Urinalysis and body

fluids
 CHAPTER ONE

Anatomy and Physiology of

Urinary System
 Objective:
At the end of this chapter the students will able to :
 explain about the urinary system components
 elucidate about anatomy of kidney
 explain about formation and composition of urine
 explain about reporting system in urinalysis
 describe about renal threshold and renal clearance
 Outline of chapter one

1.1- Urinary system

1.2- Anatomy of the Kidney
1.3- Physiology of the Kidney & Formation of Urine
1.4-The Composition of Urine
1.5- Renal threshold and renal clearance
1.6-Type of urine tests and reporting system
 The Urinary System

 composed of two kidneys, two ureters, one bladder

and one urethra.
 The two human kidneys are the main structural part of
urinary system, responsible for the formation of urine.
 Each kidney contains about a million filter units, called
nephrons, designed for the synthesis of urine in our
body.
 Ureters are two tubes stretched from kidney to bladder.
 function of ureters is to transport urine from the kidney
to the bladder.
 The transport methods in ureters are by gravity and
peristalsis (a rhythmic squeezing) of smooth muscle of
ureters.
Anatomy of Kidney

 kidneys are two bean shaped organs, about 150 gm each

 Urine forming units:
 Cortex
 Medulla (lobed: renal pyramids)
 Cortex and medulla composed chiefly of nephrons and
blood vessels
 About 25% of cardial out put Supplied to kidney through
renal arteries (branches of descending aorta)
 Returns back by renal veins (branches of inferior vena
cava)
Kidney mainly divided into two regions;

 a pale outer region- the cortex

 a darker inner region- the medulla.
 The medulla is divided into renal pyramids (8-18)
 the base of each pyramid starts at the corticomedullary
border.
 the apex ends in the renal papilla which merges to form
the renal pelvis and then on to form the ureters.
 The Nephrons is the Fundamental Urine-Producing Unit
of the Kidney
 We have a total of 2 million nephrons in the 2 kidneys
 Components of the nephron;
 Glomerulus - tuft of capillaries where filtration occurs
 Bowman's capsule- surrounds glomerulus, collects
filtrate
 Proximal convoluted tubule
 Loop of Henle
 Distal convoluted tubule
 Collecting duct- adjusts volume & concentration of
urine
Functions of the Kidney

 Regulation of the water and electrolyte content of the

body.
 Retention of substances vital to the body such as protein
and glucose
 Maintenance of acid/base balance.
 Excretion of waste products, water soluble toxic
substances and drugs.
 Endocrine functions.
Retention of substances vital to the body

 One of the main function of kidney:

 selectively absorption of substances necessary for
our body
 removal of waste products and surplus substances,
that would be harmful to our body in the form of urine.
 The formation of urine by the kidneys achieved by three
phase processes:
 Simple filtration
 Selective and passive reabsorption
 Excretion
The Nephron

 Each kidney consists

of about one million
nephrons.
 The nephron is made
up of a glomerulus and
its tubule
 The urine contains
little water, no glucose
or amino acids,
abundant urea, toxins,
and ions found in
excess in the body.
Filtration

 takes place through the semi permeable walls of the

glomerular capillaries
 impermeable for molecular size above 7nm
 virtually free of protein and has no cellular elements.
 The driving hydrostatic pressure is controlled by the
afferent and efferent arterioles, and provided by arterial
pressure.
 About 20% of renal plasma flow is filtered each minute
(125 ml /min). This is the glomerular filtration rate
(GFR).
Filtration cont’d…

 Auto regulation:
 processes in which glomerulus has to be kept fairly
constant.
 Auto regulation of GFR is achieved by auto regulation of
renal blood flow and a feedback mechanism known as
"glomerular tubular balance".
 .
Filtration cont’d…
 Glomerular Tubular balance:
 When there is a decrease in GFR, there is a resulting
decrease in the fluid flow rate within the tubule
 At the loop of Henle, there is greater time for reabsorption
of sodium and chloride ions.
 Therefore there is a decrease in the number of sodium and
chloride ions reaching the distal tubule which is detected
by the macula densa.
 This in turn decreases the resistance in the afferent
arteriole which results in an increase in renal blood flow.
 It also increases rennin release from the juxtaglomerular
apparatus which stimulates angiotensin II production
causing constriction of the efferent arteriole.
 figure 4.

figure 4.
Filtration cont’d…
 juxtaglomerular complex:
 consists of macula densa cells which are special
distal tubular epithelial cells which detect chloride
concentration and modified smooth muscle cells,
juxtaglomerular cells, in the walls of the afferent and
efferent arteriole. These cells produce rennin.
 Rennin is an enzyme which converts the plasma protein
angiotensinogen to angiotensin I.
 Filtration cont’d…
 angiotensin II which causes vasoconstriction and an
increase in blood pressure.
 Angiotensin II also stimulates the adrenal gland to produce
aldosterone which causes water and sodium retention
which together increase blood volume.
 This is a negative feedback system.***
 When blood volume, renal perfusion and GFR improve the
system feeds back to switch off or turn down the response
to the stimulus.
 Renin-angiotensin-aldosterone axis

