URINARY SYSTEM

URINARY SYSTEM initiates a cascade leading to increased

blood pressure.
Learning Outcomes: • Regulation of Electrolyte Balance:
1. Identify the components of the urinary The kidneys meticulously control the
system levels of various ions in the blood,
2. Discuss the physiological mechanism including sodium, potassium, calcium,
of the urinary system and chloride, which are essential for
3. Identify the macroscopic and nerve and muscle function.
microscopic features of the urinary • Regulation of Acid-Base Balance: By
system excreting hydrogen ions (H+) and
4. Draw and label the different structures bicarbonate ions (HCO3−), the kidneys
of the urinary system help maintain the blood's pH within a
5. Discuss the physiological and narrow physiological range.
pathophysiological basis of some • Production of Hormones: The kidneys
common diseases affecting the urinary synthesize erythropoietin, a hormone
system that stimulates red blood cell
6. Appreciate the importance of the production in the bone marrow, and
urinary system activate vitamin D, which is crucial for
calcium absorption.
Outline:
• Structure & functions of the urinary Structurally, the urinary system consists of:
system • Two Kidneys: Bean-shaped organs
• The Kidneys located retroperitoneally in the
• The Nephrons abdominal cavity. They are the primary
• Physiology of urine production filtering units of the blood.
• The Ureters • Two Ureters: Thin, muscular tubes that
• Urinary bladder & micturition reflex transport urine from the kidneys to the
• The Urethra urinary bladder.
• Urinary Bladder: A hollow, distensible
• Common disorders of the urinary
muscular organ that stores urine.
system
• Urethra: A tube that carries urine from
the urinary bladder out of the body (not
seen in the image below).
STRUCTURE & FUNCTIONS OF THE
URINARY SYSTEM
Kidneys
The urinary system is a dynamic network of
organs working in concert to ensure the
body's internal environment remains stable.
Its primary functions are:
• Waste Excretion: Filtering metabolic
wastes, such as urea, creatinine, and
uric acid, from the blood. These
substances are byproducts of cellular
Ureters
metabolism and, if allowed to
accumulate, can be toxic.
• Regulation of Blood Volume and
Pressure: The kidneys adjust the
Urinary
amount of water returned to the blood,
bladder
thereby influencing blood volume and
consequently blood pressure. They
also produce renin, an enzyme that

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URINARY SYSTEM

THE KIDNEYS Each minor calyx surrounds the renal

papilla of a pyramid and collects urine
The kidneys, typically about 12 cm long, 6 draining from it.
cm wide, and 3 cm thick in adults, are
remarkable organs responsible for the
continuous processing of blood. Each
kidney has a convex lateral surface and a
concave medial surface. The medial surface
features a vertical fissure called the renal
hilum, which serves as the entry and exit
point for the renal artery, renal vein,
lymphatic vessels, nerves, and the ureter.

Blood supply to the kidneys is extensive.

The renal artery, branching directly from
the abdominal aorta, brings blood to each
kidney. Within the kidney, the renal artery
further subdivides into smaller arteries,
eventually leading to the afferent arterioles
that supply the nephrons. Filtered blood
then exits the kidney through a series of
veins, ultimately draining into the renal
vein, which empties into the inferior vena
cava.
Each kidney is enclosed by three layers of
connective tissue: the renal capsule
(innermost), the adipose capsule (middle),
and the renal fascia (outermost).

Internally, a kidney has three main regions:

• Renal Cortex: The outer region,
characterized by a granular appearance
due to the presence of renal
corpuscles.
• Renal Medulla: The inner region,
consisting of cone-shaped structures
called renal pyramids. The base of
each pyramid faces the cortex, while
the apex, called the renal papilla,
points towards the renal pelvis. Within THE NEPHRONS
the pyramids are bundles of collecting
ducts and the loops of Henle of some The nephron is the functional unit of the
nephrons. kidney, responsible for filtering blood and
• Renal Pelvis: A funnel-shaped cavity producing urine. Each kidney contains
that collects urine from the renal millions of nephrons.
pyramids and directs it into the ureter.
The renal pelvis branches into two or
three major calyces, which further
subdivide into several minor calyces.

