Chapter 26 – Urinary System

Notes

Functions of the Urinary System

The Nephron [ONLINE]

The _______________ is the functional unit of the kidney. Each kidney has approximately 1 million nephrons. It performs the
major function of filtering and eliminating toxins and harmful substances from the blood, regulating blood volume and
pressure, regulating plasma concentrations of important ions and blood pH, and conserves valuable nutrients. The function of
the nephron is dependent upon its anatomy and histology.

Describe the major function of each region within the nephron. Know what process (absorption, secretion, etc.) takes place in
each region and what is transported.

Describe the difference between cortical and juxtamedullary nephrons:

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Renal Corpuscle – the Bowman’s capsule and the glomerulus together are called the _____________________. Bowman’s
capsule is a double-layered cover encasing the capillary where filtration occurs, the glomerulus.

Draw a diagram of the renal corpuscle. Include a diagram and description of the filtration membrane.

Describe the juxtaglomerular apparatus, the hormones it secrets, and how they regulate renal function.

[ONLINE] List the vessels, in correct order, that a drop of blood would pass through as it flows from the abdominal aorta,
through the kidney, and back to the inferior vena cava.

How does the afferent arteriole control blood flow into the glomerulus? Why is this important for homeostasis? Why is
pressure in the glomerular capillaries higher than other capillaries?

Principles of Renal Physiology

The kidneys maintain homeostatic concentrations of nutrients and ions that end up in the extracellular fluid that bathes cells
by _______________ the blood across the surface of the glomerulus. Pressure in the glomerulus forces a fluid, called
____________, out of the blood, through the glomerular wall and into the capsular space. The filtrate contains “good”
substances like nutrients and beneficial ions as well as “bad” substances like waste (urea), toxins, and harmful ions (H+ and
NH+4). The goal is to rid the body of the wastes and keep the necessary materials by reabsorption.

As the filtrate enters the renal tubule (at the proximal convoluted tubule) it is now called _______________. As the tubular
fluid flows through the tubule, substances and water are reabsorbed across the tubule wall and into the peritubular fluid (the
fluid surrounding the tubule). Necessary materials reenter the bloodstream by diffusing back into the peritubular capillaries.
Excess K+ and H+ are secreted into the tubular fluid at the distal convoluted tubule. These ions and the harmful substances

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end up as urine in the collecting duct and are dumped into the minor calyces, major calyces, flow through the renal pelvis,
into the ureter and are stored in the bladder until released by ___________________ (urination).

The kidneys filter approximately 125 ml/min or 180L/day (50 gallons) of fluid. We urinate less than ½ a gallon or 1.8 L/day.
Therefore the kidneys must reabsorb 99% (49.5 gallons) of the filtrate.

Three Processes of Urine Formation

___________________________ – the removal of substances from blood by forcing them, under pressure, across the
filtration membrane.

______________________________ – the return of beneficial substances (nutrients, some ions, vitamins and water) from the
filtrate to the blood.

_______________________________ – the addition of excess K+ and H+ from the blood to the filtrate.

What goes where? Fill in the table below:

Substance Present in Filtrate Comments

Water
Nutrients (glucose, fatty acids,
amino acids, vitamins)
Sodium ions
Chloride ions
Potassium ions
Hydrogen ions
Urea
Blood cells
Plasma proteins

Filtration and the Glomerulus

Blood pressure drives filtration across the filtration membrane (forces fluid and solutes out of the blood and into the capsular
space). The table below details what each layer of the filtration membrane allows and prevents filtering across the
membrane.

Layer Permeable to Impermeable to

Capillary Endothelium Large and small proteins, nutrients, ions,
water
Basement Membrance Small proteins, nutrients, ions, water
(Lamina Densa)
Filtration slits (slit pores) Nutrients, ions, water

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Filtration Pressures

Two pressures, hydrostatic and osmotic pressure, affect filtration. The resulting net filtration pressure determines the volume
of filtrate produced.

