CH 26

Chapter 26
The
Urinary System
The Urinary System
The urinary systems consists of the kidneys, ureters,
bladder, and urethra, along with its associated nerves and
blood vessels.
The system maintains homeostasis by:
Regulating blood volume, pressure, pH, and
concentration (osmolarity) of electrolytes (Na+, K+,
Ca 2+, Cl-, HPO4-3, Mg2+, HCO3-)
Reabsorbing glucose and excreting wastes
Releasing certain hormones like renin and EPO
Copyright John Wiley & Sons, Inc. All rights reserved.
Renal Anatomy
The kidneys are bean-shaped organs located just above
the waist between the peritoneum and the posterior wall
of the abdomen (in the retroperitoneal space).
They are partially protected
by the eleventh and
twelfth pairs of ribs.
Because of the position
of the liver, the right
kidney is slightly
lower than the left.
Renal Anatomy
A ureter (approximately 25 cm long)
originates near an indented area of each
kidney called the hilum and travels to
the base of the bladder. Renal blood
vessels also emerge from the hilum.
From the bladder, the
urethra (4 cm in length in
women and 24 cm in length
in men) allows urine to
be excreted.
Renal Anatomy
A frontal section through the kidney reveals two distinct
regions of internal anatomy, the cortex and medulla.
The main function of the cortex
is filtration to form urine.
The main function of
the medulla is to
collect and
excrete urine.

Renal Anatomy
The renal pyramids consists of 8 to 18 conical
subdivisions within the medulla that contain the kidneys
secreting apparatus and tubules.
Renal columns are
composed of lines of
blood vessels and
fibrous material
which allows the
cortex to be better anchored.

Renal Anatomy
The renal papilla is the location where the medullary
pyramids empty urine into cuplike structures called
minor and major calyces.
8-18 minor calyces and
2-3 major calyces receive
urine from the papilla of
one renal pyramid.
Once the filtrate
enters the calyces, it
becomes urine because no
further reabsorption can occur.
Renal Anatomy
From the major calyces, urine drains into a single large
cavity called the renal pelvis and then out through
the ureter.
The hilum expands into
a cavity within the
kidney called the renal
sinus, which contains part
of the renal pelvis, the calyces,
and branches of the renal blood
vessels and nerves.
Renal Anatomy
The ureters transport urine from the renal pelvis of the
kidneys to the bladder using peristaltic waves,
hydrostatic pressure and gravity to move the urine.
There is no anatomical
valve at the
opening of the
ureter into
the bladder.

Renal Anatomy
The urinary bladder is a hollow, distensible muscular
organ with a capacity that averages 700-800mL.
The act of emptying the bladder is called micturition or
urination and requires a combination of voluntary and
involuntary muscle contractions.
When volume increases, stretch receptors send signals
to a micturition center in the spinal cord triggering a

spinal reflex the micturition reflex.
In early childhood, we learn to initiate and stop the
reflex voluntarily.
Renal Anatomy
The urethra is a small tube leading from the internal
urethral orifice in the bladder floor to the exterior.
In males, it
is also used
to discharge
semen.

Renal Anatomy
The urethra is a small tube leading from the internal
urethral orifice in the bladder floor to the exterior.
In males, it
is also used
to discharge
semen.

Renal Blood Flow
The renal artery and renal vein pass into the substance
of the kidney (the parenchyma) at the hilum.
Arterial blood enters via the renal artery and exits the
renal vein.
The renal arteries are
very large branches

of the aorta, and up
to a third of total
cardiac output can pass
through them to be filtered by the kidneys.
Renal Blood Flow
Blood follows the path depicted in the
graphic to the right:

The Nephron
The nephron is the functional unit of the kidney.
It is a microscopic
structure composed
of blood vessels and
tubules that collect
the filtrate which
will ultimately
become urine.

The Nephron
Each nephron receives one afferent arteriole, which
divides into a tangled, ball-shaped capillary network
called the glomerulus.
The glomerular
capillaries then
reunite to form an
efferent arteriole that
carries blood out of
the glomerulus.

