ANATOMY AND PHYSIOLOGY OF THE

URINARY SYSTEM

Course instructor: NKAUM Larissa

RN, HND, Bsc, Msc in anesthesia/Reanimation UCAC Yde

Target: Level 100 students

COURSE OBJECTIVES

General Objective

 By the end of this course, the student should be able to have a clear understanding and
mastery of the anatomy and physiology of the urinary system in humans.

Specific Objectives

 Describe the anatomical structure and organization of the urinary system

 Describe the structure of the kidney and the nephron
 Explain the process of urine formation and other functions of the kidney
 Describe other structures of the urinary system

PLAN

INTRODUCTION

I. Structure of the urinary system

i. The kidneys
a. Structure and functions of the nephron
b. functions of the kidney
c. Composition of urine
ii. The structure and function of the Ureters
iii. The structure and function of the bladder
iv. The structure and function of the Urethra

CONCLUSION
Introduction.

The principal function of the urinary system is to maintain the volume and composition of body
fluids within normal limits. One aspect of this function is to rid the body of waste products that
accumulate as a result of cellular metabolism, and, because of this, it is sometimes referred to as
the excretory system.

Although the urinary system has a major role in excretion, other organs contribute to the excretory
function. The lungs in the respiratory system excrete some waste products, such as carbon
dioxide and water. The skin is another excretory organ that rids the body of wastes through
the sweat glands. The liver and intestines excrete bile pigments that result from the destruction
of hemoglobin. The major task of excretion still belongs to the urinary system. If it fails the other
organs cannot take over and compensate adequately.

The urinary system maintains an appropriate fluid volume by regulating the amount of water that
is excreted in the urine. Other aspects of its function include regulating the concentrations of
various electrolytes in the body fluids and maintaining normal pH of the blood.

In addition to maintaining fluid homeostasis in the body, the urinary system controls red blood
cell production by secreting the hormone erythropoietin. The urinary system also plays a role in
maintaining normal blood pressure by secreting the enzyme renin.

I. Structure of the urinary system

The urinary system is the main excretory system and consists of the following structures:

 2 kidneys, which secrete urine

 2 ureters that convey the urine from the kidneys to the urinary bladder
 The urinary bladder, which collects and stores urine
 The urethra through which urine leaves the body.
i. The Kidneys

 Position and structure of the Kidneys

- The kidneys lie on the posterior abdominal wall, one on each side of the vertebral column,
behind the peritoneum and below the diaphragm.
 - They extend from the level of the 12th thoracic vertebra to the 3rd lumbar vertebra,
receiving some protection from the lower rib cage.
- The right kidney is usually slightly lower than the left, probably because of the considerable
space occupied by the liver. Kidneys are bean-shaped organs, about 11 cm long, 6 cm wide,
3 cm thick and weigh 150 g.
- They are embedded in, and held in position by, a mass of fat. A sheath of fibrous connective
tissue, the renal fascia, encloses the kidney and the renal fat. As the kidneys lie on either
side of the vertebral column, each is associated with different structures.

Right kidney

- Superiorly – the right adrenal gland

- Anteriorly – the right lobe of the liver, the duodenum and the hepatic flexure of the colon
- Posteriorly – the diaphragm, and muscles of the posterior abdominal wall.

Left kidney

- Superiorly – the left adrenal gland

- Anteriorly – the spleen, stomach, pancreas, jejunum and splenic flexure of the colon
- Posteriorly – the diaphragm and muscles of the posterior abdominal wall

b. Functions of the kidney

. The main functions of the kidneys are:

• Formation of urine, maintaining water, electrolyte and acid–base balance

• Excretion of waste products

• Production and secretion of erythropoietin, the hormone that stimulates formation of red blood
cells

• Production and secretion of renin, an important enzyme in the control of blood pressure (p. 225).
Urine is stored in the bladder and excreted by the process of micturition
 a. Microscopic structure of the kidney (Nephron)

The kidney contains about 1–2 million functional units, the nephrons, and a much smaller number
of collecting ducts. The collecting ducts are supported by connective tissue, containing blood
vessels, nerves and lymph vessels. The nephron is essentially a tubule closed at one end that joins
a collecting duct at the other end.

