URINARY SYSTEM:

DR LSK
Introduction

The urinary system consists of

four (4) main components;
The kidneys
The ureters
The bladder
The urethra
Functions of the urinary system
 Excretion– removal of waste material from the blood
plasma and the disposal of this waste in the urine .
 Elimination– removal of waste from other organ systems.
From digestive system – undigested food, water , salt , ions
drugs. From respiratory system – CO2, H+, water, toxins.
From skin – water, NaCl, nitrogenous wastes (urea , uric
acid, ammonia , creatinine).
 water balance - kidney tubules regulate water
reabsorption and urine concentration.
 Regulation of pH - volume ,and composition of body fluids
.
 production of erythropoietin: for hematopoieses, and
renin for blood pressure regulation .
Anatomy of the urinary System
 kidneys– a pair of bean – shaped organs located
retroperitoneally , responsible for blood filtering and urine
formation.
 Renal capsule – a layer of fibrous connective tissue covering
the kidneys.
 Renal cortex– the outer region of the kidneys where
most nephrons are located .
 Renal medulla– t h e inner region of the kidneys where
some nephrons are located , also where urine is collected
( Collecting duct) to be excreted outward .
 Renal calyx– duct – like sections of renal medulla for
collecting urine from nephrons and direct urine into renal
pelvis.
 continues
Renal pyramid– connective tissues in the renal medulla
binding various structures together .
 Renal pelvis – central urine collecting area of renal medulla
.
Hilum– concave notch of kidneys where renal artery, renal
vein, ureter , nerves ,and lymphatic vessels converge .
Ureter – a tubule that transport urine (mainly by peristalsis)
from the kidney to the urinary bladder .
Urinary bladder – a spherical storage organ that contains
up to 400 ml of urine .
Urethra– a tubule that excretes urine out of the urinary
bladder to the outside , through the urethral orifice .
KIDNEYS,URETERS & ADRENAL GLANDS:
 Structure & position.
 Relations.
 Functions.
 Blood supply.
 Functions of Urinary System
• Kidneys carry out four function

• Filter nitrogenous wastes, toxins, ions, etc. from blood to be

excreted as urine.
• Regulate volume and chemical composition of blood (water,
salts, acids, bases).
• Produce regulatory enzymes.
• Renin – regulates BP/ kidney function
• Erthropoeitin – stimulates RBC production from marrow.
• Metabolism of Vitamin D to active form.
Structure & position.
• Two Kidneys
– Perform major functions .
• Two Ureters
– Convey urine from Kidneys to Urinary Bladder
• Urinary Bladder
– Holds Urine until excretion
• Urethra
– Conveys urine from bladder to outside of body
Complete System
Location and description
• Lie against posterior abdominal wall at level of T12-L3.
• Right kidney is lower than left kidney due to the shape of the
liver.
• It is a retroperitoneal organ
Location of kidney

Copyright 2009, John Wiley & Sons, Inc.

 Kidney External Anatomy
• Average size – 12cm x 6cm x 3 cm
• Weights 150 grams
• Surrounded by three membranes (deep to superficial)
• 1. Renal capsule – a fibrous barrier for kidneys.
• 2. Adipose capsule(PERIRENAL FAT) – fatty tissue
designed for protection/stability.
• 3. Renal fascia – dense fibrous CT anchors kidneys/ adrenals/
membrane 1 and 2 to surroundings.
Relations:
Structures related to kidneys anteriorly.
Posteriorly,
 Kidney Anatomy
• Renal arteries and veins
• Renal cortex
• Renal medulla
• Nephron: functional unit & runs across medulla & cortex
• Renal pyramids (6-10)
• Renal papilla
• Calyx (ces)
• Renal pelvis
• Ureter
 Kidney- External Anatomy