The Nephron
Glomerular capillaries are unique among capillaries in
the body because they are positioned between two
arterioles, rather than between an arteriole and a venule.
There are venules in the kidney, but they come later.
The Renal Corpuscle consists of two structures:
The glomerular capillaries
The glomerular capsule (Bowmans capsule) a
double-walled epithelial cup that surrounds the
glomerular capillaries.

The Nephron
Bowmans capsule consists of visceral and parietal layers.
The visceral layer is made of modified simple
squamous epithelial cells called podocytes. The many
foot-like projections of these cells (pedicels) wrap
around the single layer of endothelial cells of the
glomerular capillaries and form the inner wall of the
capsule.
The parietal layer of the glomerular capsule is a simple
squamous epithelium and forms the outer wall of the
capsule.
The Nephron
The epithelium of the visceral
and parietal layers of the
renal corpuscle form
festrations (pores)
which act as a
filtration (dialysis)
membrane.

The Nephron
Fluid filtered from the glomerular capillaries enters
Bowmans space, (the space between the two layers of
the glomerular capsule), which is the lumen of the urinary
tube.

The Nephron
Blood plasma is filtered through the glomerular capillaries
into the glomerular capsule.
Filtered fluid passes into
the renal tubule, which
has three main sections:
the proximal convoluted
tubule (PCT)
the loop of Henle
the distal convoluted
tubule (DCT)
The Nephron
The distal convoluted tubules of several nephrons empty
into a single collecting duct.
Collecting ducts
unite and converge
into several hundred
large papillary ducts
which drain into the
minor calyces, major calyces,
renal pelvis, and ureters.

The Nephron
The first part of the loop of Henle (the descending limb)
dips into the renal medulla. It then makes a hairpin turn
and returns to the renal cortex as the ascending limb.
The descending limb of the loop of Henle is composed of
a simple squamous epithelium.
The ascending limb of the loop may be either thin
(composed of a simple squamous epithelium) or thick
(composed of simple cuboidal to low columnar cells).
Some nephrons contain both thick and thin ascending
limbs.

The Nephron
Based on the length of the loop of Henle and the presence
of thin segments in the ascending limb, nephrons can be
sorted into two populations:
cortical and juxtamedullary.
Nephrons with long loops of
Henle enable the kidneys to
create a concentration gradient
in the renal medulla and to
excrete very dilute or very
concentrated urine. Copyright John Wiley & Sons, Inc. All rights reserved.
The Nephron
Cortical nephrons make up about 8085% of the 1
million microscopic nephrons that comprise each kidney.
Their renal corpuscles are located in the outer portion of
the cortex, with short loops of Henle that penetrate only
a small way into the medulla.
The ascending limbs of their loops of Henle consist of
only a thick segment, lacking any thin portions.
Nephrons with short loops receive their blood supply
from peritubular capillaries that arise from efferent
arterioles.
The Nephron

The Nephron
The other 1520% of the nephrons are juxtamedullary
nephrons .
Their renal corpuscles lie deep in the cortex, close to
the medulla, and they have long loops of Henle that
extend into the deepest region of the medulla.
The ascending limbs of their loops of Henle consist of
both thin and thick segments.
Nephrons with long loops receive their blood supply
from the vasa recta that arise from peritubular
capillaries before becoming peritubular venules.
Juxtamedullary Nephron

The Nephron
In each nephron, the final part of the ascending limb of
the loop of Henle makes contact with the afferent
arteriole serving that renal corpuscle. Because the
columnar tubule cells in this region are crowded together,
they are known as the macula densa.
Alongside the macula densa, the wall of the afferent
arteriole contains modified smooth muscle fibers called
juxtaglomerular (JG) cells.
Together with the macula densa, they constitute the
juxtaglomerular apparatus (JGA).

The Nephron
As we will shortly see, the JGA helps regulate blood
pressure within the kidneys.

Renal Physiology
The 3 basic functions performed by nephrons and
collecting ducts are:
Glomerular filtration - pressure forces filtration of
waste-laden blood in the glomerulus. The glomerular
filtration rate (GFR) is the amount of filtrate formed in
all the renal corpuscles of both kidneys each minute.
Tubular reabsorption the process of returning
important substances from the filtrate back to the body.
Tubular secretion the movement of waste materials
from the body to the filtrate.
Glomerular Filtration
Glomerular filtration is the formation of a protein-free
filtrate (ultrafiltrate) of plasma across the glomerular
membrane.
Only a portion of the blood plasma delivered to the
kidney via the renal artery is filtered.
Plasma which escapes filtration, along with its protein
and cellular elements, exits the renal corpuscle via the
efferent arteriole, perfuses the tubular capillary beds,
and is eventually collected in the renal venous system.

