Urinary System

Organs of the urinary System

The kidneys: 2, secretes urine
The ureters: 2, drain urine from the kidney to the urinary bladder
The urinary bladder-1, acts as urinary reservoir where urine is collected and stored for a
short period temporarily)
The urethra- 1, a canal through which the urine is eliminated from the urinary bladder.
Kidney
Bean shaped organ situated against the posterior abdominal wall behind the peritoneum,
one on each side of the vertebral column.
Extends from the 12th thoracic vertebrae (T12) to the 3rd lumbar vertebrae (L3).
The size of each kidney is about 11cm long, 6cm wide and 3cm thick.
Average weight: 150 gm in male and 135 gm in female.
Organs associated with the kidney
Position
Superiorly
Inferiorly
Anteriorly
Posteriorly
Medially

Right Kidney
Left Kidney
The right suprarenal (adrenal) gland which lie Left suprarenal gland
like a cap
Hepatic flexure of colon (right colic flexure)
Splenic flexure of the colon (left
colic flexure)
Liver, duodenum
Spleen, stomach, tail of pancreas
and jejunum
The right part of the diaphragm and the right The left part of the diaphragm
psoas muscle.
and left psoas muscle
Inferior venecava and right ureter
Aorta and left ureter.

Gross Anatomy of Kidney

The kidney can be divided into external and internal structure
External structure: a) renal capsule b) Hilum
Internal structure: a) the solid portion: cortex and medulla
b) the cavity portion
In transverse section external structure has
1. Renal capsule: is a protective thin fibrous tissue that envelopes the kidney.
2. Hilum: the medial surface of each kidney has concave fissure in the centre called hilum.

At hilum, the renal artery and renal nerves enter the kidney and the renal vein and ureter
leave the kidney.
The hilum leads into a central space/ cavity known as renal sinus which contains the renal
blood vessels and renal pelvis of the ureter (expanded part of the ureter).
Within the renal sinus the pelvis divides into 2 (or 3) parts called major calyces.
Each calyx divides into a number of minor calyces.

Internal Structure in longitudinal section

1. Solid portion: consists of countless minute tubules. It has 2 layers:
Cortex: the reddish brown outer part of the kidney, immediately after the fibrous capsule,
composed of renal corpuscle, convoluted tubules and adjacent part of the loop of Henle.
Medulla: the inner most portion which consists of series of pale conical shaped projection
called renal pyramids, it is composed of loop of Henle and collecting tubules.
2.The cavity portion: renal pelvis
Each pyramid has a base directed toward the cortex and an apex (or papilla) that is
directed towards the cortex and the renal pelvis and fits into a minor calyx.
Pyramid shows striation that pass radially towards the apex.
The urine formed in the kidney passes into the calyces through a papilla at the apex of the
pyramid. It then passes through the pelvis into the ureter.
Microscopic structure of the kidney

It consists of countless microscopic structure called nephron and collecting tubules

which together are called uriniferous tubules.
The uriniferous tubules are supported by a small amount of connective tissue which
contains blood vessels, nerves and lymph vessels.
The kidney is composed of 3 main structures i.e. renal corpuscles or malphigian body,
renal tubules, renal arteries, veins and supporting tissue.

The nephron
It is the anatomical and functional unit of the kidney.
They are approximately 1 million nephron in each kidney,
Each nephron consists of the following structure:
i) Glomerulus
The cluster of capillaries invaginated into the glomerular capsule is known as
glomerulus.
It is lined by columnar epithelium
ii) The glomerular capsule or Bowmans Capsule
It is cuplike double layered covering for the glomerulus.