Parts of a Nephron
 The Bowman’s capsule / Glomerular capsule:
The Bowman’s capsule (also called the glomerular capsule), is the beginning of a nephron.
It surrounds the glomerulus. It is a double walled cup, It is composed of inner visceral and outer
parietal layers. Parietal (outer) layer of glomerular capsule is simple squamous epithelium. Visceral
(inner) layer of glomerular capsule consists of elaborate cells called podocytes that wrap around
the capillaries of the glomerulus. Capsular space separates the two layers of glomerular capsule
  The Glomerulus
The glomerulus is a capillary tuft that receives its blood supply from an afferent arteriole of the
renal circulation. First step of urine formation “filtration of blood” happens at the glomerulular
capillaries. – glomerular filtration.
The glomerular capillaries are fenestrated capillaries. Fenestrated capillaries have pores in the
endothelial cells those provide channels across the capillary wall so we could have small molecules
pass through easily.
These capillaries are more permeable than continuous capillaries. Fenestrations allow many
substances to diffuse from the blood based primarily on size.
Substances cross readily if they are less than 4 nm in size and most pass freely up to 8 nm in size.
Water and small molecules like glucose, urea and ions like sodium cross the glomerular
capillaries and get into the glomerular capsule of nephron. The fenestrations (pores) prevent
filtration of blood cells or large proteins.
Red blood cells and large proteins, such as serum albumins, cannot pass through the glomerulus
under normal circumstances because they are too big to pass through glomerular capillaries.
However, in some injuries they may be able to pass through and can cause blood and protein
content to enter the urine, which is a sign of problems in the kidney.
As blood passes through the glomerular capillaries, 10 to 20 percent of the plasma filters between
these sieve-like fingers to be captured by Bowman’s capsule and funneled to the PCT.
The glomerulus and the double walled cup-shaped chamber that surrounds it, called the glomerular
or Bowman’s capsule, together is referred to as Renal corpuscle.

 Renal tubule: long, coiled tube that converts the filtrate into urine
The renal tubule is a long and convoluted structure that emerges from the glomerular capsule and
can be divided into three parts based on function. The first part is called the proximal
convoluted tubule (PCT) due to its proximity to the glomerulus; it stays in the renal cortex. The
second part is called the loop of Henle, because it forms a loop (with descending and ascending
limbs) that goes through the renal medulla. The third part of the renal tubule is called the distal
convoluted tubule (DCT) and this part is also restricted to the renal cortex. The DCT, which is
the last part of the nephron, connects and empties its contents into collecting ducts that line the
medullary pyramids. The collecting ducts amass contents from multiple nephrons and fuse together
as they enter the papillae of the renal medulla.
i. Proximal Convoluted Tubule: Filtered fluid collected by Bowman’s capsule enters into
the PCT. It is called convoluted due to its tortuous path. Simple cuboidal cells form this
tubule with prominent microvilli on the luminal surface, forming a brush border. These
microvilli create a large surface area to maximize the absorption and secretion of solutes
(Na+, Cl–, glucose, etc.), the most essential function of this portion of the nephron. These
cells actively transport ions across their membranes, so they possess a high concentration
of mitochondria in order to produce sufficient ATP.
ii. The loop of Henle is a U-shaped tube that consists of a descending limb and ascending
limb. It transfers fluid from the proximal to the distal tubule. The descending and ascending
portions of the loop of Henle (sometimes referred to as the nephron loop) are continuations
of the same tubule. They run adjacent and parallel to each other after having made a hairpin
turn at the deepest point of their descent. The descending loop of Henle consists of an initial
short, thick portion and long, thin portion, whereas the ascending loop consists of an initial
short, thin portion followed by a long, thick portion.
iii. Distal Convoluted Tubule (DCT): The distal convoluted tubule and collecting duct is the
final site of reabsorption in the nephron. Unlike the other components of the nephron, its
permeability to water is variable depending on a hormone stimulus to enable the complex
regulation of blood osmolarity, volume, pressure, and pH. The DCT, like the PCT, is very
tortuous and formed by simple cuboidal epithelium, but it is shorter than the PCT. These
cells are not as active as those in the PCT; thus, there are fewer microvilli on the apical
surface. However, these cells must also pump ions against their concentration gradient, so
you will find of large numbers of mitochondria, although fewer than in the PCT.
iv. Collecting Ducts: The collecting ducts are continuous with the nephron but not technically
part of it. In fact, each duct collects filtrate from several nephrons for final modification.
Collecting ducts merge as they descend deeper in the medulla to form about 30 terminal
ducts, which empty at a papilla. They are lined with simple squamous epithelium with
receptors for ADH. When stimulated by ADH, these cells will insert aquaporin channel
proteins into their membranes, which as their name suggests, allow water to pass from the
duct lumen through the cells and into the interstitial spaces to be recovered by the vasa
 recta. This process allows for the recovery of large amounts of water from the filtrate back
into the blood. In the absence of ADH, these channels are not inserted, resulting in the
excretion of water in the form of dilute urine. Most, if not all, cells of the body contain
aquaporin molecules, whose channels are so small that only water can pass. At least 10
types of aquaporins are known in humans, and six of those are found in the kidney. The
function of all aquaporins is to allow the movement of water across the lipid-rich,
hydrophobic cell membrane.
 Nephrons and Blood Vessels
Each nephron has its own independent blood supply.