In the average adult, the bodys entire extracellular fluid
volume is filtered about 12 times per day.
Since we cannot afford to lose that amount of fluid, the

vast majority must be reclaimed, with just a small
portion being excreted in the urine.
Amount
Total Amount in 180
returned to Amount in
Amount L of filtrate
blood/d Urine (/day)
in Plasma (/day)
(Reabsorbed)
Water (passive) 3L 180 L 178-179 L 1-2 L
Protein (active) 200 g 2g 1.9 g 0.1 g
Glucose (active) 3g 162 g 162 g 0g
Urea (passive) 1g 54 g 24 g 30 g
(about 1/2) (about 1/2)
0g 1.6 g
Creatinine 0.03 g 1.6 g (all filtered)
(none
reabsorbed)
The daily composition of plasma, filtrate, and urine are compared.

Filtration is controlled by 2 opposing hydrostatic forces
and 2 opposing osmotic forces at the glomerular
membrane called Starling forces.
Blood hydrostatic pressure (55mmHg) is the main force
that pushes water and solutes through the filtration
membrane (promotes filtration).
Capsular hydrostatic pressure (15 mmHg) is exerted
against the filtration membrane by fluid in the capsular
space (opposes filtration).

Starling forces continued
Blood osmotic (oncotic) pressure (30 mmHg) is the
pressure of plasma proteins pulling on water (opposes
filtration).
Normally very little protein escapes through the
filtration membrane making capsular oncotic pressure a
negligible force except in certain disease states.
Net Filtration = Blood Hydrostatic Pressure Blood
Osmotic Pressure Capsular Hydrostatic Pressure
Net Filtration = 55-30-15 = 10 mmHg
Normally, 3 Starling forces are at work in glomerular filtration

Regulation of the GFR is critical to maintaining
homeostasis and is regulated by an assortment of local and
systemic mechanisms:
Renal autoregulation occurs when the kidneys
themselves regulate GFR.
Neural regulation occurs when the ANS regulates
renal blood flow and GFR.
Hormonal regulation involves angiotensin II and
atrial natriuretic peptide (ANP).
Renal autoregulation of GFR occurs by two means:
Stretching in the glomerular capillaries triggers
myogenic contraction of smooth muscle
cells in afferent arterioles (reduces GFR).
Pressure and flow monitored in the
macula densa provides tubuloglomerular
feedback to the glomerulus, causing the
afferent arterioles to constrict (decreasing
blood flow and GFR) or dilate (increasing
blood flow and GFR) appropriately.
Neural regulation of GFR is possible because the renal
blood vessels are supplied by sympathetic ANS fibers that
release norepinephrine causing vasoconstriction.
Sympathetic input to
the kidneys is most
important with extreme
drops of B.P. (as occurs
with hemorrhage).

Two hormones contribute to regulation of GFR
Angiotensin II is a potent vasoconstrictor of both
afferent and efferent arterioles (reduces GFR).
A sudden large increase in BP stretches the cardiac atria
and releases atrial
natriuretic peptide (ANP).
ANP causes the
glomerulus to relax,
increasing the surface
area for filtration.
The Filtration Membrane
Podocyte of visceral
layer of glomerular
(Bowmans) capsule
Filtration slit
Pedicel
1 Fenestration (pore) of glomerular

endothelial cell: prevents filtration of
blood cells but allows all components
of blood plasma to pass through
2 Basal lamina of glomerulus:

prevents filtration of larger proteins
3 Slit membrane between pedicels:

prevents filtration of medium-sized
proteins
(a) Details of filtration membrane
Pedicel of podocyte Filtration slit
Basal lamina
Lumen of glomerulus
Fenestration (pore) of TEM 78,000x