• Lateral surface- convex

• Medial is concave-
• Renal Hilum
• Opening to Kidney
• Renal Sinus
• Space within hilus
• Kidneys receive blood vessels and nerves.
 Kidney Internal Anatomy I
• Renal arteries and veins
• Bring blood in and out of kidney
• Renal cortex
• Outer layer of Kidney
• Renal medulla
• Inner layer of Kidney
• Nephron: in both layers
Kidney Internal Anatomy II
• Renal Pyramids: 6-8
• Renal Columns
• Space between pyramids
within the medula
• Renal Papilla
• Narrow end of pyramid
• Calyx (ces)
• Collecting tubes
• Renal Pelvis
• Collecting vessel prior to ureter
Human Cadaveric Kidney
BLOOD SUPPLY.
• Although kidneys constitute less than
0.5% of total body mass, they receive
20-25% of resting cardiac output.
• renal artery, a lateral branch of the
abdominal aorta

• left renal artery usually arises a little

higher than the right, and the right
renal artery is longer and passes
posterior to the inferior vena cava
The blood flow sequence is: renal artery → afferent arteriole → glomerulus → efferent arteriole → renal vein.
Microscopic Anatomy/Nephron
 Each kidney consists of about 1 million basic functional
units called nephrons where blood filtering and urine
formation occur .
 Each nephron is composed of 10 parts –
 afferent arteriole → glomerulus →bowman's capsule →efferent
arteriole → proximal convoluted tubule (PCT) → descending limb
of loop of henle → loop of henle → ascending limb of loop of
henle → distal convoluted tubule(DCT) → collecting duct
(though,not part of the nephron).
 molecules in the blood that will be transformed to become
part of urine travel through the above structures , while
molecules that will be retained and reabsorbed back to the
blood will come out of the bowman's capsule , and go into
efferent arteriole and the peritubular capillaries .
Nephron
• Blood processing unit which serves to produce urine

• 1 million per kidney

• Consists of a glomerular capsule (Glomerulus), Renal tubule, and ends

with a collecting duct.
 Nephron: Vascular System
• Afferent arteriole
• Glomerulus
• Efferent arteriole
• Peritubular capillaries
• Capillary beds reabsorb in cortex
• Vasa recta
• Capillary beds reabsorb in medulla
 Nephron
• Tubular system
• Proximal convoluted tubule
• Descending limb
• Loop of Henle (nephron loop)
• Ascending limb
• Distal convoluted tubule
• Collecting duct
Nephron
 Urine Formation I
• Glomerular filtration
• Blood moves into the B.C via afferent arteriole.
• Hydrostatic pressure and osmotic pressure
drives: Water, ions, amino acids, glucose and
some metabolic waste such as Urea and
Creatinine get into capsular space from blood.
• Proteins and blood cells stay in the blood – too
big to leave capillaries.
• The amount of filtrate per minute is called GFR.
• Total filtrate volume (TFV): is 150 to 180
litre/day
• Only 1% of the filtrate is excreted in the urine,
99% reabsorb to the blood
 Urine Formation II
• Proximal convoluted tubule and
Peritubular capillary
• Of all the filtrates, Sodium is very
important.
• Na+ goes down the gradient and brings
glucose, amino acids, etc., back into the
bloodstream (cotransport).
• 2/3 of the filtrate reabsorb in the PC.
• Half of nitrogenous waste reabsorb back
to the blood stream
 Urine Formation III
Countercurrent Multiplication in the Nephron Loop
• Descending limb • Ascending limb
• Goes up toward cortex
• Goes into medulla -
increasing salt gradient - decreasing salt
gradient
• Water leaves
• Na+ pumped out
• Fluid concentrates
• Fluid relatively diluted
Nephron Loop
Urine Formation IV
• Collecting duct
• Travels down into medulla
• Water leaves tubule and enters blood
• Urine becomes concentrated and enters renal papilla
• ADH controls water channel
• ADH – Antidiuretic hormone
Collecting duct
OSMOREGULATION
• Kidneys play a very large role in human osmoregulation by
regulating the amount of water reabsorbed from glomerular
filtrate in kidney tubules, which is controlled
by hormones such as antidiuretic
hormone (ADH), aldosterone, and angiotensin II.
• For example, a decrease in water potential is detected
by osmoreceptors in the hypothalamus, which stimulates
ADH release from the pituitary gland to increase
the permeability of the walls of the collecting ducts in the
kidneys. Therefore, a large proportion of water is
reabsorbed from fluid in the kidneys to prevent too much
water from being excreted.
 Aldosterone
• It produces in the adrenal cortex of the adrenal gland
• It plays a central role in the homeostatic regulation of blood
pressure, plasma sodium (Na+), and potassium (K+) levels
• It does so primarily by acting on the mineralocorticoid receptors in
the distal tubules and collecting ducts of the nephron.
• Aldosterone and ADH cause your kidneys to retain sodium.
• In addition, it causes loss of potassium through the urine.
• Hence, increase in Sodium Concentration in the bloodstream causes
water retention.
 Action of ADH and osmoregulation

