CHAPTER 15 Urinary System 1

The Urinary System
Prepared by: Emmanuel D. Habilag, RN, MANc
© 2018 Pearson Education, Inc.

Functions of the Urinary System
 Kidneys dispose of waste products in urine

 Nitrogenous wastes
 Toxins
 Drugs
 Excess ions
 Kidneys’ regulatory functions include:
 Production of renin to maintain blood pressure
 Production of erythropoietin to stimulate red blood cell
production
 Conversion of vitamin D to its active form

Organs of the Urinary System
 Kidneys
 Ureters
 Urinary bladder
 Urethra

Figure 15.1a Organs of the urinary system.
Hepatic veins (cut)

Inferior vena cava
Adrenal gland Renal artery

Renal hilum
Aorta Renal vein
Kidney
Iliac crest
Ureter
Rectum (cut)
Uterus (part
of female Urinary
reproductive bladder
system) Urethra
(a)

Kidneys
 Location and structure

 The kidneys are situated against the dorsal body wall
in a retroperitoneal position (behind the parietal
peritoneum)
 The kidneys are situated at the level of the T12 to L3
vertebrae
 The right kidney is slightly lower than the left (because
of position of the liver)

Figure 15.1b Organs of the urinary system.
12th rib
(b)
Kidneys
 Kidney structure
 An adult kidney is about 12 cm (5 in) long and 6 cm
(2.5 in) wide
 Renal hilum
 A medial indentation where several structures enter or
exit the kidney (ureters, renal blood vessels, and
nerves)
 An adrenal gland sits atop each kidney

Kidneys
 Kidney structure (continued)

 Three protective layers enclose the kidney
 Fibrous capsule encloses each kidney
 Perirenal fat capsule surrounds the kidney and cushions
against blows
 Renal fascia is the most superficial layer that anchors
the kidney and adrenal gland to surrounding structures

Kidneys

 Three regions revealed in a longitudinal section
1. Renal cortex—outer region
2. Renal medulla—deeper region
 Renal (medullary) pyramids—triangular regions of tissue
in the medulla
 Renal columns—extensions of cortexlike material that
separate the pyramids

Kidneys

 Three regions (continued)
3. Renal pelvis—medial region that is a flat, funnel-
shaped tube
 Calyces form cup-shaped ―drains‖ that enclose the renal
pyramids
 Calyces collect urine and send it to the renal pelvis, on to
the ureter, and to the urinary bladder for
storage

Figure 15.2a Internal anatomy of the kidney.
Renal cortex
Renal column
Major calyx
Minor calyx
Renal
pyramid
(a)
Figure 15.2b Internal anatomy of the kidney.
Cortical radiate vein
Cortical radiate artery

Renal cortex Arcuate vein
Arcuate artery
Renal column Interlobar vein
Interlobar artery
Segmental
arteries
Renal vein
Renal artery
Minor calyx Renal pelvis
Major calyx
Renal Ureter
pyramid
Fibrous capsule
(b)
Kidneys
 Blood supply
 One-quarter of the total blood supply of the body
passes through the kidneys each minute
 Renal artery provides each kidney with arterial blood
supply
 Renal artery divides into segmental arteries →
interlobar arteries → arcuate arteries → cortical
radiate arteries

Kidneys
 Venous blood flow

 Cortical radiate veins → arcuate veins → interlobar
veins → renal vein
 There are no segmental veins
 Renal vein returns blood to the inferior vena cava

Figure 15.2b Internal anatomy of the kidney.
Cortical radiate vein
Cortical radiate artery

Renal cortex Arcuate vein
Arcuate artery
Renal column Interlobar vein
Interlobar artery
Segmental
arteries
Renal vein
Renal artery
Minor calyx Renal pelvis
Major calyx
Renal Ureter
pyramid
Fibrous capsule
(b)
Figure 15.2c Internal anatomy of the kidney.
Aorta Renal Segmental Interlobar Arcuate Cortical Afferent

artery artery artery artery radiate arteriole
artery
Glomerulus
(capillaries)
Inferior Renal Interlobar Arcuate Cortical Peritubular Efferent

vena vein vein vein radiate capillaries arteriole
cava vein
(c)