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URINARY SYSTEM

A nephron consists of two main parts:

Glomerulus
• Renal Corpuscle: Composed of the
glomerulus, a network of capillaries,
and Bowman's capsule, a cup-like
structure that surrounds the
glomerulus.
• Renal Tubule: A long, winding tube that
extends from Bowman's capsule and is
divided into three main sections: the
Bowman’s capsule
proximal convoluted tubule (PCT), the
loop of Henle (descending and
ascending limbs), and the distal
convoluted tubule (DCT). Several Renal Tubule: A continuous tube extending
DCTs drain into a collecting duct. from Bowman's capsule:
• Proximal Convoluted Tubule (PCT):
Lined with simple cuboidal epithelial
cells with a prominent brush border of
microvilli on their apical surface,
greatly increasing the surface area for
reabsorption. These cells have
numerous mitochondria to support
active transport processes.
• Distal Convoluted Tubule (DCT):
Lined with simple cuboidal epithelial
cells, but they are smaller and have
fewer microvilli than PCT cells. The DCT
Renal Corpuscle is primarily involved in secretion and
• Glomerulus: A network of fenestrated selective reabsorption under hormonal
capillaries where blood filtration control.
occurs.
• Bowman's Capsule (Glomerular PCT
Capsule): A double-layered epithelial
cup surrounding the glomerulus. The
outer parietal layer is simple
squamous epithelium, while the inner
visceral layer consists of specialized
cells called podocytes. Podocytes
have foot-like processes called DCT

pedicels that interdigitate, forming

filtration slits. The filtration membrane,
through which plasma is filtered,
consists of the fenestrated • Loop of Henle (Nephron Loop): Has a
endothelium of the glomerular descending limb (initially thick simple
capillaries, the fused basement cuboidal epithelium, then thin simple
membrane, and the filtration slits squamous epithelium) and an
between the pedicels. ascending limb (initially thin simple
squamous epithelium, then thick
simple cuboidal epithelium). The thin
segments are permeable to water
and/or solutes, while the thick
segments actively transport solutes.

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URINARY SYSTEM

Thick limbs
Macula
Collecting ducts densa

Thin limbs

Collecting Duct: Not technically part of the

nephron but receives filtrate from several PHYSIOLOGY OF URINE PRODUCTION
nephrons. It is lined with simple cuboidal
epithelium that becomes columnar towards Urine formation involves three main
the renal papilla. Collecting ducts play a processes: glomerular filtration, tubular
crucial role in water reabsorption and urine reabsorption, & tubular secretion.
concentration, influenced by ADH.
Glomerular Filtration: Creating the
Juxtaglomerular Apparatus (JGA): A Filtrate
specialized structure found where the
afferent arteriole and the DCT come into This initial stage takes place in the renal
close contact. corpuscle, specifically across the filtration
membrane located between the glomerulus
& Bowman’s capsule.

Blood enters the glomerulus via the afferent

arteriole. The blood pressure within the
glomerular capillaries is relatively high,
forcing water and small solutes from the
blood plasma across the filtration
membrane into Bowman’s capsule. This
fluid is now called glomerular filtrate.

It consists of: The filtration membrane acts like a sieve,

• Juxtaglomerular (JG) cells: Modified allowing small molecules such as water,
smooth muscle cells in the wall of the ions (sodium, potassium, chloride, etc.),
afferent arteriole that contain renin. glucose, amino acids, urea, creatinine, and
• Macula densa: A group of specialized uric acid to pass through. However, it
epithelial cells in the wall of the DCT prevents larger components like blood cells
that monitor the sodium chloride and most plasma proteins from entering the
content of the filtrate. filtrate. These larger components remain in
the blood within the glomerulus and exit via
the efferent arteriole.