i. Afferent Arteriole: The renal artery first divides into smaller arteries, followed by further
branching and pass through the renal columns to reach the cortex. In the cortex they divide
further and form afferent arterioles. The afferent arterioles service about 1.3 million
nephrons in each kidney. The branch that enters the glomerulus is called the afferent
arteriole. A group of specialized cells known as juxtaglomerular apparatus (JGA) are
located around the afferent arteriole where it enters the renal corpuscle. The JGA secretes
an enzyme called renin, due to a variety of stimuli, and it is involved in the process of blood
volume homeostasis.

ii. Efferent Arteriole: After passing through the renal corpuscle, the capillaries form a
second arteriole, the efferent arteriole The branch that exits the glomerulus is called
the efferent arteriole. These will next form a capillary network around the more distal
portions of the nephron tubule, the peritubular capillaries and vasa recta, before
returning to the venous system. As the glomerular filtrate progresses through the nephron,
these capillary networks recover most of the solutes and water, and return them to the
circulation. Since a capillary bed (the glomerulus) drains into a vessel that in turn forms a
second capillary bed, the definition of a portal system is met. This is the only portal system
in which an arteriole is found between the first and second capillary beds.
iii. Peritubular capillaries: Peritubular capillaries are tiny blood vessels, supplied by the
efferent arteriole, that travel alongside nephrons and surrounds them allowing reabsorption
and secretion between blood and the inner lumen of the nephron. In cortical nephrons, the
peritubular capillary network surrounds the PCT and DCT. In juxtamedullary nephrons, the
 peritubular capillary network forms a network around the loop of Henle and is called
the vasa recta. Peritubular capillaries join together and form the renal veins and return the
filtered blood with less waste materials to the venous system.