glomerular endothelial cell
(b) Filtration membrane Copyright John Wiley & Sons, Inc. All rights reserved.
(Interactions Animation)
Renal Filtration
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Pressures That Drive Glomerular Filtration
1 GLOMERULAR BLOOD
2 CAPSULAR HYDROSTATIC
HYDROSTATIC PRESSURE
PRESSURE (CHP) = 15 mmHg
(GBHP) = 55 mmHg
3 BLOOD COLLOID
OSMOTIC PRESSURE
Afferent arteriole (BCOP) = 30 mmHg
Proximal convoluted tubule
Efferent
arteriole NET FILTRATION PRESSURE (NFP)
=GBHP CHP BCOP
= 55 mmHg 15 mmHg 30 mmHg
= 10 mmHg
Glomerular
(Bowman's) Capsular
capsule space

Tubular Reabsorption
Tubular reabsorption is the process of returning
important substances (good stuff) from the filtrate back
into the renal interstitium, then into the renal blood
vessels... and ultimately back into the body.

The good stuff is glucose, electrolytes, vitamins, water,
amino acids, and any small proteins that might have
inadvertently escaped from the blood into the filtrate.
Ninety nine percent of the glomerular filtrate is
reabsorbed (most of it before the end of the PCT)!
To appreciate the magnitude of tubular reabsorption, look
once again at the table in the next slide and compare the
amounts of substances that are filtered, reabsorbed, and
excreted in urine.
Amount
Total Amount in 180
returned to Amount in
Amount L of filtrate
blood/d Urine (/day)
in Plasma (/day)
(Reabsorbed)
Water (passive) 3L 180 L 178-179 L 1-2 L
Protein (active) 200 g 2g 1.9 g 0.1 g
Glucose (active) 3g 162 g 162 g 0g
Urea (passive) 1g 54 g 24 g 30 g
(about 1/2) (about 1/2)
0g 1.6 g
Creatinine 0.03 g 1.6 g (all filtered)
(none
reabsorbed)

Reabsorption into the interstitium has two routes:
Paracellular reabsorption is a passive process that
occurs between adjacent tubule

cells (tight junctions do
not completely seal off
interstitial fluid from
tubule fluid.)
Transcellular reabsorption
is movement through an
individual cell.

It is a tremendous feat to reabsorb all of the nutrients and
fluid we must to survive, while still filtering out,
concentrating and excreting toxic substance.
To accomplish this, the kidney establishes a
countercurrent flow between the filtrate in the limbs
of the Loops of Henle and the blood in the peritubular
capillaries and Vasa Recta.
Two types of countercurrent mechanisms exist in
the kidneys: countercurrent multiplication and

countercurrent exchange.
Countercurrent multiplication is the process by which
a progressively increasing osmotic gradient is formed in
the interstitial fluid of the renal medulla as a result of
countercurrent flow.
Countercurrent exchange is the process by which
solutes and water are passively exchanged between the
blood of the vasa recta and interstitial fluid of the renal
medulla as a result of countercurrent flow.
This provides oxygen and nutrients to the renal medulla
without washing out or diminishing the gradient.
Both mechanisms contribute to reabsorption of fluid and
electrolytes and the formation of concentrated urine.

Reabsorption of fluids, ions, and other substances occurs
by active and passive means.
A variety of symporters and antiporters actively transport
Na+ , Cl , Ca2+, H+, HCO3 , glucose, HPO42 , SO42 , NH4+,
urea, all amino acids, and lactic acid.
Reabsorption of water can be obligatory or facultative,
but it always moves by osmosis down its concentration
gradient depending on the permeability of the tubule cells
(which varies between the PCT, the different portions of
the loop of Henle, DCT, and collecting ducts).
Obligatory reabsorption of water occurs when it is
obliged to follow the solutes as they are reabsorbed (to
maintain the osmotic gradient).
Facultative reabsorption describes variable water
reabsorption, adapted to specific needs.
It is regulated by the effects
of ADH and aldosterone on
the principal cells of the renal
tubules and collecting ducts.

This graphic depicts the formation of a dilute urine, mostly
through obligatory
reabsorption of water.
Compare this process to
the one depicted on the
next slide where urine is
concentrated by the action
of ADH on the DCT and
collecting ducts of
juxtamedullary nephrons.
Urine can be
up to 4 times
more
concentrated
than blood
plasma.