The glomerular filtration rate (GFR) is the

volume of filtrate formed by both kidneys
per minute and is a crucial indicator of
kidney function. In a healthy adult, the GFR
is typically around 125 mL/min, which
translates to about 180 liters of filtrate
produced per day. This is a massive

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URINARY SYSTEM

amount, highlighting the importance of the The DCT and collecting ducts fine-tune
subsequent reabsorption stage. reabsorption based on the body's needs,
regulated by hormones like aldosterone
The rate of glomerular filtration is and antidiuretic hormone (ADH).
determined by the net filtration pressure Aldosterone influences sodium and
(NFP). This refers to the balance between potassium reabsorption and ADH increases
the pressures that promote filtration and water reabsorption.
those that oppose it.
Reabsorption is a highly selective process
NFP = HPg – (HPc + OPg) that can occur via active transport, passive
diffusion, and osmosis. The body reclaims
Where: substances it needs to maintain
• HPg: Glomerular hydrostatic pressure – homeostasis, such as:
referring to the blood pressure in the • Water: A significant amount of water
glomerulus that favors filtration (about 99%) is reabsorbed via osmosis.
• HPc: Capsular hydrostatic pressure – • Glucose and Amino Acids: Normally,
referring to the pressure exerted by the all filtered glucose and amino acids are
fluid already in Bowman’s capsule that reabsorbed by active transport in the
opposes filtration proximal convoluted tubule.
• OPg: Blood colloid osmotic pressure - • Ions: Various ions like sodium (Na+),
osmotic pressure due to proteins the potassium (K+), calcium (Ca2+),
blood plasma that opposes filtration chloride (Cl−), and bicarbonate
(HCO3−) are reabsorbed to varying
Tubular Reabsorption: Reclaiming degrees depending on the body's
Essential Substances needs, often involving active and
passive transport mechanisms.
This stage occurs as the glomerular filtrate • Urea: About 50% of filtered urea is
flows through the renal tubules and the passively reabsorbed.
collecting ducts. As the filtrate flows
through the renal tubules, essential
substances are selectively transported from
the tubular fluid back into the blood in the
peritubular capillaries (surrounding renal
tubules) and vasa recta (surrounding the
loop of Henle).

The PCT is the primary site for reabsorption,

reclaiming a significant amount of water,
most of the nutrients, mainly glucose &
amino acids, and ions. Its cells have a brush
border of microvilli that increases surface
area for reabsorption.

The loop of Henle plays a critical role in Tubular Secretion: Fine-Tuning & Waste
establishing the osmotic gradient in the Removal
renal medulla, which is essential for
concentrating urine. The descending limb is Similar to reabsorption, secretion occurs
highly permeable to water but less so to along the renal tubules and collecting
solutes, while the ascending limb is ducts. Particularly, the DCT is a major site
permeable to solutes but not water. for secretion. Through this process, certain
substances, such as waste products,
excess ions, and some drugs, are actively

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URINARY SYSTEM

transported from the blood in the THE URETERS

peritubular capillaries into the renal
tubules. The ureters are paired, slender tubes,
approximately 25-30 cm long, that transport
Secretion serves several important urine from the renal pelvis of each kidney to
functions: the urinary bladder. Their walls are
• Eliminating Substances Not Readily composed of three layers:
Filtered: Some substances, like certain • Mucosa: The inner lining, consisting of
drugs (e.g., penicillin) and metabolites transitional epithelium (urothelium),
that are tightly bound to plasma which is specialized to withstand the
proteins, are not easily filtered at the chemical composition of urine and
glomerulus and need to be actively stretch as urine passes.
secreted into the tubules for removal. • Muscularis: The middle layer,
• Removing Excess Wastes: Secretion composed of smooth muscle fibers
helps to eliminate certain metabolic arranged in inner longitudinal and outer
wastes, such as creatinine and uric circular layers. Peristaltic contractions
acid, that were either not filtered in of this layer propel urine towards the
sufficient amounts or were partially bladder.
reabsorbed. • Adventitia: The outer layer, a fibrous
• Regulating Blood pH: The secretion of connective tissue that anchors the
hydrogen ions (H+) and bicarbonate ureters to the surrounding tissues.
ions (HCO3−) in the DCT and collecting
ducts plays a critical role in
maintaining the acid-base balance of
the blood.
• Eliminating Excess Potassium:
Aldosterone stimulates the secretion of
excess potassium ions (K+) into the
DCT and collecting ducts.