Continuing from the glomerular capsule the remainder of the nephron is about 3cm
long and is described in 3 parts:

iii) the proximal convoluted tubule

iv)The medullary loop (loop of Henle)
v) The distal convoluted tubules, leading into a collecting duct.
iii) Proximal convoluted tubules
First portion of the renal tubule
Starts from the glomerular capsule and ends to the upper part upto the loop of Henle.
Approximate length is 12.24mm
iv) Loop of Henle
Second portion of the renal tubule
It is continuous of proximal convoluted tubules to the distal convoluted tubules.
This is thin walled and U-shaped.
It is lined with columnar cells.
v) Distal convoluted tubules
Third portion of the renal tubule
Starts from the ascending part of loop of Henle and end into the collecting tubules.
Length: 4-8mm long
vi) Collecting Tubules
Each collecting tubule receives urine from several nephrons.
The collecting tubule go to the medulla and open at the apices of the pyramids into the
pelvis of the kidney whereas the loop of Henle and collecting tubules lie in the medulla of
the kidney.
The kidney is richly supplied with blood from the renal artery.
After entering the kidney at the hilum the renal artery divides into smaller arteries and
arterioles.
In the cortex, an arteriole, the afferent arteriole, enter each glomerular capsule then
subdivides into a cluster of capillaries, forming the glomerulus.
The blood vessels leading away from the glomerulus is the efferent arteriole, it breaks up
into a second capillary network to supply oxygen and nutrients to the remainder of the
nephron.
The venous blood drains away from this capillary bed and leaves the kidneys by the renal
vein.
The blood then empties into the inferior venecava.
The blood pressure in the glomerulus is higher than in other capillaries because the calibre
of the afferent arteriole is greater than that of the efferent arterioles and also because it is
near to the abdominal aorta.

Functions of the Kidneys

Secretes urine which passes through the ureters to the urinary bladder for excretion (thus
maintains fluid and electrolyte balance and excretes the waste material from the body.)
Maintains water balance by excreting excess water from the body.
Maintains electrolyte balance
Excretes end product of protein metabolism
Excretes drugs, toxins and other chemical substances which may be harmful for the body
Secretes erythropoeitin hormones necessary for RBC production
Forms 1,25-dihydroxychole-calciferol (biologically active vitamin D)
Regulates and maintains blood pressure

Physiology of Urine Formation

The kidneys form urine which passes through the ureters to the bladder for storage prior to
excretion.
Waste products of protein metabolism and other body wastes are excreted in the form of
urine.
Electrolytes and pH (acid base) balance is also maintained by excretion of sodium,
potassium and hydrogen.

Process involved in urine Formation

a. Simple filtration
b. Selective reabsorption
c. Secretion

a. Simple filtration

The blood from the renal artery enters the smaller afferent arteriole which then turns into
even smaller capillaries of the glomerulus.
As the blood vessels travel this course the vessels get narrower and narrower.
This results in an increase in blood pressure. This high pressure forces a plasma-like fluid
to filter from the blood in the glomerulus into the Bowman's capsule.
Filtration occurs through semi permeable wall of the glomerulus and glomerular capsule.
The glomerular membrane acts as a simple filter.
Water and a large number of small molecules pass through the glomerulus as filtrate.
It consists of water, glucose amino acids, some salts, uric acid, urea, potassium,
phosphate, sodium and sulphur etc. which are again reabsorbed according to the bodys
need.
The filtrate does not contain plasma proteins because they are too large to pass through
the pores of the capillary membrane so they remain in the blood present in capillaries.
Renal filtrate is very much like blood plasma; except that there is far less protein and no
blood cells are present.

Filtration is assisted by 3 pressure

 Capillary Hydrostatic Pressure

Osmotic pressure
Filtrate hydrostatic pressure
Capillary hydrostatic pressure (55-70mm of Hg)
This pressure is exerted by the difference between blood pressure in the glomerular and
the pressure of the filtrate in th e glomerular capsule.
It is caused by difference in the diameter of afferent and efferent arterioles (A>E)
Osmotic pressure (30mm of Hg)
The capillary hydrostatic pressure is opposed by osmotic pressure present in the
glomerulus.
Filtrate hydrostatic pressure (5-15mm of Hg)
It is caused by presence of filtrate in the capsule. Therefore net filtration pressure is the
pressure which remains in the capsule and the different tubules i.e.
(55-70)-{30+(5-15)}= 20-25 mm of Hg
About 25% of the cardiac output of blood in each cardiac cycle is distributed through the
renal arteries to the kidneys for filtration. Each minute about 1200ml blood enters the
glomerular tuft of capillaries, but only 125ml are filtered per minute.
The volume of fluid filtered from the renal glomerular capillaries into the bowmans capsule
per unit time is called glomerular filtration rate (GFR)

