Holes Human Anatomy and Physiology

Twelfth Edition

Shier w Butler w Lewis

Chapter 20 Urinary System

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20.1: Introduction
A major part of homeostasis is maintaining the composition, pH, and volume of body fluids within normal limits (Define homeostasis) The urinary system removes metabolic wastes and substances in excess, including foreign substances like drugs and their metabolites that may be toxic It consists of a pair of kidneys, a pair of ureters, a urinary bladder and a urethra

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Kidney Renal artery Inferior vena cava Abdominal aorta

Renal vein Hilum

Ureters

Urinary bladder Urethra

CNRI/SPL/Photo Researchers, Inc.

20.2: Kidneys
The kidney is a reddish brown, bean-shaped organ with a smooth surface In the adult it is about 12 centimeters long, 6 centimeters wide, and 3 centimeters thick It is enclosed in a tough, fibrous capsule

Location of the Kidneys

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Kidney Adipose tissue Parietal peritoneum Inferior vena cava Pancreas Spleen Aorta Small intestine Large intestine Stomach (a)

Adrenal gland Twelfth rib

Liver

Kidney Renal fascia

Parietal peritoneum Renal fascia

Hip bone (cut)

Large intestine

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(b)

Kidney Structure
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Renal capsule Renal cortex Nephrons Renal cortex Renal corpuscle

Renal medulla Minor calyx Major calyx Renal sinus Renal column Fat in renal sinus Renal pelvis Renal papilla

Renal medulla Collecting duct Papilla Minor calyx (b)

Renal tubule

(c)

Renal pyramid Ureter

(a)

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Inferior vena cava

Abdominal aorta

Suprarenal artery
Adrenal gland

Suprarenal vein
Renal artery Renal column

Renal capsule Renal pelvis Renal papilla Renal medulla

Renal vein Hilum

Renal pyramid

Renal cortex Ureter Minor calyx

Function of the Kidneys

The main function of the kidneys is to regulate the volume, composition, and pH of body fluids The kidneys remove metabolic wastes from the blood and excrete them to the outside of the body, including nitrogenous and sulfur-containing products of protein metabolism

The kidneys also help control the rate of red blood cell production, regulate blood pressure, and regulate calcium ion absorption

Renal Blood Vessels

Copyright The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Copyright The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Cortical radiate artery and vein Arcuate vein and artery Interlobar vein and artery Proximal Cortex convoluted tubule Medulla Efferent arteriole Peritubular capillary Cortical radiate artery and vein Afferent arteriole Distal convoluted tubule

Renal artery Renal vein Renal pelvis

Ureter (a)

Efferent Afferent arteriole arteriole Glomerulus (a)

Peritubular capillary

Renal tubules

Glomerulus (b)

Glomerular capsule

(a) : Tissues and Organs: A Text-Atlas of Scanning Electron Microscopy, by R.G. Kessel and R.H. Kardon. 1979 W.H. Freeman and Company (b) : Courtesy of R.B. Wilson MD, Eppeley Institute for Research in Cancer, University of Nebraska Medical Center

(b) b: L.V. Bergman/The Bergman Collection

Nephrons
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Afferent arteriole Blood flow

Efferent arteriole

Slit pore

Pedicel

Primary process of podocyte

Blood flow

Glomerular capsule Parietal layer of glomerular capsule Glomerulus Visceral layer of glomerular capsule Pedicel Primary process of podocyte

Slit pore

Proximal convoluted tubule

David M. Phillips/Visuals Unlimited

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Animation: Fluid Exchange Across the Walls of Capillaries

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Copyright The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

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Glomerular capsule Proximal convoluted tubule

Cortical radiate artery Cortical radiate vein

Collecting ducts

Glomerulus

Afferent arteriole Distal convoluted tubule From renal artery To renal vein

Epithelial cell

Efferent arteriole

Renal cortex
(a) Renal tubules Glomerular Glomerulus capsule Renal corpuscle

Blood vessel

Peritubular capillary

(b)

a: Biophoto Associates/Photo Researchers, Inc., b: Manfred Kage/Peter Arnold

Nephron loop

Descending limb Ascending limb Collecting duct

Renal medulla

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Juxtaglomerular Apparatus
Copyright The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Afferent Glomerular arteriole capsule Glomerulus Juxtaglomerular apparatus

Distal convoluted tubule Efferent arteriole

Proximal convoluted tubule

Glomerulus Podocyte Afferent arteriole

Nephron loop

(a)

Juxtaglomerular cells Macula densa Ascending limb of nephron loop

Juxtaglomerular apparatus

Glomerular capsule

Efferent arteriole (b)

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Cortical and Juxtamedullary Nephrons