The main action of ADH in the kidney is to regulate the volume and osmolarity of the
urine. Specifically, it acts in the distal convoluted tubule (DCT) and collecting
ducts (CD).

ADH can also act on the blood vessels to increase peripheral vascular resistance, the
result of which is increased blood pressure. This mechanism is useful in restoring
blood pressure during hypovolemic shock.
URETERS:
• Muscular tubes that transport urine from the kidneys to the bladder
& are 25cm long.
• Are continuous superiorly with the renal pelvis at the ureteropelvic
junction.
• Inferior to this junction, the ureters descend retroperitoneally on the
medial aspect of the psoas major muscle.
Internal structure.
Ureters.
• At the pelvic brim, the ureters cross
either the end of the common iliac
or the beginning of the external iliac
arteries, enter the pelvic cavity, and
continue their journey to the
bladder.
• Three points along their course the
ureters are constricted :
1. At the ureteropelvic junction, just
inferior to the kidney;
2. Where the ureters cross the
common iliac vessels at the pelvic
brim;
3. Where the ureters enter the wall
of the bladder.
SUPRA RENAL GLAND:

• Are associated with the superior pole of each kidney.

• Consist of an outer cortex and an inner medulla.
• Right gland is shaped like a pyramid, while the left gland is semilunar
in shape and the larger of the two.
 Ureters and Bladder
• Ureters
• 25 cm long
• Enters on the floor of bladder
• Urinary Bladder
• Muscular sac on the floor of the pelvic cavity
• Muscle layer formed by detrusor muscle
• It is a pelvic organ when empty, and it moves to the lower abdominal region
when filled up
• It consists of Apex, Base, Neck and Trigone
• It contains internal and external sphincters
URINARY BLADDER- RELATIONS
Male Female
 Parts
• Apex
• Base
• Neck
• Trigone
Rugae, internal urethral orifice &
sphincter, peritoneum
Bladder- Hisology
Micturition (urination), the periodic emptying of the bladder
• The basic reflexes occur at the level of the sacral spinal cord and are modified by
centers in the midbrain and cerebral cortex.
• The bladder has a capacity of 120-320ml, although it can distend up to 400 ml on
average.
• The 1st sensation of bladder filling occurs at a volume of 100 -150 mL in an adult,
and the first desire to micturate is elicited when the bladder contains about 150 to
250 mL of urine.
• At about age 2.5 years, it begins to come under cortical control, and, in most
children, complete control is achieved by age 3 years
• Micturition reflex
• Stretching of bladder wall due to filling
• Increase activity in sensory neurons
• Increase parasympathetic motor to detrusor
• Increased detrusor contraction
• Inhibition of sympathetic supply to internal urethral sphincter (to cause relaxation)
• Inhibition of pudendal nerve (to cause relaxation of external sphincter)
46
• Micturition
 Control of Bladder

• Urinary incontinence- involuntary release of urine

• caused by atonic bladder as a result of destruction of sensory fibers to bladder
• Automatic bladder- caused by damage to spinal cord above the sacral region
• Prostate issue