b. Selective reabsorption
2nd stage of urine formation
It is the process by which the composition and the volume of the glomerular filtrate are
altered during its passage through the renal tubules.
It includes the reabsorption of useful substances from the filtrate within the renal tubules.
(in order to maintain fluid and electrolyte balance, Acid-base balance)
These substances are water, glucose, amino acids, vitamins, bicarbonate ions, and the
chloride salts of calcium, magnesium, sodium and potassium.
Reabsorption starts in the proximal tubules and continues through the Henle's loop, to the
distal tubule and then to the collecting tubules
Water, glucose, salts, amino acid and vitamins are high threshold substances (are
absorbed highly)
Urea, uric acid and other waste products are low threshold substances(are absorbed only
to slight amount)
Reabsorption take place by the process of osmosis, diffusion and active transport.
Absorption process is regulated by certain hormones:
Parathyroid hormone from parathyroid gland and calcitonin from the thyroid gland regulate
the reabsorption of calcium phosphate,

 Antidiuretic hormone (ADH, Vasopressin) from the posterior lobe of pituitary gland affects
the permeability of the distal convoluted tubules and .collecting tubules for increasing
water absorption.
Aldosterone (mineralo-corticoid) hormone secreted by the cortex of adrenal gland
increases the reabsortption of sodium and secretion of potassium.
Secretion
Third step of urine secretion
It is the process in which substances that are not absorbed from the renal tubules are
passed from the body in the urine.
Foreign materials and unwanted materials (drugs) are cleared by this process into the
convlouted tubules and excreted from the body
Thus this mechanism changes the composition of urine.
Some substances are actively secreted into the tubules.
Substances secreted into the urine include ammonia, hydrogen ions, potassium and some
drugs.
Secretion of H+ ions helps to maintain normal pH. They are secreted in combination with
bicarbonate as carbonic acid, with ammonia as ammonium chloride and with hydrogen
phosphate as dihydrogen phosphate.
The normal pH of urine varies from 4.5-7.8.

Composition of urine

Water 96%
Urea 2%
Others 2%- uric acid, creatinine, sodium, potassium, chlorides, phosphates, sulphates,
oxalates, some hormones vitamins, drugs (aspirin, sulfa drugs)

Normal Values of urine

Daily output of an adult= 1000-1500ml

Urine pH=4.5-7.5 (reaction is acidic), alkaline immediately after a meal
Specific gravity: 1.020-1.030
Color: clear, yellow or amber colored fluid due to the presence of bile pigment
Odor- like ammonia, aromatic (fresh)
Sediment: according to the diet and other changes, phosphate, urate, uric acid crystals,
calcium oxalate seen. Blood cells and epithelial cells are occasionally seen.
Ureter
2 tubes which convey urine from the kidney to the urinary bladder.
Size: 25-30cm (10-12 inch) in length and the diameter is approximately 3mm
It is continuous with the funnel shaped renal pelvis.

It passes downwards through the abdominal cavity behind the peritoneum, in front of
psoas muscle into the pelvic cavity and passes obliquley through the posterior wall of the
bladder for 2cm.
The obliquity of the ureter through the muscle of the bladder prevents the reflux of urine
from the bladder into the ureter (vesico-ureteric reflux).
Layers of the ureter
Outer: covering of fibrous tissue continuous with the fibrous capsule of the kidney.
Middle layer: muscle layer consisting of interlacing muscle fibers that form a
syncytium spiraling round the ureter, some in clockwise direction and some in
anticlockwise direction and additional outer longitudinal layer in lower third.
Inner layer: lining of mucous membrane consisting of transistional epithelium in the
basement membrane.

Function of ureter
Propels urine from kidneys into the urinary bladder by peristaltic contraction of the
muscular wall.

Urinary bladder

It is a roughly pear shaped, hollow muscular organ.