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Cortical nephron

Renal cortex

Juxtamedullary nephron

Renal medulla

Collecting duct

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Blood Supply of a Nephron

Copyright The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Copyright The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Renal artery

Glomerular capsule

Cortical radiate artery and vein

Proximal convoluted tubule

Interlobar artery

Arcuate artery

Glomerulus
Efferent arteriole

Afferent arteriole Distal convoluted tubule

Interlobular artery

Afferent arteriole

Peritubular capillaries

Glomerular capillaries

Efferent arteriole

Vasa recta
Peritubular capillaries

Interlobular vein

Arcuate vein

Collecting duct Nephron loop

Interlobar vein

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Renal vein

20.3: Urine Formation

The main function of the nephrons and collecting ducts is to control the composition of body fluids and remove wastes from the blood, the product being urine Urine contains wastes, excess water, and electrolytes

Urine is the final product of the processes of:

Glomerular filtration Tubular reabsorption Tubular secretion
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Urine Formation
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Arteriole

Venule Net reabsorption Blood flow

Net filtration Interstitial fluid (a) In most systemic capillaries, filtration predominates at the arteriolar end and osmotic reabsorption predominates at the venular end.

Peritubular capillaries Afferent arteriole Glomerular capillaries Efferent arteriole Venule Blood flow

Glomerular filtration Filtered fluid

Tubular reabsorption Tubular fluid Renal tubule

Tubular secretion Urine

(b) In the kidneys, the glomerular capillaries are specialized for filtration. The renal tubule is specialized to control movements of substances back into the blood of the peritubular capillaries (tubular reabsorption) or from the blood into the renal tubule (tubular secretion).

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Glomerular Filtration
Glomerular filtration Substances move from the blood to the glomerular capsule
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Glomerulus Afferent arteriole

Proximal convoluted tubule

Podocyte

Capillary endothelium

Glomerular capsule

Glomerular filtrate

Blood flow

Fenestrae

Podocyte Efferent arteriole

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(a) (b)

Plasma, Glomerular Filtrate, and Urine Components

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Filtrate Pressure
The main force that moves substances by filtration through the glomerular capillary wall is hydrostatic pressure of the blood inside (Compare to osmotic pressure)
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Hydrostatic pressure of blood Glomerular hydrostatic pressure

Capsular hydrostatic pressure

Plasma colloid osmotic pressure

Net Outward Pressure Outward force, glomerular hydrostatic pressure = Inward force of plasma colloid osmotic pressure = Inward force of capsular hydrostatic pressure = Net filtration pressure =

+60 mm 32 mm 18 mm +10 mm

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Filtrate Rate
Glomerular filtration rate (GFR) is directly proportional to the net filtration pressure
Net filtration pressure = force favoring filtration (glomerular capillary hydrostatic pressure) forces opposing filtration (capsular hydrostatic pressure and glomerular capillary osmotic pressure)
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Normally the glomerular net filtration pressure is positive causing filtration The forces responsible include hydrostatic pressure and osmotic pressure of plasma and the hydrostatic pressure of the fluid in the glomerular capsule

180 170 160 150 140 130 120 110 Liters 100 90 80 70 60 50 40 30 20 10 0 (a)

180 Liters

0.6 2.5 Liters Glomerular filtrate (b) Urine

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Control of Filtrate Rate

GFR remains relatively constant through a process called autoregulation Certain conditions override autoregulation, including when GFR increases Primarily three mechanisms are responsible for keeping the GFR constant: Autoregulation Increased sympathetic impulses that decrease GFR by causing afferent arterioles to constrict The hormone-like renin-angiotensin system There also is the hormone atrial natriuretic peptide (ANP) which affects sodium, causing an increase in GFR
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Lung capillaries

Kidney
Liver

Renin

Angiotensinconverting enzyme
Angiotensin I Angiotensin II

Angiotensinogen

Bloodstream Vasoconstriction Increased aldosterone secretion Increased ADH secretion Increased thirst

Release into bloodstream

Stimulation

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Effects of Aldosterone
Aldosterone is a hormone secreted by the adrenal cortex. It helps regulate the concentration of extracellular electrolytes by conserving sodium and excreting potassium ions. Its secretion is regulated by concentration of electrolytes in body fluids and by the renin-angiotensin mechanism.

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Effects of ANP
ATRIAL NATRIURETIC PEPTIDE (ANP)

A hormone produced by the heart, atrial natriuretic peptide (ANP), increases sodium excretion and decreases blood pressure and blood volume. ANP is released into the bloodstream in response to stretching of the atrial muscle cells by increased blood volume. ANP has the following physiological effects: Increases glomerular filtration rate by dilating afferent arterioles Inhibits the collecting ducts from reabsorbing sodium, both directly and indirectly (by inhibiting aldosterone secretion) Inhibits release of renin The renin-angiotensin system and ANP function antagonistically in the maintenance of fluid/electrolyte balance and blood pressure.