Nephrons
 Structural and functional units of the kidneys

 Each kidney contains over a million nephrons
 Each nephron consists of two main structures
1. Renal corpuscle
2. Renal tubule

Nephrons
 Renal corpuscle consists of:

1. Glomerulus, a knot of capillaries made of podocytes
 Podocytes make up the inner (visceral) layer of the
glomerular capsule
 Foot processes cling to the glomerulus
 Filtration slits create a porous membrane—ideal for
filtration
2. Glomerular (Bowman’s) capsule is a cup-shaped
structure that surrounds the glomerulus
 First part of the renal tubule

Figure 15.3c Structure of the nephron.
Glomerular
PCT
capsular
space
Glomerular
capillary
covered by
podocytes
Efferent
arteriole
Afferent
arteriole
(c)

Figure 15.3d Structure of the nephron.
Filtration slits
Podocyte
cell body
Foot
processes
(d)

Nephrons
 Renal tubule
 Extends from glomerular capsule and ends when it
empties into the collecting duct
 From the glomerular (Bowman’s) capsule, the
subdivisions of the renal tubule are:
1. Proximal convoluted tubule (PCT)
2. Nephron loop (loop of Henle)
3. Distal convoluted tubule (DCT)

Nephrons
 Cortical nephrons
 Located entirely in the cortex
 Include most nephrons
 Juxtamedullary nephrons
 Found at the cortex-medulla junction
 Nephron loop dips deep into the medulla
 Collecting ducts collect urine from both types of
nephrons, through the renal pyramids, to the calyces,
and then to the renal pelvis

Nephrons
 Two capillary beds associated with each nephron

1. Glomerulus
2. Peritubular capillary bed

Nephrons
 Glomerulus
 Fed and drained by arterioles
 Afferent arteriole—arises from a cortical radiate artery
and feeds the glomerulus
 Efferent arteriole—receives blood that has passed
through the glomerulus
 Specialized for filtration
 High pressure forces fluid and solutes out of blood and
into the glomerular capsule

Figure 15.3c Structure of the nephron.
Glomerular
PCT
capsular
space
Glomerular
capillary
covered by
podocytes
Efferent
arteriole
Afferent
arteriole
(c)

Nephrons
 Peritubular capillary beds

 Arise from the efferent arteriole of the glomerulus
 Low-pressure, porous capillaries
 Adapted for absorption instead of filtration
 Cling close to the renal tubule to receive solutes and
water from tubule cells
 Drain into the interlobar veins

Urine Formation and Characteristics
 Urine formation is the result of three processes

1. Glomerular filtration
2. Tubular reabsorption
3. Tubular secretion

Figure 15.4 The kidney depicted schematically as a single large, uncoiled
nephron.
Afferent arteriole
Glomerular
capillaries
Efferent
Cortical arteriole
radiate
artery
Glomerular
1
capsule Three major
renal processes:
Rest of
renal tubule 1 Glomerular filtration: Water and solutes
containing 1 smaller than proteins are forced through the
filtrate capillary walls and pores of the glomerular
capsule into the renal tubule.
Peritubular
2 capillary 2 Tubular reabsorption: Water, glucose,
amino acids, and needed ions are
3 transported out of the filtrate into the tubule
cells and then enter the capillary blood.
To cortical
radiate vein 3 Tubular secretion: H1, K1, creatinine, and
drugs are removed from the peritubular blood
and secreted by the tubule cells into the
Urine filtrate.

 Glomerular filtration
 The glomerulus is a filter
 Filtration is a nonselective passive process
 Water and solutes smaller than proteins are forced
through glomerular capillary walls
 Proteins and blood cells are normally too large to pass
through the filtration membrane
 Once in the capsule, fluid is called filtrate
 Filtrate leaves via the renal tubule

 Glomerular filtration (continued)

 Filtrate will be formed as long as systemic blood
pressure is normal
 If arterial blood pressure is too low, filtrate formation
stops because glomerular pressure will be too low to
form filtrate

 Tubular reabsorption
 The peritubular capillaries reabsorb useful substances
from the renal tubule cells, such as:
 Water
 Glucose
 Amino acids
 Ions
 Some reabsorption is passive; most is active (ATP)
 Most reabsorption occurs in the proximal convoluted
tubule

