Urinary System

Anatomy and Physiology

Part I
 Urinary System
 Kidneys (2)
 Most important excretory organ
 Eliminate waste
 Ureters (2)
 Bladder (1)
 Urethra (1)
 Nephron Unit
 Functional unit of the kidney
 Formation of urine
 Tubular and vascular structures
Kidney Location and Protection
 Kidneys are located in the posterior wall of the
abdominal cavity
 In the retroperitoneal space
 Connective tissue (renal fascia) hold the
kidneys in place
 Adipose tissue cushion the kidneys
 The lower rib cage partially enclose the kidney
and protect them
 Urinary System –
Anterior/Posterior Views
 Kidney Structures
 Kidney is reddish-brown
 Looks like a bean
 Approximately 4 inches x 2 inches
 Hilus – indentation where blood vessels and
structures enter or exit the kidney
 Three Regions in the kidney if sliced in half –
renal cortex, renal medulla, renal pelvis
 Average adult kidney weighs 113-170 g.
 10 – 12 cm long.
 6 cm wide.
 2.5 cm thick.
 Right kidney is lower than the left due to
location of liver.
 Adrenal gland lies on top of each kidney.
 Renal parenchyma is divided into two parts:
 ~ Cortex
 ~ Medulla
 Renal Cortex
 Light, outside region
 Cortex means “bark”
 Contains: Nephron
 Renal Medulla
 Dark, triangular structure
 Form small cone shaped
regions called renal
pyramids
 Each pyramid is separated
by renal columns
 The lower ends of the
pyramids point to the
renal pelvis
 Renal Medulla
 Contains: Loops of  Each kidney contains
Henle, Vasa Recta 8 -18 pyramids.
and collecting ducts  Pyramids drain into
of the juztamedullary 4 – 13 minor calices.
nephrons.  2 – 3 major calices.
 Renal pelvis
 A basin that collects the
urine made by the kidney
and helps form the upper
end of the ureter
 The edges of the renal
pelvis closest to the renal
pyramids are called
calices
 Calices collect the urine
formed in the kidney
 Renal pelvis
 Is the beginning of
collecting system
and composed
structures that are
designed to
COLLECT and
TRANSPORT
URINE.
 How do they work?
 Need a blood supply
 Brought to the kidney via the renal artery
 Renal artery stems from the abdominal aorta
 20-25% of cardiac output goes to the kidneys
 Smaller arteries supply blood to the nephron unit
 Blood leaves the kidney via the renal veins
 The renal veins empty into the inferior vena cava
 Functions of the Kidneys
 Excrete nitrogenous waste from the body
 Urea
 Ammonia

 Creatinine

 Regulate blood volume

 Help regulate electrolyte content of the blood
 Regulate acid-base balance (pH)
 Regulate blood pressure
 Regulates red blood cell production
 The Formation of Urine
 The Nephron Unit
 Each kidney contains about 1 million nephron
units
 The number does not increase after birth
 They cannot be replaced if damaged
 2 parts
 Tubular component (renal tubule)
 Vascular component
 Renal Tubules
 Glomerular capsule (Bowman’s Capsule) –
“C” shaped capsule surrounding the
glomerulus
 Glomerulus – cluster of capillaries
 Proximal convoluted tubule
 Loop of Henle – ascending and descending limb

 Distal Convoluted tubule

 Collecting duct
Nephron
 Renal Vasculature
 Receives blood from the renal artery
 Renal artery branches into the afferent arterioles (Branches
to form glomerulus)
 Afferent arterioles feed into Bowman’s capsule
 The efferent arterioles exit Bowman’s capsule
 The efferent arterioles form the peritubular capillaries
 The peritubular capillaries empty into the venules, large
veins, and then into the renal veins
 It is imperative you know the relationship between the
tubular and vascular structures.
 Urine Formation
 Formed in the nephron unit
 Water and dissolved substances move through
the renal tubules and vessels
 Three processes are involved in urine
formation
 Glomerular filtration
 Tubular reabsorption