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Tubular Reabsorption
Tubular reabsorption Substances move from the renal tubules into the interstitial fluid where they then diffuse into the peritubular capillaries The proximal convoluted tubule reabsorbs (70%): Glucose, water, urea, proteins, and creatine Amino, lactic, citric, and uric acids Phosphate, sulfate, calcium, potassium, and sodium ions

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Blood flow Afferent arteriole Glomerular capsule Glomerulus Glomerular filtrate Efferent arteriole Glomerular capsule Glomerulus Glomerular filtrate

Blood flow Afferent arteriole Efferent arteriole

Peritubular capillary Tubular reabsorption Peritubular capillary Tubular secretion Renal tubule

Renal tubule
Blood flow (a)

Blood flow (b)

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Blood flow Glomerulus Glomerular capsule

Glomerular filtrate

Blood flow

Proximal convoluted tubule

Na+ Na+ Cl PO43 HCO3 N+ Cl Na+ H2O H2O

+ + + + + + + + + ++ + + ++

Sodium ions are reabsorbed by active transport Negatively charged ions are attracted to positively charged ions As concentration of ions (solute) increases in plasma, osmotic pressure increases

Water moves from proximal tubule to capillary by osmosis

Isotonic tubular fluid

Peritubular capillary Blood flow

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Tubular Secretion
Tubular secretion Substances move from the plasma of the peritubular capillaries into the fluid of the renal tubules Active transport mechanisms function here Secretion of substances such as drugs and ions

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Peritubular capillary Blood flow K+ or H+

Tubular reabsorption

Tubular secretion

Na+ Na+ Na+ Na+

Na+ Na+

Na+

H+ K+

Na+ K+

Na+

K+ Na+

Tubular fluid

Distal convoluted tubule

H+ K+ Na+

Na+
Na+ Ascending limb of nephron loop Collecting duct

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Regulation of Urine Concentration and Volume

Hormones such as aldosterone and ANP affect the solute concentration of urine, particularly sodium (How does this relate to blood pressure?) The ability of the kidneys to maintain the internal environment rests in a large part on their ability to concentrate urine by reabsorbing large volumes of water The distal convoluted tubule and the collecting duct are impermeable to water, so water may be excreted as dilute urine If ADH is present, these segments become permeable, and water is reabsorbed by osmosis into the extremely hypertonic medullary interstitial fluid (What is ADH? What does hyper-, hypo- and isotonic mean?) A countercurrent mechanism in the nephron loops (the descending and the ascending limbs) ensures that the medullary interstitial fluid becomes hypertonic This mechanism is known as the countercurrent multiplier The vasa recta also contributes as a countercurrent mechanism
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Distal convoluted tubule Medullary interstitial fluid

H2O

Medullary interstitial fluid

H2O

H2O

H2O H2O

H2O

H2O
Collecting duct

Hypertonic interstitial fluid

Collecting duct

Hypertonic interstitial fluid H2O

Dilute urine (a) low ADH levels (b)

Concentrated urine high ADH levels

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H2O

Na+ Cl

Salty Increasing NaCl concentration 2 Cl Na+ Cl Na+ Cl Na+ Hypotonic fluid Thick ascending limb (impermeable to water) 3 Medullary interstitial fluid H2O H2O Na+ Cl More salty

Isotonic fluid
H2O

H2O Descending limb (permeable to water)

Na+ Cl Even more salty

H2O

(a)

Hypertonic fluid

(b)

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Blood flow

Blood flow

Increasing NaCl concentration

NaCl NaCl NaCl NaCl NaCl NaCl

Medullary interstitial fluid NaCl NaCl

Vasa recta

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Urea and Uric Acid Excretion

Urea: A by-product of amino acid catabolism (Where is it produced?) The plasma concentration reflects the amount or protein in diet It enters the renal tubules through glomerular filtration It contributes to the reabsorption of water from the collecting duct (How?) About 80% is recycled Uric acid: Is a product of nucleic acid metabolism It enters the renal tubules through glomerular filtration Most reabsorption occurs by active transport 38 About 10% is secreted and excreted

Urine Composition
Urine composition reflects the volumes of water and solutes that the kidneys must eliminate from the body or retain in the internal environment to maintain homeostasis It varies from time to time due to dietary intake and physical activity, but is: About 95% water Usually contains urea, uric acid, and creatinine May contain trace amounts of amino acids and varying amounts of electrolytes Volume varies with fluid intake and environmental factors