Vasa
recta
Loop of
Henle
Juxtamedullary nephron
and its blood supply Glomerular (Bowmans) capsule
together H2 O
Glomerulus Na+CI
Afferent Blood flow
arteriole Distal convoluted tubule
Presense of Na+-K+-2CI
symporters
Interstitial Flow of tubular fluid
200
HO fluid in
Efferent H2O 2
300 renal cortex
arteriole
H2O 300 320
Proximal Collecting
convoluted duct
tubule 300 300
300
H2 O 100 320 3 Principal cells in H2 O
collecting duct
Na+CI reabsorb more Na+CI
H2O water when ADH
Interstitial fluid 400
400 380 200 is present
in renal medulla 400
500
H2 O
600
H2 O
580 400 H2O

600 Na+CI
600
Osmotic 1 Symporters in thick
gradient ascending limb cause 700
buildup of Na+ and Cl H2O 800
800 780 600
H2 O
800
H2 O Urea 900
4 Urea recycling Na+CI
causes buildup H2 O
1000 980 800 1000 of urea in the 1000
renal medulla
1100
H2O
1200 1200 1200 Papillary 1200
2 Countercurrent flow
through loop of Henle duct
establishes an osmotic Loop of Henle
gradient 1200 Concentrated urine
(a) Reabsorption of Na+CI and water in a long-loop juxtamedullary nephron (b)Copyright

Recycling
of John
salts Wiley & Sons,
and urea Inc. All
in the vasa rights
recta reserved.
(Interactions Animation)
Water Homeostasis
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If higher than normal amounts of a substance are present
in the filtrate, then the renal threshold for reabsorption
of that substance may be surpassed.
When that happens, the substance cannot be reabsorbed
fast enough, and it will be excreted in the urine.
For example, the renal [reabsorption] threshold of
glucose is 180-200mg/dl. When this level is exceeded (as
in diabetes mellitus), the glucose is said to spill into
the urine (meaning a substance which is not normally
present in urine begins to appear).
Tubular Secretion
Tubular secretion is the movement of substances from the
capillaries which surround the nephron into the filtrate.
It occurs at a site other than the filtration membrane (in
the proximal convoluted tubule, distal convoluted tubule
and collecting ducts) by active transport.
The process of tubular secretion controls pH.
Hydrogen and ammonium ions are secreted to decrease
the acidity in the body, and bicarbonate is conserved.
Secreted substances include H+, K+, NH4+, and some
drugs; the amount often depends on body needs.

Tubular Secretion
Maintaining the bodys proper pH requires cooperation
mainly between the lungs and the kidneys.
The lungs eliminate CO2.
Provides a rapid response (minutes)
The kidneys eliminate H+ and NH4+ ions and conserve
bicarbonate.
This is a slower response (hours-days).
The alimentary canal (digestive), and integumentary
system (skin) provide minor contributions.

Hormones and Homeostasis
Five hormones affect the extent of Na+, Cl, Ca2+, and
water reabsorption as well as K+ secretion by the renal
tubules. These hormones, all of which are key to
maintaining homeostasis of not only renal blood flow and
B.P., but systemic blood flow and B.P., are:
angiotensin II
antidiuretic hormone (ADH)
aldosterone
atrial natriuretic peptide (ANP)
parathyroid hormone (PTH)
We have already mentioned the effect of ANP on GFR.
ADH is released by the posterior pituitary in response to
low blood flow in this part of the brain.
ADH affects facultative water reabsorption by
increasing the water permeability of principal cells in
the last part of the distal convoluted tubule and
throughout the collecting duct.
In the absence of ADH, the apical
membranes of principal cells

are almost impermeable to water.
Secretion of the hormones angiotensin II and aldosterone
are tied to one another: When blood volume and blood
pressure decrease or the sympathetic NS is stimulated, the
walls of the
afferent arterioles
are stretched
less, and the
cells of the JGA
secrete renin.