It acts as reservoir of urine.
Location: lies in the pelvic cavity and its size and position vary depending on th4e
amount of urine it contains
It becomes more oval in shape when distended and raises in the abdominal cavity.

Organs associated with bladder

In female
Anteriorly: the symphysis pubis
Posteriorly: the uterus
Superiorly: the small intestine
Inferiorly: the urethra and the muscle forming pelvic floor.
In male
Anteriorly: the symphysis pubis
Posteriorly: the rectum and seminal vesicles
Superiorly: the small intestine
Inferiorly: the urethra and prostate gland.
Structure
Lined by 4 layers of tissue
Peritoneum
Muscle layer: longitudinal and circular muscle fiber. It is also called detrusor muscle which
is primarily responsible for emptying the bladder during the micturation.

 Submucous layer: this layer joins the inner lining with the muscular layer and is made up
of areolar tissue containing blood vessels, lymphatic and sympathetic and parasympathetic
nerves.
Mucous layer: composed of transistional epithelium

When the bladder is empty or contracted the inner lining appears in folds. These folds
gradually disappear as the bladder distends with urine.
On examination the interior surface of the bladder, there are 3 orifices (the upper two
orifices on the posterior wall-openings of the two ureters), the inferior orifice is the point of
origin of the urethra.
The 2 orifices form a triangle which is known as trigone of the bladder where urethra
commences.
There is a thickening of the smooth muscle layer which acts as sphincter and controls the
passage of urine from the bladder into the urethra.
The internal sphincter is under autonomic nerve control.
Capacity of bladder: 500ml
Desire arouses if volume increases to 250-300ml

Functions of the urinary bladder

Serves as reservior of urine before it leaves the body.
Expels urine from the body with the help of urethra.

Urethra
The urethra is a canal extending from the neck of the bladder to the extending from the
neck of the bladder to the exterior.
Its length differs in two sexes
The female urethra is associated with the urinary system only whereas the male urethra is
associated with the urinary and reproductive system.
The female urethra is approximately 4cm (1.5 inches) long.
It leaves the base of the bladder at the trigone, runs downwards and forwards behind the
symphysis pubis and opens at the external urethral orifice, just in front of the vagina.
The external urethral orifice is guarded by the external sphincter which is under the
voluntary control.
In male, the urethra is 18-20cm (8 inches) long and about 6mm of diameter leading from
the bladder to its external orifice.
There is internal and external sphincter to the urethra: the internal sphincter is involuntary
and the external sphincter is under voluntary control except in early infancy and in nerve
injury or certain disease conditions.
The opening of the urethra to the exterior is called the urethral meatus.

Structure
A muscular layer which is continuous with the bladder. At its origin, there is an internal
sphincter, composed mainly of elastic tissues and smooth muscle fibers under autonomic
control.
Near the external urethral orifice, the smooth muscle is replaced by straited muscle which
forms the external sphincter under voluntary control.
The inner layer: a lining of mucous membrane continuous with that of the bladder in the
upper part of the urethra.
The lower part consists of stratified squamous epithelium, continuous externally with the
skin of the vulva.

Functions
Acts as passage way foe eliminating urine from the body.
In male serves as terminal portion of the reproductive tract and also the passage way for
the reproductive fluid, semen

Mechanism of micturation

It is the process of emptying the bladder and passing urine.

Also called voiding or urination.
There are 3 anatomical structures or facts involved in the micturation
The bladder
Two sphincter that surrounds the urethra
Parasympathetic nerves

Urine is collected drop by drop in the urinary bladder through the ureters by peristaltic
movement.
As urine accumulates in the bladder the muscle fibers of its wall becomes gradually
stretched to accommodate the fluid within it.
At first the increase in pressure within the bladder (intravesical pressure) is slight.
During increase in pressure, there is modification in the tone of the detrusor muscle.
When the pressure reaches a certain level, the sensory or afferent nerves of the bladder
are stimulated and an impulse passes to the spinal cord and thence to the higher center
(micturation center) where it is interpreted as the desire to micturate.
At this point, the individual can control the act and if necessary to postpone for emptying
the bladder.
The desire to micturate is first felt as a bladder volume of about 150ml.
If the urge is neglected, it is followed by a sensation of fullness and eventually of pain.