a. Functions of the kidney

Formation of urine
- The kidneys form urine, which passes to the bladder for storage prior to excretion.
- The composition of urine reflects exchange of substances between the nephron and the
blood in the renal capillaries.
- Waste products of protein metabolism are excreted, water and electrolyte levels are
controlled and pH (acid–base balance) is maintained by excretion of hydrogen ions.
- There are three processes involved in the formation of urine:
 Filtration
 Selective reabsorption
 Secretion.
 Filtration
- This takes place through the semipermeable walls of the glomerulus and glomerular capsule.
Water and other small molecules readily pass through, although some are reabsorbed later.
Blood cells, plasma proteins and other large molecules are too large to filter through and
therefore remain in the capillaries.
- The filtrate in the glomerulus is very similar in composition to plasma with the important
exceptions of plasma proteins and blood cells.
- Filtration takes place because there is a difference between the blood pressure in the
glomerulus and the pressure of the filtrate in the glomerular capsule. Because the efferent
arteriole is narrower than the afferent arteriole, a capillary hydrostatic pressure of about 7.3
kPa (55 mmHg) builds up in the glomerulus.
- This pressure is opposed by the osmotic pressure of the blood, provided mainly by plasma
proteins, about 4 kPa (30 mmHg), and by filtrate hydrostatic pressure of about 2 kPa (15
mmHg) in the glomerular capsule. The net filtration pressure is, therefore: 10
- The volume of filtrate formed by both kidneys each minute is called the glomerular filtration
rate (GFR). In a healthy adult the GFR is about 125 mL/min, i.e. 180 litres of filtrate are formed
 each day by the two kidneys. Nearly all of the filtrate is later reabsorbed from the kidney
tubules with less than 1%, i.e. 1–1.5 litres, excreted as urine.
- The differences in volume and concentration are due to selective reabsorption of some filtrate
constituents and tubular secretion of others.
 Selective reabsorption
- Most reabsorption from the filtrate back into the blood takes place in the proximal
convoluted tubule, whose walls are lined with microvilli to increase surface area for
absorption.
- Many substances are reabsorbed here, including some water, electrolytes and organic
nutrients such as glucose. Some reabsorption is passive, but some substances, e.g. glucose,
are actively transported. Only 60–70% of filtrate reaches the medullary loop. Much of this,
especially water, sodium and chloride, is reabsorbed in the loop, so that only 15–20% of
the original filtrate reaches the distal convoluted tubule, and the composition of the filtrate
is now very different.
- More electrolytes are reabsorbed here, especially sodium, so the filtrate entering the
collecting ducts is actually quite dilute.
- The main function of the collecting ducts is to reabsorb as much water as the body needs.
Active transport takes place at carrier sites in the epithelial membrane, using chemical
energy to transport substances against their concentration gradients.
- Some ions, e.g. sodium and chloride, can be absorbed by both active and passive
mechanisms depending on the site in the nephron. Some constituents of glomerular filtrate
(e.g. glucose, amino acids) do not normally appear in urine because they are completely
reabsorbed unless blood levels are excessive.
- Reabsorption of nitrogenous waste products, such as urea, uric acid and creatinine is very
limited.
- The kidneys’ maximum capacity for reabsorption of a substance is the transport maximum,
or renal threshold. For example, the normal blood glucose level is 3.5–8 mmol/L (63 to 144
mg/100 mL) and if this rises above the transport maximum of about 9 mmol/L (160 mg/100
mL), glucose appears in the urine.
- This occurs because all the carrier sites are occupied and the mechanism for active transport
out of the tubules.
 Tubular secretion
- Filtration occurs as blood flows through the glomerulus. Substances not required and
foreign materials, e.g. drugs including penicillin and aspirin, may not be entirely filtered
out of the blood because of the short time it remains in the glomerulus.
- Such substances are cleared by secretion from the peritubular capillaries into the filtrate
within the convoluted tubules. Tubular secretion of hydrogen ions (H+) is important in
maintaining normal blood PH.
b. Composition of urine
- Urine is clear and amber in color.
- The specific gravity is between 1020 and 1030, and the pH is around 6 (normal range 4.5–
8). A healthy adult passes from 1000 to 1500 mL per day.
- The volume of urine produced and the specific gravity vary according to fluid intake and
the amount of solute excreted. The constituents of urine are: Water 96% Urea 2% ,Uric
acid, Creatinine, Ammonia, Sodium, Potassium, Chlorides, Phosphates, Sulphates Oxalates
2%.
Water balance and urine output
- The balance between fluid intake and output, is controlled by the kidneys. The minimum
urinary output, i.e. the smallest volume required to excrete body waste products, is about
500 mL per day. Urinary volume in excess of this is controlled mainly by antidiuretic
hormone (ADH) released into the blood by the posterior pituitary gland.
- Sensory nerve cells in the hypothalamus (osmoreceptors) detect changes in the osmotic
pressure of the blood. Nerve impulses from the osmoreceptors stimulate the posterior
pituitary to release ADH. When the osmotic pressure is raised, i.e. the blood is becoming
more concentrated, ADH output is increased and as a result, water reabsorption by the distal
convoluted tubules and collecting ducts is increased, reducing the blood osmotic pressure
and ADH output.
Electrolyte balance
- Changes in the concentration of electrolytes in the body fluids may be due to changes in:
the body water content, or electrolyte levels. Several mechanisms maintain the balance
between water and electrolyte concentration which include:
 Sodium and potassium balance
  PH balance