Renin clips off a 10-amino-acid peptide called angiotensin
I from angiotensinogen, which is synthesized by
hepatocytes. By clipping off two more amino acids,
angiotensin converting enzyme (ACE) converts
angiotensin I to angiotensin II, which is the active form
of the hormone. Angiotensin II has 3 main effects:
1. Vasoconstriction decreases GFR.
2. It increases blood volume by increasing reabsorption of
water and electrolytes in the PCT.
3. It stimulates the adrenal cortex to release aldosterone.
Aldosterone stimulates the principal cells in the
collecting ducts to reabsorb more Na+ and Cl and secrete
more K+. The osmotic consequence of reabsorbing more
Na+ and Cl is that more
water is reabsorbed,
which increases blood
volume and blood
pressure.

Summary of Renal Function
The events of
filtration,
absorption, and
secretion are
summarized in
this graphic.

Urine
Increases in GFR usually result in an increase in urine
production. However, as we have seen, the mechanisms
which control electrolyte and
water reabsorption in the
various parts of the nephron
and collecting ducts are subject
to many complex controls.
Normal urine output (UOP)
is 1-2 L/d.

Urine
A urinalysis analyzes the physical, chemical and
microscopic properties of urine.
Water accounts for 95% of total urine volume.
The solutes normally present in urine are filtered and
secreted substances that are not reabsorbed.
If disease alters metabolism or kidney function, traces of
substances normally not present or normal constituents
in abnormal amounts may appear (bacteria, albumin
protein, glucose, white blood cells, red blood cells to
name a few).
Urine
In addition to a urinalysis, two blood tests are commonly
done clinically to assess the adequacy of renal function.
Blood urea nitrogen (BUN) measures nitrogen wastes in
blood from catabolism and deamination of amino acids.
Creatinine levels appear in the blood as a result of
catabolism of creatine phosphate in skeletal muscle.
The serum creatinine test measures the amount of
creatinine in the blood, which increases in states of

renal dysfunction.

End of Chapter 26
Copyright 2012 John Wiley & Sons, Inc. All rights reserved.
Reproduction or translation of this work beyond that permitted
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Chapter 26

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Copyright John Wiley & Sons, Inc. All rights reserved.

to a micturition center in the spinal cord triggering a

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very large branches

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Copyright John Wiley & Sons, Inc. All rights reserved.

Copyright John Wiley & Sons, Inc. All rights reserved.

Copyright John Wiley & Sons, Inc. All rights reserved.

Copyright John Wiley & Sons, Inc. All rights reserved.

Copyright John Wiley & Sons, Inc. All rights reserved.

Copyright John Wiley & Sons, Inc. All rights reserved.

Copyright John Wiley & Sons, Inc. All rights reserved.

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juxtaglomerular apparatus (JGA).

Copyright John Wiley & Sons, Inc. All rights reserved.

Copyright John Wiley & Sons, Inc. All rights reserved.

Since we cannot afford to lose that amount of fluid, the

Water (passive) 3L 180 L 178-179 L 1-2 L

Protein (active) 200 g 2g 1.9 g 0.1 g

Glucose (active) 3g 162 g 162 g 0g

The daily composition of plasma, filtrate, and urine are compared.

Copyright John Wiley & Sons, Inc. All rights reserved.

Normally, 3 Starling forces are at work in glomerular filtration

Copyright John Wiley & Sons, Inc. All rights reserved.

1 Fenestration (pore) of glomerular

2 Basal lamina of glomerulus:

3 Slit membrane between pedicels:

(a) Details of filtration membrane

Pedicel of podocyte Filtration slit

Fenestration (pore) of TEM 78,000x

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Copyright John Wiley & Sons, Inc. All rights reserved.

Copyright John Wiley & Sons, Inc. All rights reserved.

Water (passive) 3L 180 L 178-179 L 1-2 L

Protein (active) 200 g 2g 1.9 g 0.1 g

Glucose (active) 3g 162 g 162 g 0g

Copyright John Wiley & Sons, Inc. All rights reserved.

occurs between adjacent tubule

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the kidneys: countercurrent multiplication and

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580 400 H2O

(a) Reabsorption of Na+CI and water in a long-loop juxtamedullary nephron (b)Copyright

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drugs; the amount often depends on body needs.

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membranes of principal cells

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creatinine in the blood, which increases in states of

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