Principal factor controlling

Ang II levels is rennin
release.
Decreased circulating
volume stimulates
rennin release via:
Decreased BP
Decreased [NaCl] at
macula densa
Decreased renal
perfusion pressure
Selective and Passive Re-absorption
 Renal tubule function : reabsorb selectively about 99% of
the glomerular filtrate.
 Proximal Tubule: reabsorbs 60% of all solute, which
includes 100% of glucose and amino acids, 90% of
bicarbonate and 80-90% of inorganic phosphate and
water.
 Reabsorption is by either active or passive transport.
 Active transport requires energy to move solute against
an electrochemical or a concentration gradient. It is the
main determinant of oxygen consumption by the kidney.
 Passive transport is where reabsorption occurs down an
electrochemical, pressure or concentration gradient.
Active Transport Pumps
Selective and Passive Re-absorption
cont’d…
 Most of the solute reabsorption is active, with water
being freely permeable and therefore moving by
osmosis.
 When the active reabsorbtion of solute from the tubule
occurs, there is a fall in concentration and hence osmotic
activity within the tubule.
 Water then moves because of osmotic forces to the
area outside the tubule where the concentration of
solutes is higher.
Selective and Passive Re-absorption
cont’d…
 The Loop of Henle
 is the part of the tubule which dips or "loops" from the
cortex into the medulla, (descending limb), and then
returns to the cortex, (ascending limb).
 is part of the tubule where urine is concentrated if
necessary.
 This is possible because of the high concentration of
solute in the substance or interstitium of the medulla.
Selective and Passive Re-absorption
cont’d…
 Vasa Recta
 is a portion of the peritubular capillary system which
enters the medulla where the solute concentration in
the interstitium is high.
 It acts with the loop of Henle to concentrate the urine
by a complex mechanism of counter current
exchange.
 If the Vasa recta did not exist, the high concentration
of solutes in the medullary interstitium would be
washed out.
 Countercurrent Mechanism

 Descending
Tubule: H2O
permeable, Salt
impermeable.
 Ascending Tubule:
Salt permeable,
H2O permeable.
 Medullary Osmotic
gradient is
maintained by the
blood in Vasa
Recta in isotonic to
interstitial fluid
 Selective and Passive Re-absorption
cont’d…
 Distal Tubule and Collecting Duct:
 The final concentration of urine depends upon the amount
of antidiuretic hormone (ADH) secreted by the posterior
lobe of the pituitary.
 If ADH is present the distal tubule and the collecting duct
become permeable to water.
 As the collecting duct passes through the medulla with a
high solute concentration in the interstitium, the water
moves out of the lumen of the duct and concentrated urine
is formed.
 In the absence of ADH the tubule is minimally permeable
to water so large quantities of dilute urine is formed.
Distal Tubule and Collecting Duct
cont’d…
 There are cells within the hypothalamus,
osmoreceptors, which are sensitive to changes in
osmotic pressure of the blood. If there is low water
intake, there is a rise in osmotic pressure of the
blood, and after excess intake of water, the reverse.
 Nerve impulses from the hypothalamus stimulate the
posterior pituitary to produce ADH when the osmotic
pressure of the blood rises.
 As a result water loss in the kidney is reduced
because ADH is secreted, and water reabsorbed in
the collecting duct.
Regulation of the Water and electrolytes
 Addition of new HCO3- to plasma by secretion
of H+

When you use up filtered HCO3- in tubule and still have excess
H+ (acidosis), then you must combine H+ with another buffer
e.g. H3PO4.Unusual since lots of HCO3- in tubular fluid!
Gives net gain of HCO3- to plasma.
 Maintenance Acid / Base Function
 Kidneys really important for acid-base balance, along
with respiratory system.
 Although the lungs excrete a large amount of CO2, a
potential acid formed by metabolism, the kidneys are
crucial for excreting non-volatile acids.
 To maintain acid-base balance, kidney must not only
reabsorb virtually all filtered HCO3-, but must also secrete
into the urine the daily production of non-volatile acids.
Maintenance Acid / Base Function
 Sources of H+ gain and loss
 H+ Gain
 CO2 in blood (combine with H2O via carbonic
anhydrase)
 Nonvolatile acids from metabolism (e.g. lactic)
 Loss of HCO3- in diarrhoea or non-gastric GI fluids
 Loss of HCO3- in urine

 H+ Loss
 Use of H+ in metabolism of organic anions
 Loss of H+ in vomit
 Loss of H+ in urine
 Hyperventilation (blow off CO2)
Addition of new HCO3- to plasma by excretion
of ammonium (NH4+)

Another way of adding

HCO3- to plasma by
metabolising glutamine.
Takes long time though,
so usually only occurs in
chronic acidosis e.g.
diabetes.
Excretion of waste products

 Filtration occurs as blood flows through the glomerulus.