Figure 15.5 Sites of filtration, reabsorption, and secretion in a nephron.
Proximal tubule Distal tubule

Glomerular HCO3− Glucose and
capsule NaCl
NaCl H2O amino acids
Blood
Some drugs H+
K+ and
and poisons some Collecting
Filtrate duct
drugs
H2O Cortex
Salts Medulla
HCO
(NaCl,3 (bicarbonate)
−
etc.) H2O
H+
Urea Nephron
loop NaCl
Glucose; amino acids
Some drugs NaCl
H2O
Reabsorption K+
Active transport
Passive transport Urea
Secretion NaCl H2O
(active transport)
Urine
(to renal pelvis)
 Tubular secretion
 Reabsorption in reverse
 Some materials move from the blood of the peritubular
capillaries into the renal tubules to be eliminated in
filtrate
 Hydrogen and potassium ions
 Creatinine

 Tubular secretion (continued)

 Secretion is important for:
 Getting rid of substances not already in the filtrate
 Removing drugs and excess ions
 Maintaining acid-base balance of blood
 Materials left in the renal tubule move toward the
ureter

 Nitrogenous wastes
 Nitrogenous waste products are poorly reabsorbed, if
at all
 Tend to remain in the filtrate and are excreted from the
body in the urine
 Urea—end product of protein breakdown
 Uric acid—results from nucleic acid metabolism
 Creatinine—associated with creatine metabolism in
muscles

Figure 15.5 Sites of filtration, reabsorption, and secretion in a nephron.
Proximal tubule Distal tubule

Glomerular HCO3− Glucose and
capsule NaCl
NaCl H2O amino acids
Blood
Some drugs H+
K+ and
and poisons some Collecting
Filtrate duct
drugs
H2O Cortex
Salts Medulla
HCO
(NaCl,3 (bicarbonate)
−
etc.) H2O
H+
Urea Nephron
loop NaCl
Glucose; amino acids
Some drugs NaCl
H2O
Reabsorption K+
Active transport
Passive transport Urea
Secretion NaCl H2O
(active transport)
Urine
(to renal pelvis)
 In 24 hours, about 1.0 to 1.8 liters of urine are

produced
 Urine and filtrate are different
 Filtrate contains everything that blood plasma does
(except proteins)
 Urine is what remains after the filtrate has lost most of
its water, nutrients, and necessary ions through
reabsorption
 Urine contains nitrogenous wastes and substances
that are not needed

 Urine characteristics
 Clear and pale to deep yellow in color
 Yellow color is normal and due to the pigment
urochrome (from the destruction of hemoglobin) and
solutes
 Dilute urine is a pale, straw color
 Sterile at the time of formation
 Slightly aromatic, but smells like ammonia with time
 Slightly acidic (pH of 6)
 Specific gravity of 1.001 to 1.035

 Solutes normally found in urine

 Sodium and potassium ions
 Urea, uric acid, creatinine
 Ammonia
 Bicarbonate ions

 Solutes NOT normally found in urine

 Glucose
 Blood proteins
 Red blood cells
 Hemoglobin
 WBCs (pus)
 Bile

Table 15.1 Abnormal Urinary Constituents

Ureters
 Slender tubes 25–30 cm (10–12 inches) attaching

the kidney to the urinary bladder
 Continuous with the renal pelvis
 Enter the posterior aspect of the urinary bladder
 Run behind the peritoneum
 Peristalsis aids gravity in urine transport

Figure 15.1a Organs of the urinary system.
Hepatic veins (cut)

Inferior vena cava
Adrenal gland Renal artery

Renal hilum
Aorta Renal vein
Kidney
Iliac crest
Ureter
Rectum (cut)
Uterus (part
of female Urinary
reproductive bladder
system) Urethra
(a)

Figure 15.6 Basic structure of the female urinary bladder and urethra.
Urinary
bladder
Ureter
Ureteral orifice Internal urethral

Trigone orifice
External urethral
Internal urethral
sphincter
sphincter
Urogenital
diaphragm
Urethra

Urinary Bladder
 Smooth, collapsible, muscular sac situated

posterior to the pubic symphysis
 Stores urine temporarily
 Trigone—triangular region of the urinary bladder
base based on three openings
 Two openings from the ureters (ureteral orifices)
 One opening to the urethra (internal urethral orifice)
 In males, the prostate surrounds the neck of the
urinary bladder