_____________________________ - Fluid pressure that pushes against walls of blood vessels (pushing pressure). It can force
substances through capillary walls. There are three hydrostatic pressures involved in the glomerulus:

• ______________________________ pressure (GHP) - fluid (blood) pressure inside the glomerular capillaries. It is
relatively high compared to other capillaries due to a large afferent arteriole and a small efferent arteriole. GHP = 50
mm Hg (HP in most other capillaries is 35mm Hg).
• __________________ pressure (CHP) - pressure in capsular space due to filtrate. CHP resists GHP. CHP = 15 mm Hg.
• ___________________ pressure (NHP) - difference between GHP & CHP. NHP = GHP – CHP
o If NHP is a positive then filtration is occurring and filtrate is formed.
o If NHP is 0, the no filtration is occurring and harmful substances remain in the blood and can reach high (toxic)
levels.
o If NHP is negative, then BP is drastically low and filtration is not occurring and again blood can become toxic.

Failure of the kidneys to filter is called ________________________. It can be due to numerous factors like low BP, ruptured
or blocked vessels in the kidney, or damage to the filtration membrane. Renal failure can be fatal because toxins will build to
dangerously high levels in the blood and kill cells in other tissues.

Osmotic pressure - “Pulling” pressure. If diffusion can occur, it will. If it can’t, osmosis will, in the opposite direction. Blood
contains numerous proteins (albumins) that give blood viscosity, but also make it hypertonic to filtrate and peritubular fluid.
Since these proteins can’t leave blood, they tend to “pull” water back into the bloodstream. Blood is more viscous than water
and is considered a colloid (syrupy).

________________________________________ (BCOP) - osmotic pressure of blood (pressure due to separating solutions of

differing solute concentration. BCOP opposes GHP. BCOP = 25 mm Hg.

___________________________________________ (CCOP) – usually 0 mm Hg unless protein leaks out of glomerulus.

______________________________ (NFP) - hydrostatic pressure (NHP) minus osmotic pressure (BCOP). NFP = NHP – BCOP

Calculate NFP under homeostatic conditions:

How does blood pressure affect filtration?

How do plasma proteins affect filtration pressure?

How does the kidney regulate its own pressures?

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Glomerular Filtration Rate (GFR)

GFR is the volume (ml) of filtrate produced over a period of time (min). Normal GFR is 125 ml/min. In 24 hours that produces
180 L (50 gallons) of filtrate. Since we urinate only an average of just less than one half a gallon daily, over 99% of the filtrate
is reabsorbed.

What would NFP be if a patient has high blood pressure and GHP = 60 mm Hg, CHP = 15 mm Hg, and BCOP is 25 mm Hg? How
would this affect filtration and reabsorption?

What would NFP be if patient has low blood pressure and GHP = 45 mm Hg, CHP = 15 mm Hg, and BCOP is 25 mm Hg? How
would this affect filtration and reabsorption?

Regulation of GFR

Glomerular filtration rate is regulated by three mechanisms:

1. ____________________ –if BP drops slightly and NFP drops then the afferent arteriole and glomerulus dilate and
efferent arteriole constricts to increase blood flow into the glomerulus, keeping pressure and filtration rates close to
normal.
2. _____________________ – if BP drops noticeably then juxtaglomerular cells release __________. This initiates the
Renin-Angiotensin pathway to increase aldosterone levels and JG cells also release EPO to increase RBC production.
This raises blood volume and therefore blood pressure.
3. ________________________ – sympathetic stimulation constricts the afferent arteriole, decreasing GFR. Less urine
is produced.

Tubular Reabsorption

Most of the material filtered out of the bloodstream must be reclaimed from the tubular fluid. This process is called
_________________________. Reabsorption requires carrier proteins in the membranes of the tubular cells that allow for
the movement of substances from the tubular fluid into the peritubular fluid.