 Tubular secretion
 Normal Urine
 Clear and pale to deep yellow or amber
 Slightly aromatic in odor
 Slightly acidic 5.0 – 8.0
 With a sp. Gravity of 1.010 – 1.030
 (+) NA, K ions, urea uric acid, creatinin,
ammonia, and HCO3 ions
 (-) Glucose, CHON, RBC, and WBC and bile
pigments
 Composition of Urine
 Sterile
 95 % water
 Nitrogen containing waste – urea, uric acid,
ammonia, creatinine
 Electrolytes
 Light yellow color of urine is due to a pigment
called urochrome
 Urochrome is formed from the breakdown of
hemoglobin in the liver
 Urine Specific Gravity
 Ratio of the amount of solute to the total volume
 Solute = substance dissolved in the urine
 The greater the solute = greater the specific
gravity
 Concentrated Urine = high specific gravity
 Ex. dehydration
 Dilute Urine = low specific gravity
 Ex. Overhydration, diabetes insipidus
 Urine Characteristics
 Amount – 1500 ml in 24 hours
 pH – average 6.0
 Specific Gravity – heavier than water (1.010-1.030)
 Color – yellow (amber, straw colored, concentrated,
orange, brown, red, sediment, clear or cloudy)
 Dehydrated = deep yellow, dark
 Overhydrated = pale yellow, colorless
Abnormal Constituents of Urine
 Albumin (protein)
 Glucose
 Red blood cells
 Hemoglobin
 White blood cells
 Ketone bodies
 Bilirubin
 Urine Testing
 Urinalysis
 Microscopic exam
 Culture and sensitivity
 Urine dipstick
 Urine Drug and alcohol screening
 24 hour urine testing
Your Plumbing – The Urinary Tract
(Ureters, Urinary bladder, Urethra)
 Ureters
 Transport urine, they do not alter it in any way
 Urine moves in response to gravity and
muscular movements called peristalsis through
ureters.
Your “Plumbing”
 The Bladder
 Stores urine temporarily until elimination
 Located behind the symphasis pubis
 A distended bladder or full bladder can be palpated above the
syphasis in the abdominal cavity.
 Bladder has 4 layers
 Mucous membrane
 Submucosa
 Detrusor muscle – involuntary smooth muscle
 Serosa
 Contain rugae to allow for stretching
 Trigone – triangular area in the floor of the bladder
 Urination – “Micturition”
 Expelling urine from the bladder
 The urge to urinate (void) happened at about 200 ml
of urine in the bladder
 At about 300 ml urine in the bladder, the urge
becomes more uncomfortable
 Moderately full = 500 ml urine
 Overdistended bladder may have over 1000 ml urine
 Bacteria in your bladder doubles every 4 hours.
 Stimulated by stretch receptors
 Urethra
 Carries urine from the bladder to the outside of the
body
 Internal sphincter prevents urine from emptying;
composed of smooth muscle; involuntary
 External sphincter at the upper portion of the urethra
allows you to resist the urge to urinate; composed of
skeletal muscle; voluntary
 Female – short, opens to the outside at the urethral
meatus
 Male – longer, passes through the prostate gland;
carries urine and sperm
Urinary Retention and Suppression
 Retention - Inability to void
 Post operative; anesthesia
 Bladder dysfunction

 Suppression – no urine formation

 Kidney dysfunction
 Data Collection & Documentation
 Characteristics of urine
 Color
 Sediment
 Clear or cloudy
 Odor
 How does the patient/resident void?
 Urinary diversions?
 Signs and symptoms
 Urgency
 Frequency
 Burning sensation
 Hesitancy
What is the Costovertebral Angle?

T11

R. Kidney L. Kidney
T12

12th Rib L
1
Costovertebral Angle
Region to assess for kidney tenderness
Disorders of the Urinary System
 Glomerulonephritis
 Polycystic Kidney
 Pyelonephritis
 Renal Calculi – kidney stones
 Renal Failure
 UTI – urinary tract infection
 As We Age
 By age 80 there is a 50% reduction in nephron
units; therefore a decreased ability to concentrate
urine
 Urinary bladder shrinks and becomes less able to
contract and relax; therefore the elderly must void
frequently
 Bladder infection incidence increases
 Increase in bladder incontinence due to weakened
muscles
 Functions of Genitourinary
System
 Filtration
 Reabsorption
 Secretion
 Excretion
 Regulation