Urinary
bladder
Ureter

Trigone orifice
External urethral
Internal urethral
sphincter
sphincter
Urogenital
diaphragm
Urethra

Urinary Bladder
 Wall of the urinary bladder

 Three layers of smooth muscle collectively called the
detrusor muscle
 Mucosa made of transitional epithelium
 Walls are thick and folded in an empty urinary bladder
 Urinary bladder can expand significantly without
increasing internal pressure

Urinary Bladder
 Capacity of the urinary bladder

 A moderately full bladder is about 5 inches long and
holds about 500 ml of urine
 Capable of holding twice that amount of urine

Figure 15.7 Position and shape of a distended and an empty urinary bladder in an adult
male.
Umbilicus
Superior wall
of distended
bladder
Superior wall
of empty bladder
Pubic
symphysis

Urethra
 Thin-walled tube that carries urine from the

urinary bladder to the outside of the body by
peristalsis
 Function
 Females—carries only urine
 Males—carries urine and sperm

Urethra
 Release of urine is controlled by two sphincters

1. Internal urethral sphincter
 Involuntary and made of smooth muscle
2. External urethral sphincter
 Voluntary and made of skeletal muscle

Urinary
bladder
Ureter

Trigone orifice
External urethral
Internal urethral
sphincter
sphincter
Urogenital
diaphragm
Urethra

Urethra
 Length
 In females: 3 to 4 cm (1.5 inches long)
 In males: 20 cm (8 inches long)
 Location
 Females—anterior to the vaginal opening
 Males—travels through the prostate and penis
 Prostatic urethra
 Membranous urethra
 Spongy urethra

Urinary
bladder
Ureter

Trigone orifice
External urethral
Internal urethral
sphincter
sphincter
Urogenital
diaphragm
Urethra

Micturition
 Micturition
 Voiding, or emptying of the urinary bladder
 Two sphincters control the release of urine, the internal
urethral sphincter and external urethral sphincter
 Bladder collects urine to 200 ml
 Stretch receptors transmit impulses to the sacral
region of the spinal cord
 Impulses travel back to the bladder via the pelvic
splanchnic nerves to cause bladder contractions

Micturition
 When contractions become stronger, urine is

forced past the involuntary internal sphincter into
the upper urethra
 Urge to void is felt
 The external sphincter is voluntarily controlled, so
micturition can usually be delayed

Fluid, Electrolyte, and Acid-Base Balance
 Blood composition depends on three factors

1. Diet
2. Cellular metabolism
3. Urine output

Fluid, Electrolyte, and Acid-Base Balance
 Kidneys have four roles in maintaining blood

composition
1. Excreting nitrogen-containing wastes (previously
discussed)
2. Maintaining water balance of the blood
3. Maintaining electrolyte balance of the blood
4. Ensuring proper blood pH

Maintaining Water Balance of the Blood
 Normal amount of water in the human body

 Young adult females = 50%
 Young adult males = 60%
 Babies = 75%
 The elderly = 45%
 Water is necessary for many body functions, and
levels must be maintained

 Water occupies three main fluid compartments

1. Intracellular fluid (ICF)
 Fluid inside cells
 Accounts for two-thirds of body fluid
2. Extracellular fluid (ECF)
 Fluids outside cells; includes blood plasma, interstitial
fluid (IF), lymph, and transcellular fluid
3. Plasma (blood) is ECF, but accounts for 3L of total
body water.
 Links external and internal environments (Figure
15.9)

Figure 15.8 The major fluid compartments of the body.
Total body water

Volume  40 L
60% body weight
Plasma
ECF
Volume  3 L, 20% of
Interstitial
Intracellular fluid (ICF) fluid (IF)
Volume  25 L Volume  12
40% body weight L 80% of
ECF
Extracellular fluid
(ECF)
Volume  15 L
20% body weight
Figure 15.9 The continuous mixing of body fluids.
Lungs Gastrointestinal Kidneys
tract
Blood O2 CO2 Nutrients H2O, H2O, Nitrogenous

plasma Ions Ions wastes
Interstitial O2 CO2 Ions Nitrogenous

Nutrients H2O
fluid wastes
Intracellular
fluid in tissue cells
 The link between water and electrolytes