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Renal Clearance
This is the rate at which a chemical is removed from the plasma It indicates kidney efficiency Tests of renal clearance: Inulin clearance test Creatinine clearance test Para-aminohippuric acid (PAH) test These tests of renal clearance are used to calculate the GFR (glomerular filtration rate)

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Animation: Renal Clearance

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20.4: Elimination of Urine

After forming along the nephrons, urine: Passes the collecting ducts to: Openings of the renal papillae: Enters the minor and major calyces: Passes through the renal pelvis: Enters into the ureters: Enters into the urinary bladder: The urethra carries the urine out of the body

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Ureters
The ureters: Each is about 25 centimeters long Extends downward posterior to the parietal peritoneum (What is this called?) Runs parallel to vertebral column Join the urinary bladder in the pelvic cavity The wall of ureter has three layers: The inner mucous coat The middle muscular coat The outer fibrous coat

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Mucous coat Lumen Muscular coat

Fibrous coat
Adipose tissue
Per H. Kjeldsen

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Urinary Bladder
The urinary bladder is a hollow, distensible, muscular organ located within the pelvic cavity, posterior to the symphysis pubis and inferior to the parietal peritoneum It contacts the anterior walls of the uterus and vagina in the female, and lies posteriorly against the rectum in the male

The openings for the ureters is the area of trigone

It has four layers: inner mucous coat, a submucous coat, a muscular coat, and an outer serous coat

Smooth muscle fibers comprise the detrusor muscle which is the muscle of the bladder wall
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Abdominal wall

Ureter

Parietal peritoneum
Urinary bladder Symphysis pubis Prostate gland Urethra Rectum Rectum

(a)

(b)

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Ureter

Serous coat

Urinary bladder Ureter

Detrusor muscle Submucous coat Mucous coat Openings of the ureters Trigone Neck Prostate gland Internal urethral sphincter Prostate gland Urethra Region of external urethral sphincter (a) (b) Seminal vesicle Ductus (vas) deferens

Urethra

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Muscular coat

Mucous coat

Submucous coat

Lumen

John D. Cunningham/Visuals Unlimited

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Ureter

Urinary bladder

Trigone

Urethra

External urethral orifice (a)

Ureter

Urinary bladder Trigone

Prostatic urethra Membranous urethra

Prostate gland Bulbourethral gland

Penile urethra

Penis

External urethral orifice (b)

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Urethra
The urethra is a tube that conveys urine from the urinary bladder to the outside of the body Its wall is lined with a mucous membrane and it has a thick layer of longitudinal smooth muscle fibers In a female: It is about 4 centimeters long It runs obliquely In a male: It is about 17.5 centimeters long It has a dual function for both urination and reproduction It has three sections: Prostatic urethra Membranous urethra Penile urethra 50

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Urethral glands Muscle layer Lumen of urethra Mucous membrane

Ed Reschke

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Micturition
Urine leaves the urinary bladder by micturition or urination reflex

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Animation: Micturition Reflex

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Micturition

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Animation: Renal Process

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Overview of Urinary System Anatomy

http://faculty.ucc.edu/biologypotter/Urinary_System/sld001.htm

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20.5: Lifespan Changes

The urinary system is sufficiently redundant, in both structure and function, to mask age-related changes The kidneys become slower to remove nitrogenous wastes and toxins and to compensate for changes that maintain homeostasis Changes include: The kidneys appear scarred and grainy Kidney cells die By age 80 the kidneys have lost a third of their mass Kidney shrinkage is due to loss of glomeruli Proteinuria may develop (What is this?) The renal tubules thicken It is harder for the kidneys to clear certain substances The bladder, ureters, and urethra lose elasticity The bladder holds less urine
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Important Points in Chapter 20: Outcomes to be Assessed

20.1: Introduction Name the organs of the urinary system and list their general functions. 20.2: Kidneys Describe the location of the kidneys.

Describe the structure of a kidney.

List the functions of the kidneys. Trace the pathway of blood flow through the major vessels within a kidney. Describe a nephron and explain the functions of its major parts. 20.3: Urine Formation Explain how glomerular filtrate is produced and describe its composition.
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Important Points in Chapter 20: Outcomes to be Assessed

Explain how various factors affect the rate of glomerular filtration and identify ways that this rate is regulated.
Define tubular reabsorption and explain its role in urine formation. Identify the changes in the osmotic concentration of the glomerular filtrate as it passes through the renal tubule. Identify the characteristics of the countercurrent mechanism and explain its role in concentrating the urine. Define tubular secretion and explain its role in urine formation. 20.4: Elimination of Urine Describe the structures of the ureters, urinary bladder, and urethra. Define micturition and explain how it occurs and how it is controlled.59

Important Points in Chapter 20: Outcomes to be Assessed

20.5: Lifespan Changes
Describe how the components of the urinary system change with age.

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