The Final Product: Urine

After glomerular filtration, tubular

reabsorption, and tubular secretion have
occurred, the remaining fluid in the
collecting ducts is urine. Urine composition
is significantly different from the initial
glomerular filtrate. It contains metabolic
wastes (urea, creatinine, uric acid), excess
ions, and varying amounts of water, Transitional
Epithelium
depending on the body's hydration status
and hormonal influences. Urine then flows
from the collecting ducts into the renal
pelvis, then down the ureters to the urinary
bladder for storage, and finally out of the
Adventitia Muscularis Mucosa
body through the urethra.
Urine movement through the ureters is
facilitated by peristalsis, gravity, and
hydrostatic pressure. Valves at the
ureterovesical junctions (where the
ureters enter the bladder) prevent the
backflow of urine into the ureters.

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URINARY SYSTEM

URINARY BLADDER & MICTURITION

REFLEX

The urinary bladder is a hollow, muscular

organ located in the pelvic cavity, posterior
to the pubic symphysis. Its primary function
is to store urine temporarily.

The lining of the bladder mucosa is folded

into rugae when the bladder is empty,
allowing for expansion. The trigone is a
smooth, triangular area at the base of the Adventitia Detrusor muscle Mucosa
bladder formed by the openings of the two
ureters (ureteral orifices) and the opening
The micturition reflex, or urination, is the
of the urethra (internal urethral orifice).
process of emptying the urinary bladder. It
is a complex reflex involving both
autonomic and somatic nervous system
control:
1. As the bladder fills with urine, stretch
receptors in its wall are activated.
2. These receptors send afferent nerve
impulses to the sacral region of the
spinal cord.
3. In the spinal cord, these impulses
stimulate parasympathetic neurons
and inhibit somatic motor neurons.
The bladder's wall is composed of three 4. Parasympathetic stimulation causes
main layers: the detrusor muscle to contract and
• Mucosa: The inner lining, also the internal urethral sphincter
consisting of transitional epithelium (smooth muscle) to relax.
(urothelium), which is highly folded 5. Simultaneously, inhibition of somatic
(rugae) when the bladder is empty, motor neurons causes the external
allowing for significant expansion as it urethral sphincter (skeletal muscle,
fills with urine. under voluntary control) to relax.
• Detrusor Muscle: The middle layer, a 6. If the individual consciously allows it,
thick layer of smooth muscle fibers urine is expelled from the bladder
arranged in multiple directions (inner through the urethra.
longitudinal, outer circular, outermost
longitudinal). Contraction of the The brain can exert voluntary control over
detrusor muscle expels urine from the micturition, particularly by controlling the
bladder. relaxation of the external urethral sphincter.
• Adventitia (Serosa): The outer layer, a This control is learned during early
fibrous connective tissue that covers childhood.
the bladder. The superior surface is
covered by the peritoneum (serosa).

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URINARY SYSTEM

THE URETHRA

The urethra is a tube that extends from the

urinary bladder to the outside of the body.
Its structure and length differ significantly
between males and females.

Female Urethra Prostatic

Approximately 4 cm long, it extends from Membranous

the bladder through the pelvic floor and Bulbous portion of
spongy
opens at the external urethral orifice,
located anterior to the vaginal opening. Its
primary function is to transport urine. The urethral wall consists of a:
• Mucosa: lined with transitional
Male Urethra epithelium near the bladder, changing
Approximately 20 cm long, it serves dual to stratified columnar or
functions: transporting urine and semen. It pseudostratified columnar epithelium,
passes through the prostate gland, the and finally stratified squamous
urogenital diaphragm, and the penis, epithelium near the external orifice
opening at the external urethral orifice at • Muscularis layer: smooth muscle
the tip of the penis.
• Connective tissue layer

The internal urethral sphincter, a

thickening of the detrusor muscle at the
bladder-urethra junction, is under
involuntary control. The external urethral
sphincter, located within the urogenital
Urethra diaphragm, is composed of skeletal
muscle and is under voluntary control.