The proximal convoluted tubule reabsorbs approximately 60 – 70% of the fluid volume of the filtrate, as well as 100% of the
nutrients. There are four main transport mechanisms:

Facilitated diffusion -

Active transport -

Cotransport -

Countertransport –

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Tubular Maximum and Renal Threshold

Tubular maximum (Tmax) is the plasma concentration of a substance at which 100% of that substance will be reabsorbed by
the renal tubule. If the concentration of a substance is high than its tubular maximum, then that % of the substance over the
tubular maximum will not be reabsorbed and ends up being lost in urine. At 100% Tmax all protein carriers are saturated.

_____________________________ is the plasma concentration at which a substance begins to appear in urine. Think of renal
threshold as Tmax + 1 untransported molecule.

Renal threshold for glucose is 180 mg/dL. What would happen if plasma concentration of glucose is 175 mg/dL?
What if it was 185 mg/dL?

Loop of Henle and Countercurrent Exchange

Characteristics of the loop of Henle [ONLINE]

• _______________ descending limb – permeable to water, impermeable to solutes

• _______________ ascending limb – impermeable to water and solutes, active transport of Na+ and Cl- (and also K+).

Draw and label a loop of Henle and indicate the thin and thick portions of the descending and ascending limbs.

Countercurrent Multiplication

Means that two substances move in ________________ directions (countercurrent) and the more one substance moves in
one direction it forces more of the other substance in the opposite direction (multiplication).

The loop of Henle accomplishes _______________________________ by actively pumping Na+ and Cl- ions out of the thick
ascending limb of the loop. The higher the salt concentration in the peritubular fluid the greater the osmotic (pulling)
pressure rises. This forces more H2O to osmose out of the thin descending limb. This increases the salt concentration of the
tubular fluid as it passes through the descending limb. When it reaches the ascending limb the high salt concentration forces
more salt to be pumped out of the tubule. This pulls more water out, which forces more salt to be pumped, forcing more
water out, etc,.

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 Countercurrent – exchange occurs in opposite direction

Multiplication – exchange between limbs promotes more fluid movement and exchange

Na+ K+/2 Cl- - transporter – each ion pump cycle transports 1 Na+, 1 K+, and 2 Cl-

Obligatory Water Reabsorption

Obligatory water reabsorption is the ________________ reabsorption (osmosis) of water that occurs in the PcT and
descending limb of the loop of Henle, which reabsorb most of the water from the tubular fluid.

Facultative Water Reabsorption

Facultative water reabsorption occurs in the DCT (and collecting duct) and only occurs if a person is _________________
(electrolytes are out of balance) or has low _________________ or _________________. Usually the DCT reabsorbs little if
any water. If BP or blood volume drops, the DCT can be stimulated to allow extra water to be reabsorbed from the filtrate to
bring electrolyte concentration back to normal or to re-establish BP and volume. This stimulation requires the presence of
hormones ________ and ________________________ to facilitate (assist) the process.

ADH and Reabsorption of Water

1. If blood/water level is too low or blood pressure is too low, the pituitary gland secretes ADH.
2. ADH increases permeability of DCT and collecting system to water
3. Water moves out of filtrate & into capillaries, blood/water level increases, blood pressure also increases.
4. 20% of water reabsorption (10L/day) is due to ADH activity. This is facultative water reabsorption.

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Aldosterone and Reabsorption of Water

1. If Na+ concentration in the blood is too low or blood pressure at the glomerulus is too low, the JG cells detect this and
release the enzyme renin.
2. Renin turns an inactive pro-hormone called angiotensinogen (secreted by the liver and always present in blood for
this emergency) into an active form called angiotensin I. Enzymes in the lungs convert angiotensin I into angiotensin
II, an even more active form.
3. Angiotensin II binds to receptors on cells in the zona glomerulosa of the renal cortex, causing them to release
aldosterone. Aldosterone targets cells of the DCT and increases Na+ and Cl- reabsorption (and K+ loss).
4. Water follows the salt and more water is reabsorbed into the bloodstream at the DCT and into the peritubular
capillaries. This increases blood volume and pressure.