 Some substances not required by the body, and some
foreign materials (e.g. drugs) may not be cleared by
filtration through the glomerulus.
 Such substances are cleared by secretion into the
tubule and excreted from the body in the urine.
Hormones and the Kidney
 ADH to concentrate urine: how does it work?

 Antidiuretic Hormone
(ADH)/Arginine Vasopressin
(AVP)
Increases permeability of
collecting ducts to H2O by
inserting H2O channels
(Aquaporins).
Helps you make small amount
of concentrated urine.
.
Renin-angiotensin-aldosterone axis

Principal factor controlling

Ang II levels is renin
release.
Decreased circulating
volume stimulates renin
release via:
Decreased BP (symp
effects on JGA).
Decreased [NaCl] at
macula densa (“NaCl
sensor”)
Decreased renal
perfusion pressure
(“renal” baroreceptor)
 Aldosterone
Aldosterone stimulates Na+
reabsorption and K+ excretion by
the renal tubule.
Aldosterone exerts indirect
negative feedback on RAAS by
increasing ECV and by lowering
plasma [K+].
In conserving Na+ and water, and
preventing massive swings in K+
levels.
 Comparison of systems controlling effective
circulating volume and osmolality
What is Effective Circulating
Plasma Osmolality
sensed? Volume
Carotid sinus, aortic arch,
Hypothalamic
Sensors renal afferent arteriole,
osmoreceptors
atria
Efferent RAAS, Symp NS, ADH,
ADH Thirst
Pathways ANP
Short term: heart, blood Brain:
Effector vessels Kidney drinking
Long term: Kidney behaviour
Short term: Blood Renal
What is pressure Water
water
affected? intake
Long term: Na+ excretion excretion
Other Substances Produced by the
kidney
 1,25 dihydroxy vitamin D (the most active form vitamin
D) which promotes calcium absorption from the gut.
 Erythropoietin which stimulates red cell production
 Synthesis of glucose through Gluconeogenesis.
The Composition of Urine

 Urine
 A fluid extracted by the kidneys, pass through the
ureters, stored in the bladder, and discharge through
the urethra.
 in the presence of disease conditions, depending on
the abnormality, the urine will have abnormal
constituents.
The Composition of Urine

Normal urine
 Freshly voided urine from healthy individuals is clear
and pale yellow in color
 Having aromatic odor from volatile organic acids, and
specific gravity about 1.024
 .It is slightly acidic (pH 5.0 to 6.0) and contains 95 %
water.
The Composition of Urine

 Normal urine contains

 Creatinine, uric acid, urea, few epithelial cells, 2-3
leukocytes/HPF and amorphous urates (in acidic
urine) and amorphous phosphates (in alkaline urines).
 Urine also have electrolytes like sodium, chlorine;
and hormones, like aldosterones, vitamins and drug
metabolic products in a very small quantities.
 Those substances considered as normal components of
urine because they are waste product of our body
metabolism, and their means of elimination from the
body is mainly through urine.
The Composition of Urine

 Abnormal compositions of urine

 Sugar, Proteins, Bilirubin, ketone bodies, different
hormones & electrolytes in higher concentration.
 Urine sediments, such as high number of
leukocytes, red blood cells, different kind of Casts,
parasites, bacteria’s, and yeasts.
Renal Clearance and Renal Threshold

 Renal Clearance value:

 indicates the degree to which a substance is removed
from the blood by excretion in the urine.
 Clearance :
 the blood volume that contains the quantity of a
substance excreted in the urine per minute.
GFR : Rate at which glomerular filtrate is formed
 About 120 ml of glomerular filtrate is produced per
minute.
 Renal Clearance and Renal Threshold
 Ccr ml / minute = U x V
S
Where U= Urine Creatinine Concentration in mol/l
V= Volume of urine in ml per 24 hrs
S= Serum Creatinine Concentration in mol/l
 Normal Range: 110 – 140 ml / minute.
 Renal Threshold

 Renal threshold :
 Highest concentration of a substance, which is present
in the blood before it is found in the urine.
 glucose is a high threshold substance, because it is
completely absorbed from the glomerular filtrate and is
only found in the urine, when the blood glucose level is
markedly raised.
 But urea and creatinine are always present in the urine
independent of the blood level because very little if any
of these substance is reabsorbed.
 Answer the Following Questions:
1. Discus the urinary system components with their
respective function.
2. Explain the renal blood flow and anatomical sections of the
kidneys.
3. Explain how Urine is formed by the nephrons.
4. Discus about renal hormones and their functions.
5. Calculate the CcCr of a patient who voided 1500 ml of
urine in 24 hrs.
The serum and urine concentration of creatinine of the
patient are 0.28 mmol/l and 10.5mmol/l respectively.
6. Classify the normal and abnormal constituents of urine.
7 Discuss about the renal threshold.
The next chapter will be dealing
with collection and preservation of
urine specimen