 As the sensory impulses increase in number and frequency, the perineal muscles are first
relaxed, while the muscles of the diaphragm and the abdominal wall contract and then the
detrusor muscle contracts and the internal and external sphincter relax in turn.
It is over the external sphincter which in under voluntary control is exercised.
The pressure in the bladder rises and the bladder neck slowly opens.
Finally the internal sphincter dilates and the external sphincter relaxes releasing urine into
the urethra which excretes it from the body.
Contraction of the bladder wall is normally continued until the bladder is empty.
After micturation, the bladder wall relaxes and the sphincter and bladder neck close.
Inhibition of reflex contraction of the bladder is possible only for limited period of time. if it
is inhibited or the desire for passing the urine is neglected for a long time, the person
would feel fullness, discomfort and eventually pain in the abdomen.
In infant, before the higher centers are fully functioning, the act of micturation is a reflex
one, the afferent stimulus passing to the spinal cord being followed immediately by the
motor response of micturation.
However, after the nervous system has fully developed, nerve impulses are conveyed to
consciousness and the brain can inhibit the reflex for limited period of time or until it is
convenient to micturate.
Extreme fear in emergency situation may cause autonomic relaxation of the sphincter with
the loss of control of urination and incontinence occur.
In certain disease condition as unconsiousness, those with damage to the brain or spinal
cord, the bladder fails to empty and urine is retained in the bladder.
When the retention reaches approximately 400ml, the urine begins to dribble away and the
patient is said to have urinary retention with overflow.
The semiconscious patient may react to fullness of bladder by becoming restless, and it
can be properly managed by keeping indwelling catheter to empty the bladder.

Electrolyte balance
Sodium and potassium concentration
Sodium is a normal constituent of urine and the amount excreted is regulated by the
hormone aldosterone, secreted by the cortex of the adrenal gland (suprarenal glands).
Juxtaglomerular cells are stimulated to produce enzyme renin by sympathetic nerves or by
low arterial blood pressure.
Renin converts angiotensinogen (plasma protein) produced by the liver, to angiotensin I
which convert to angiotensin II by ACE and stimulates the adrenal glad to secrete
aldosterone.
Water is reabsorbed with sodium and together they increase the blood volume leading to
reduced rennin secretion.
When sodium absorption is increased, potassium secretion is increased, indirectly
reducing intracellular potassium.

Blood pressure Regulation

When there is low blood pressure in the systemic circulation or constriction of either the
carotid or renal arteries, cause decreased arterial pressure in the carotid baroreceptors (a
collection of sensory nerves endings specialized to monitor change in B.P) or directly in
the renal arteries stimulates the renin-aldosterone mechanism.
The decreased blood flow stimulates the release of the proteolytic enzyme renin from
juxtaglomerular cells.
The renin aids in converting angiotensinogen to angiotensin I to angiotensin II
Angiotensin II increases blood pressure by two action
Constriction of peripheral blood vessels temporarily raise the blood pressure.
Stimulation of the adrenal cortex to produce aldosterone which stimulates the renal tubules
for reabsorption of sodium accompanied by water. This reabsorption increase blood
volume that raises blood pressure.

Water balance
The balance between the fluid intake and output is controlled by the kidneys.
Excess urine production is controlled mainly by anti-diuretic hormone (ADH) released into
the blood by the posterior lobe of the pituitary gland.
There is a close link between the posterior lobe of the pituitary gland and the
hypothalamus in the brain.
The hypothalamus contains special cells known as osmoreceptor, which is sensitive to
changes in the osmotic pressure of the blood.
ADH is synthesized by the cells of the supraoptic nucleus in the hypothalamus following
which it is transported down to the axon for the storage in the posterior pituitary lobe.
Nerve impulses from the osmoreceptor stimulate the posterior lobe of the pituitary gland to
release ADH.
When the osmotic pressure is raised, ADH output is increased and as a result, water
reabsorption is increased which reduces the osmotic blood pressure, thus ultimately
decreased or reduced ADH output and vice versa.