47
Major events of micturition
 Urinary bladder distends as it fills with urine.
 Stretch receptors in the bladder wall are stimulated and
signal the micturition center in the sacral spinal cord.
 Parasympathetic nerve impulses travel to the detrusor
muscle , which respond by contracting rhythmically.
 The need to urinate is sensed as urgent.
 Voluntary contraction of the external urethral sphincter and
inhibition of the micturition reflex by impulses from the
brain stem and the cerebral cortex prevent urination.
 Following the decision to urinate, the external urethral
sphincter is relaxed, the impulses from the pons and
hypothalamus facilitate the micturation reflex.
 continues
 The detrusor muscle contracts and urine is expelled through
the urethra .
 Neurons of the micturition reflex center fatigue, the
detrusor muscle relaxes, and the bladder begins to fill with
urine again.
Urethra
• Urethra
• Conveys urine out of body
• Female urethra – 3 - 4 cm
• Opens into external urethral oriface
• Lies between vaginal oriface and clitoris
• Male urethra – 18 cm
• 3 regions
• Prostatic urethra – 2.5 cm
• Membranous urethra – 0.5 cm
• Penile urethra – 15 cm
Micturition Reflex
Bladder with >= 200 ml of urine

Sensory input to parasympathetic system

Contraction of detrusor muscle and relaxation of internal

urethral sphincter

Relaxation of external urethral sphincter

Micturition
Urinary bladder and its innervation
 Applied anatomy
• Diabetic Nephropathy
• Kidney stone
• Kidney tumour
• Developmental anomalies ( horseshoe kidney,renal agenesis-
missing one kidney)
• Renal transplant
• Ureteric Calculi
• Suprapubic cystotomy (suprapubic catheter)/ urethral
catheterization
• Absent and ectopic kidneys
• Nephritis
PROSTATE
• Doughnut shaped
• Measures 4cm* 3cm*2cm
• Increases in size from birth – 30 yrs
• Has about 30-40 glands
• Has prostatic ducts
• Secrets milky fluid for motility & viability of sperm
CLINICAL CORRELATES:
• Urinary Tract Infections:
• An infection of a part of the urinary system or the presence of large numbers of
microbes in urine.
• More common in females due to the shorter length of the urethra.
• Symptoms include painful or burning urination, urgent and frequent urination,
low back pain, and bedwetting.
• UTIs include urethritis (inflammation of the urethra), cystitis (inflammation of the
urinary bladder), and pyelonephritis (inflammation) of the kidneys
Nephrotic syndrome

 Nephrotic syndrome is a condition characterized by proteinuria and

hyperlipidemia (high blood levels of cholesterol,phospholipids, and triglycerides).
• Edema, usually seen around the eyes, ankles, feet, and abdomen,
• occurs in nephrotic syndrome because loss of albumin from the blood decreases
blood colloid osmotic pressure.
• N.S. Is associated with several glomerular diseases of unknown cause, as well as
diabetes mellitus, systemic lupus erythematosus (SLE),cancers, and AIDS.
Renal Failure
• Decrease or cessation of glomerular filtration.

1) Acute renal failure (ARF), the kidneys abruptly stop working entirely (or
almost entirely).
• The main feature of ARF is the suppression of urine flow, usually characterized
either by oliguria (daily urine output between 50 mL and 250 mL), or by anuria
(daily urine output less than 50 mL).
 2) .Chronic renal failure (CRF)- progressive and usually irreversible decline in
glomerular filtration rate (GFR).
• CRF may result from chronic glomerulonephritis, pyelonephritis, polycystic
kidney disease,or traumatic loss of kidney tissue.
Kidney stones
• A hard granule of calcium, phosphate, uric acid and protein.
• Form in renal pelvis and get lodged in pelvis or ureter.
• Caused by urinary tract infections, dehydration, pH imbalances, or an
enlarged prostate gland.
• Treated with stone dissolving drugs, surgical removal, or lithotripsy
(ultrasonic vibrations)
Polycystic Kidney Disease
• Inherited disorder where the kidney tubules become riddled
with hundreds or thousands of cysts (fluid-filled cavities).
• Patients may have cysts and apoptosis in the liver, pancreas,
spleen, and gonads; increased risk of cerebral aneurysms;
heart valve defects; and diverticuli in the colon.
• symptoms are not noticed until adulthood, when patients
may have back pain, urinary tract infections, blood in the
urine, hypertension, and large abdominal masses.