 Electrolytes are charged particles (ions) that conduct
electrical current in an aqueous solution
 Sodium, potassium, and calcium ions are
electrolytes

 Regulation of water intake and output

 Water intake must equal water output if the body is to
remain properly hydrated
 Sources for water intake
 Ingested foods and fluids
 Water produced from metabolic processes (10%)
 Thirst mechanism is the driving force for water intake

Figure 15.10 Water intake and output.
Metabolism 100 ml Feces 4%

10% 250 ml Sweat 8%
200 ml
Insensible
Foods losses via
750 ml 700 ml
30%
skin and
2500 ml
lungs 28%
Beverages 1500 ml 1500 ml Urine 60%

60%
Average intake Average output

per day per day

 Thirst mechanism
 Osmoreceptors are sensitive cells in the hypothalamus
that become more active in reaction to small changes
in plasma solute concentration
 When activated, the thirst center in the hypothalamus
is notified
 A dry mouth due to decreased saliva also promotes
the thirst mechanism
 Both reinforce the drive to drink

Figure 15.11 The thirst mechanism for regulating water intake.
Plasma solutes
Saliva Osmoreceptors
in hypothalamus
Dry mouth
Hypothalamic
thirst center
Sensation of
thirst; person
takes a drink
Water moistens
mouth, throat;
stretches stomach,
intestine
KEYS
Water absorbed Initial stimulus

from GI tract
Physiological response
Result
Plasma Increases, stimulates
solutes Reduces, inhibits
 Sources of water output

 Lungs (insensible since we cannot sense the water
leaving)
 Perspiration
 Feces
 Urine

 Hormones are primarily responsible for

reabsorption of water and electrolytes by the
kidneys
 Antidiuretic hormone (ADH) prevents excessive water
loss in the urine and increases water reabsorption
 ADH targets the kidney’s collecting ducts

Maintaining Electrolyte Balance
 Small changes in electrolyte concentrations

cause water to move from one fluid compartment
to another
 A second hormone, aldosterone, helps regulate
blood composition and blood volume by acting on
the kidney
 For each sodium ion reabsorbed, a chloride ion
follows, and a potassium ion is secreted into the filtrate
 Water follows salt: when sodium is reabsorbed, water
follows it passively back into the blood

Electrolyte Balance
 Renin-angiotensin mechanism
 Most important trigger for aldosterone release
 Mediated by the juxtaglomerular (JG) apparatus of the
renal tubules
 When cells of the JG apparatus are stimulated by low
blood pressure, the enzyme renin is released into
blood

Electrolyte Balance
 Renin-angiotensin mechanism (continued)

 Renin catalyzes reactions that produce angiotensin II
 Angiotensin II causes vasoconstriction and
aldosterone release
 Result is increase in blood volume and
blood pressure

Figure 15.12 Flowchart of mechanisms regulating sodium ion and water balance to help maintain blood pressure
homeostasis.
Falling systemic blood

pressure/volume
(+)
Reduced filtrate volume Inhibits baroreceptors Hypothalamic
or solute content in renal in blood vessels osmoreceptors
tubules
(+) (+)
(+)
(+) Sympathetic nervous Posterior pituitary
JG cells of kidneys system
Releases
(+)
Release ADH (antidiuretic
Systemic arterioles hormone)
Causes (+)
Renin
Vasoconstriction Collecting ducts
Leads to of kidneys
Results
in Ca
Peripheral resistance us
Angiotensin II
es
H2O reabsorption
formed in blood
(+)
(+) (+)
Systemic arterioles Adrenal cortex
Causes Secretes
Vasoconstriction Aldosterone
Results in Targets
Peripheral resistance Kidney tubules

Causes
Na+ reabsorption (and
H2O absorption)
Results
in
Blood volume
KEY:
(+) = stimulates
Rising blood pressure
Renin-angiotensin system
Neural regulation (sympathetic
nervous system effects)
Effects of ADH release

Maintaining Acid-Base Balance of Blood
 Blood pH must remain between 7.35 and 7.45 to

maintain homeostasis
 Alkalosis—pH above 7.45
 Acidosis—pH below 7.35
 Physiological acidosis—pH between 7.0 and 7.35