Tubular Secretion

Tubular secretion ______________ materials to the filtrate from the blood. Tubular epithelial cells pump excess K+, H+, and
NH+4 into the lumen of the __________________________________________. These ions can be very harmful and will
eventually be lost in urine. Although tubular secretion occurs along the length of the nephron, it mainly occurs in the DCT.
Secretion regulates body fluid _________ via H+ secretion.

Substance Comment
Secreted
Excess may cause heart attack
Excess would change fluid pH to acidic
Toxic nitrogen-bearing waste, generated from the deamination of amino acids; damaging to the
CNS

Potassium Secretion

The Na-K exchange pump delivers K+ from the peritubular fluid into the tubular cells of the DCT. K+ then diffuses into the
filtrate. This secretion of K+, from the peritubular fluid to the filtrate, assist the reabsorption of Na+. (Figure 26-13a)

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Hydrogen Secretion (Figure 26-13c)

Ammonium Secretion

Proteins are composed of amino acids. There are 20 different amino acids, 10 of which are essential and are obtained only
from the diet. Each amino acid is composed of an amino group (NH2). When amino acids enter the TCA cycle, the amino
group is removed via a process called deamination. The removed amino group generates nitrogen waste ions and molecules
such as ammonia and urea. During deamination, a molecule of ammonia (NH3) is produced which combines with a H+ and
produces an ammonium ion (NH4+). This ion is secreted countertransport with Na+. Ammonium ions can combine with CO2
and produce a less toxic molecule, urea. Urea diffuses across the tubular epithelium and is excreted in urine. Most nitrogen
waste in urine is urea.

Urine Transport, Storage and Elimination

Read Clinical Note: Urinary Obstruction (pg 1013)

Ureter (Figure 26-1)

The renal pelvis of each kidney empties urine into a ureter that descends to the urinary bladder. The ureters are
approximately 12” long and are retroperitoneal. The ureters pass under the urinary bladder and empty at the trigone of the
posterior bladder. There are no valves in the ureters.

Urinary Bladder (Figure 26-1)

The urinary bladder is a hollow muscular sac that stores urine until it is eliminated from the body. Like the stomach, the
bladder has numerous folds called rugae that allow for compliance. The bladder can hold about 200 ml of fluid. When it is
near full stretch receptors in the trigone signal the brain and micturition (urinary reflex) can occur. Micturition occurs as
smooth muscle in the wall of the bladder (detrusor muscle) contract.

Urethra (Figure 26-1)

The urethra is a tubular duct that transports urine from the bladder to the outside world. In males the urethra also transports
semen, the fluid ejaculated by a male at orgasm. There are two urethral sphincters, one at the junction of the bladder and
urethra called the internal urethral sphincter, and one near the very end of the urethra called the external urethral sphincter.

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Micturition Reflex and Urination (Figure 26-20)

Urination involves involuntary and voluntary nerve activity.

1. Stretch receptors in the bladder wall are stimulated (about 200 mL or urine) and send action potentials into the sacral
region of the spinal cord (and eventually to the brain).
2. Parasympathetic activation stimulates the detrussor muscle in wall of the bladder to contract. Simultaneously the
cerebral cortex receives sensory information and a conscious awareness of the need to urinate occurs.
3. Cerebral cortex generates conscious motor commands to relax the external urethral sphincter. The internal urethral
sphincter also relaxes.
4. As urethral sphincters relax, urination occurs.

This reflex may be voluntarily initiated or stopped through conscious control of the external urethral sphincter. This over-
riding control of the reflex can only temporarily halt urination.

_______________________ is the inability to control the sphincters so urine cannot be held.

Causes of incontinence:

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