b. The Ureters
 Position and structure
- The ureters carry urine from the kidneys to the urinary bladder.
- They are about 25–30 cm long with a diameter of approximately 3 mm. The ureter is
continuous with the funnel-shaped renal pelvis.
- It passes downwards through the abdominal cavity, behind the peritoneum in front of the
psoas muscle into the pelvic cavity, and passes obliquely through the posterior wall of the
bladder.

The walls of the ureters consist of three layers of tissue:

• An outer covering of fibrous tissue, continuous with the fibrous capsule of the kidney

• A middle muscular layer consisting of interlacing smooth muscle fibres that form a functional
unit round the ureter and an additional outer longitudinal layer in the lower third

• An inner layer, the mucosa, composed of transitional epithelium.

 Function
- Sending of urine from the collecting duct to the bladder.
c. Bladder
 Position and structure
- The urinary bladder is a reservoir for urine. It lies in the pelvic cavity and its size and
position vary, depending on the volume of urine it contains.
- The bladder is roughly pear shaped, but becomes more balloon shaped as it fills with urine.
The posterior surface is the base.
- The bladder opens into the urethra at its lowest point, the neck. The peritoneum covers only
the superior surface before it turns upwards as the parietal peritoneum, lining the anterior
abdominal wall. Posteriorly it surrounds the uterus in the female and the rectum in the male.
The bladder wall is composed of three layers:
 The outer layer of loose connective tissue, containing blood and lymphatic vessels and
nerves, covered on the upper surface by the peritoneum
  The middle layer, consisting of interlacing smooth muscle fibers and elastic tissue loosely
arranged in three layers. This is called the detrusor muscle and when it contracts, it
empties the bladder
 The inner mucosa, composed of transitional epithelium that readily permits distension of
the bladder as it fills.
- The total capacity of urine in bladder is rarely more than about 600 mL. The Bladder has
three orifices. The upper two orifices on the posterior wall are the openings of the ureters;
the lower orifice is the opening into the urethra.
- The internal urethral sphincter, a thickening of the urethral smooth muscle layer in the
upper part of the urethra, controls outflow of urine from the bladder.
- This sphincter is not under voluntary control.
 Function
- For temporal storage of urine
d. The Urethra
 Position and structure
- The urethra is a canal extending from the neck of the bladder to the exterior, at the external
urethral orifice. It is longer in the male than in the female.
- The male urethra is associated with both the urinary and reproductive systems.
- The female urethra is approximately 4 cm long and 6 mm in diameter. It runs downwards
and forwards behind the symphysis pubis and opens at the external urethral orifice just in
front of the vagina.
- The external urethral orifice is guarded by the external urethral sphincter, which is under
voluntary control. The wall of the female urethra has two main layers: an outer muscle layer
and an inner lining of mucosa.
 Function
- Micturition or voiding of urine