filtered through this sieve-
like structure. This filtration is
uncontrolled
2} proximal convoluted tubule
-controlled absorption of glucose,
sodium, and other solutes goes on in
this region.
3} Loop of Henle
-responsible for concentration and
dilution of urine by utilizing “counter-
current multiplying mechanism”
-it is water-impermeable but
can pump sodium out, which affects
the osmolarity tissues and will affect
the subsequent movement of water
in or out of the water-permeable
collecting duct.
4} Distal convoluted tubule
-responsible, along with
the collecting duct for absorbing
water back into the body
-kidney doesn't produce 125ml of
urine every minute. 99% of the water
is normally reabsorbed, leaving
highly concentrated urine to flow into
the collecting duct and then into the
renal pelvis.
*GLOMERULAR FILTRATION RATE (GFR) is the volume of
ultrafiltrate made per minute by both kidneys. The
GFR is an important measure of kidney function
The Ureters
-muscular ducts that propel urine from
the kidneys to theurinary bladder.
-25–30 cm (10–12 in) long (adult)
-arise from the renal pelvis on the medial
aspect of each kidney before descending
towards the bladder on the front of the psoas
major muscle
-cross the pelvic brim near the bifurcation of
the iliac arteries
*pelviureteric junction is a common site for the
impaction of kidney stones (the 2nd is ureterovesical
valve)
1

- URETERS run posteroinferiorly on the
lateral walls of the pelvis
-then curve anteriormedially to enter the
bladder through the back(vesicoureteric)
junction, running within the wall of the
bladder for a few centimeters
Ureterovesical valves
-prevents backflow of urine.
*In the female, the ureters pass through
the mesometrium on the way to the urinary bladder.
The Urinary Bladder
-midline in the abdominal pelvis
-collect and store urine
-can hold up to 500 ml ((700 to 1000ml max) of
urine
-three openings
-2 ureteral openings to receive urine
from the kidneys
-1urethral opening to drain the urine
-form the trigone(smooth and
triangular) sensitive to expansion
Detrusor Muscle - smooth muscle of the bladder
Blood Supply: O2 vesical
obturator
uterine
gluteal
vaginal arteries
UnO2 = venous network drains the blood
to the abdominal iliac vein
The Urethra
-urethra is a tube like organ which drains
urine from the bladder to the exterior
-lined with endothelium and surrounded by
involuntary muscles
-females it is about 5 to 6 cm long. (Generally
it is 6mm wide in healthy patients)
-males it is 15 to 22 cm long. It begins at the
base of the bladder (surrounded by the
prostate gland) and extends to the tip of the
penis
*Since the female urethra is shorter and located close
to the vagina it is subjected to frequent urinary tract
infections
internal pudendal
vaginal arteries O2 supply arterial blood to the
urethra in females
inferior vesical
middle rectal arteries O2 supply the bulk or
arterial blood in males
Nerve Innervation = pudendal nerve
NCM 104 GU-Nsg.
Paul Christian P. Santos
Urethral Sphincter
-at the base of the bladder consists of ring like
muscles which facilitate its opening and closing
-the sphincter relaxes detrusor muscle contract and
urination occurs
Bladder muscle (detrusor muscle)
is capable of distending to accept urine
without increasing the pressure inside
large volumes can be collected (700-1000ml)
without high-pressure damage to the renal
system occurring.
*When urine is passed, the urethral sphincter at the
base of the bladder relaxes, the detrusor contracts
and urine is voided via the urethra
URINE FORMATION
The afferent arteriole brings unfiltered blood to the
renal corpuscle
flows through the glomerulus.
glomerulus and of Bowman’s capsule
The fluid and solutes that enter the capsule are called ultrafiltrate.
Some water and solutes from the
blood pass through this filtration membrane
From the renal corpuscle, the blood flows through the
peritubular capillaries, and the ultrafiltrate flows
through the tubule
Water and solutes pass back and forth between the
capillaries and the tubule in a highly controlled
pattern
(early part of tubule)
Much of the filtrate gets reabsorbed
(leaves the tubule and returns to the blood)
before it reaches the end of the nephron
over 99% of the water filtered out in the corpuscle is reabsorbed into the blood vessels
(later parts of the tubule)
contents of the filtrate are “fine-tuned”
Hormones control this process of fine-tuning
aldosterone helps the body retain sodium and water
ANP hormone (atrial natriuretic peptide) helps the body get rid of excess water
FILTRATE CHANGED INTO URINE
Collecting duct
Antidiuretic hormone (ADH) works in the collecting duct to regulate urine concentration
MICTURATION
*If the body is dehydrated, ADH causes water to
leave the collecting duct and return to circulation in
the body, the urine will be concentrated
*If a person has been drinking a lot of water and the
body is well hydrated, ADH causes water to stay in
the collecting duct, so it will leave the body in urine.
In this case, the urine will be diluted