 Kidneys play greatest role in maintaining acid-

base balance
 Other acid-base controlling systems
 Blood buffers
 Respiration

 Blood buffers
 Acids are proton (H+) donors
 Strong acids dissociate completely and liberate all of
their H+ in water
 Weak acids, such as carbonic acid, dissociate only
partially
 Bases are proton (H+) acceptors
 Strong bases dissociate easily in water and tie up
H+
 Weak bases, such as bicarbonate ion and ammonia,
are slower to accept H+

Figure 15.13 Dissociation of strong and weak acids in water.
HCI H2CO3
H+HCO –
CI– CI
–
3 H2CO3
H+ H+
– H+ H2CO3 HCO3–
CI CI– CI– CI–
H2CO
H+ H + H+
H+ – H2CO3
CI 3
H+
(a) A strong (b) A weak acid such
acid such as as H2CO3 does
HCI not dissociate
dissociates completely.
completely
© 2018 Pearson Education, Inc. into its ions.
Developmental Aspects of the
Urinary System
 The kidneys begin to develop in the first few
weeks of embryonic life and are excreting urine
by the third month of fetal life
 Common congenital abnormalities include
polycystic kidney and hypospadias
 Common urinary system problems in children and
young to middle-aged adults include infections
caused by fecal microorganisms, microorganisms
causing sexually transmitted infections, and
Streptococcus

Developmental Aspects of the
Urinary System
 Control of the voluntary urethral sphincter does
not start until age 18 months
 Complete nighttime control may not occur until
the child is 4 years old
 Urinary tract infections (UTIs) are the only
common problems before old age
 Escherichia coli (E. coli), a bacterium, accounts for 80
percent of UTIs

Developmental Aspects of the Urinary
System
 Renal failure is an uncommon but serious
problem in which the kidneys are unable to
concentrate urine, and dialysis must be done to
maintain chemical homeostasis of blood
 With age, filtration rate decreases and tubule
cells become less efficient at concentrating urine,
leading to urgency, frequency, and incontinence
 In men, urinary retention is another common
problem

Developmental Aspects of the Urinary
System
 Problems associated with aging
 Urgency—feeling that it is necessary to void
 Frequency—frequent voiding of small amounts of urine
 Nocturia—need to get up during the night to urinate
 Incontinence—loss of control
 Urinary retention—common in males, often the result
of hypertrophy of the prostate gland

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CHAPTER 15 Urinary System 1

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The Urinary System

Prepared by: Emmanuel D. Habilag, RN, MANc

© 2018 Pearson Education, Inc.

 Kidneys dispose of waste products in urine

© 2018 Pearson Education, Inc.

© 2018 Pearson Education, Inc.

Hepatic veins (cut)

Adrenal gland Renal artery

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 Location and structure

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© 2018 Pearson Education, Inc.

 Kidney structure (continued)

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 Kidney structure (continued)

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 Kidney structure (continued)

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Cortical radiate vein

Cortical radiate artery

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 Venous blood flow

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Cortical radiate vein

Cortical radiate artery

Aorta Renal Segmental Interlobar Arcuate Cortical Afferent

Inferior Renal Interlobar Arcuate Cortical Peritubular Efferent

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 Structural and functional units of the kidneys

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 Renal corpuscle consists of:

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© 2018 Pearson Education, Inc.

© 2018 Pearson Education, Inc.

© 2018 Pearson Education, Inc.

© 2018 Pearson Education, Inc.

 Two capillary beds associated with each nephron

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© 2018 Pearson Education, Inc.

© 2018 Pearson Education, Inc.

 Peritubular capillary beds

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 Urine formation is the result of three processes

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© 2018 Pearson Education, Inc.

© 2018 Pearson Education, Inc.

 Glomerular filtration (continued)

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© 2018 Pearson Education, Inc.

Proximal tubule Distal tubule

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 Tubular secretion (continued)

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© 2018 Pearson Education, Inc.

Proximal tubule Distal tubule

 In 24 hours, about 1.0 to 1.8 liters of urine are

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© 2018 Pearson Education, Inc.

 Solutes normally found in urine