COMMON DISORDERS OF THE URINARY

SYSTEM
The male urethra is divided into three
regions: Urinary Tract Infections (UTIs)
• Prostatic urethra that passes through • Description: UTIs are infections
the prostate gland involving any part of the urinary system,
• Membranous urethra, which is a short including the bladder (cystitis), urethra
segment passing through the urogenital (urethritis), kidneys (pyelonephritis),
diaphragm and ureters. Bladder infections are the
• Spongy (penile) urethra, which is the most common.
longest part that runs through the penis • Causes: Primarily caused by bacteria
& opens at the external urethral orifice (often Escherichia coli from the
digestive tract) entering the urinary
tract. Fungal and viral infections are
less common.
• Risk Factors: Female anatomy
(because it has shorter urethra), sexual
activity, poor hygiene, urinary
catheters, kidney stones, diabetes, and
suppressed immune systems.

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URINARY SYSTEM

• Symptoms: Frequent and painful urination, itching, muscle cramps, and

urination, burning sensation during difficulty concentrating.
urination (dysuria), urgency, cloudy or
bloody urine, pelvic pain (in women), Acute Kidney Injury (AKI) / Acute Renal
and back or flank pain (in kidney Failure:
infection). • Description: A sudden loss of kidney
function that develops over a few hours
Kidney Stones (Nephrolithiasis) or days. It can range from a minor loss
• Description: Solid masses or crystals of function to complete kidney failure.
formed from minerals and salts that • Causes: Reduced blood flow to the
accumulate in the kidneys. These kidneys (e.g., due to dehydration, blood
stones can vary in size from a grain of loss, heart failure), direct damage to
sand to a pebble or even larger. the kidneys (e.g., from toxins, certain
• Causes: Dehydration, family history, medications, infections), or blockage of
certain diets high in protein, sodium, urine flow (e.g., due to kidney stones,
and oxalate, obesity, some medical tumors, enlarged prostate).
conditions (e.g., hyperparathyroidism, • Symptoms: Decreased urine output,
gout), and urinary tract abnormalities. swelling in the legs and ankles,
• Symptoms: Often asymptomatic until shortness of breath, fatigue, confusion,
a stone moves into the ureter, causing nausea, and seizures in severe cases.
severe pain in the flank and back that
may radiate to the groin. Other References:
symptoms include nausea, vomiting, 1. Eroschenko, V. P. (2013). DiFiore’s Atlas
frequent urination, painful urination, of Histology with Functional
and blood in the urine (hematuria). Correlations 12th edition
2. Kumar, V., Abbas, A. K., & Aster, J.C.
Chronic Kidney Disease (CKD) (2013). Robbins Basic Pathology 9th
• Description: A progressive and edition
irreversible loss of kidney function over 3. Marieb, E. N. & Keller, S. M. (2022).
months or years. The kidneys gradually Essentials of Human Anatomy &
lose their ability to filter waste and Physiology 13th edition
excess fluid from the blood. 4. Netter, F. H. (2014). Atlas of Human
• Causes: Diabetes (diabetic Anatomy 6th edition
nephropathy) and high blood pressure 5. Roiger, D. & Bullock, N. (2022).
(hypertensive nephropathy) are the Anatomy, Physiology, & Disease:
leading causes. Other causes include Foundations for the Health Professions
glomerulonephritis, polycystic kidney 3rd edition
disease, lupus, obstructions of the 6. Young, B., Woodford, P., & O’Dowd, G.
urinary tract, and recurrent kidney (2014). Wheater’s Functional Histology:
infections. A Text and Colour Atlas 6th edition
• Stages: CKD is classified into five
stages based on the glomerular
filtration rate (GFR), with stage 5
representing kidney failure (end-stage
renal disease - ESRD).
• Symptoms: Often develops slowly and
may not have noticeable symptoms in
the early stages. As it progresses,
symptoms can include fatigue, swelling
in the legs and ankles, nausea,
vomiting, loss of appetite, changes in

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