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Chapter 24 - 25: Urinary System 79

24.1 OVERVIEW OF THE URINARY

SYSTEM

OVERVIEW OF THE URINARY

SYSTEM STRUCTURES §  Urinary tract – composed of a pair of ureters,
urinary bladder, and a single urethra
•  Urinary system (organs of excretion) – composed of a
o  Urineexits kidneys through ___________ found
pair of kidneys and urinary tract
on posterior body wall
§  ___________ filter blood to remove metabolic waste
products; modify resulting fluid for following
o  Each ureters empties into urinary bladder on
purposes: floor of pelvic cavity where urine is stored
o  Fluid and electrolyte homeostasis
o  Acid-base and blood pressure homeostasis o  Urineexits from urinary bladder through ______ ;
allows urine to exit body

OVERVIEW OF KIDNEY FUNCTION OVERVIEW OF THE URINARY

SYSTEM STRUCTURES
•  Kidneys are site where urinary system regulates
homeostatic processes:
§  Filter blood to remove metabolic wastes
•  Kidneys look like beans in both shape and color
§  Regulate fluid and electrolyte balance
•  Both kidneys are found outside and posterior to
peritoneal membrane (______________ )
§ 
•  Right kidney is found in a slightly inferior position
§  Influence blood pressure due to liver
§  Releasing hormone erythropoietin

§ 

§ 
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•  Left kidney is positioned between T12–L3 using

vertebral column as reference
•  11th and 12th ribs provide some protection for both
kidneys
•  ___________ ___________ – component of
endocrine system; found on superior pole of each
kidney

EXTERNAL ANATOMY OF THE

KIDNEYS
•  Three external layers of connective tissue from deep to
superficial:
1. ___________ capsule – thin layer of dense irregular
connective tissue; covers exterior of each kidney
24.2 ANATOMY OF THE KIDNEYS
2. ___________ capsule – protects from physical trauma
3. ___________ fascia – dense irregular connective tissue;
anchors each kidney to peritoneum and musculature of posterior
abdominal wall
•  Hilum – opening on medial surface of kidney where renal artery,
vein, nerves, and ureters enter and exit

INTERNAL ANATOMY OF THE

KIDNEYS
•  Renal cortex and the renal medulla make up
urine-forming portion of kidney
§  ___________ 90–95% of all kidney’s blood vessels are
found in renal cortex
§  Renal columns – extensions of renal cortex; pass
through renal medulla toward renal pelvis
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•  Over one million nephrons are found within cortex and

medulla of each kidney
§  Renal corpuscle found in •  Each renal pyramid tapers into a slender papilla
§  Renal tubule found mostly in cortex with some tubules à
dipping into medulla à
•  Cone-shaped _______________ are found within renal à
medulla separated by renal columns on either side à
§  Smooth muscle tissue contraction within walls of the
calyces and renal pelvis propel urine towards the ureter

BLOOD SUPPLY OF THE KIDNEYS

•  Left and right renal arteries are branches of
abdominal aorta
1-renal artery à
2-segmental artery à
3-interlobar artery à
4- à
5-interlobular (cortical radiate artery)

•  Venous blood exits kidney parallel to arterial pathway

•  Kidney contains unusual capillary bed system where
arterioles both feed and drain capillaries; normally
10-interlobular veins à
function of a venule
11-arcuate veins à
6-afferent arteriole à
12-interlobar vein à
7- à 13-
8-efferent arteriole à
9- capillaries à §  Renal vein exits kidney from hilum to drain into
inferior vena cava
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NEPHRON AND THE COLLECTING SYSTEM

BLOOD SUPPLY OF THE KIDNEYS
•  Nephron – renal corpuscle and renal tubule
§  Renal corpuscle –filters blood
o  ___________ – group of looping fenestrated
capillaries

o  Glomerular capsule (Bowman’s capsule) –

consists of outer parietal and inner visceral
layer

o  ___________ space – hollow region between

parietal and visceral layers

•  Proximal tubule – reabsorption (some secretion)

Filtrate from Bowman’s capsule enters renal tubule:
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•  Nephron loop (loop of Henle) – dips into medulla; consists •  Distal tubule –
of a descending and an ascending limb (reabsorption)

•  Juxtaglomerular apparatus (JGA) – composed of

both macula densa and juxtaglomerular (JG) cells;
§  Macula densa is a group of cells in contact with
modified smooth muscle cells (juxtaglomerular (JG)
cells)
§  JGA regulates blood pressure and glomerular filtration
rate

•  Collecting system – both medullary collecting duct and

papillary duct that further modify filtrate before it exits
kidney
§  cortical collecting duct à medullary collecting
duct à
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•  Once filtrate enters papillary duct it is known as urine,

not filtrate
•  Urine exits papillary duct at papilla of renal pyramid
into a ___________

TYPES OF NEPHRONS
•  ___________ nephrons make up about 80% of
nephrons in kidneys
§  Renal corpuscles are found in outer renal cortex;
have short nephron loops that barely enter renal
medulla
•  _______________ nephrons – much less common than
cortical nephrons
§  Renal corpuscles are found near boundary between
renal cortex and medulla; have long nephron loops
that travel deep within renal medulla

NEPHROLITHIASIS
•  Formation of renal calculi (kidney stones); crystalline
structures composed most commonly of calcium
oxalate salts
•  Form when concentrations of ions (also sodium ions, 24.3 OVERVIEW OF RENAL
hydrogen ions, and uric acid) are present in filtrate in PHYSIOLOGY
higher than normal amounts;
known as supersaturation
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GLOMERULAR FILTRATION TUBULAR REABSORPTION

•  Selectively based on size so cells and large proteins are •  Reclaiming or reabsorbing substances such as water,
not filtered and remain in the circulating blood glucose, amino acids, and electrolytes from tubular
fluid to return them into circulating blood
§  Smaller substances exit blood to enter capsular space
as filtrate

TUBULAR SECRETION
•  Substances are added into filtrate from peritubular
capillaries
§  Helps maintain electrolyte and acid-base
homeostasis; removes toxins from blood that did not
enter tubular fluid by filtration

THE FILTRATION MEMBRANE AND

THE FILTRATE
•  Fenestrated glomerular capillary
§  Fenestrations

24.4 RENAL PHYSIOLOGY I: §  Water and small dissolved solutes pass through filtration
membrane easily
GLOMERULAR FILTRATION §  Nitrogenous wastes – group of small substances that are readily
filtered; include:
o  _________ and ammonium ions (NH4+) from protein metabolism
o  Creatinine
o  ___________ – product of nucleic acid metabolism
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GLOMERULAR FILTRATION RATE

Amount of filtrate formed by both kidneys in one minute
is known as glomerular filtration rate (GFR); 125 ml/
min (___________)
•  Net filtration pressure at glomerulus is determined by
three driving forces:
1. Glomerular hydrostatic pressure (_________) – blood
pressure; higher than average capillary bed hydrostatic pressure

2. Glomerular colloid osmotic pressure (_________) –

created mostly by albumin; pulls water back into glomerular
capillaries

3. Capsular hydrostatic pressure (CHP) – generated as

capsular space rapidly fills with new filtrate (10 mm Hg) as
fluid can only move so quickly into renal tubule which opposes GLOMERULONEPHRITIS
filtration

•  Net filtration pressure (NFP) is combination of these three

•  Common condition that involves damage to and
destruction of glomeruli; inflammation of glomerular
forces:
capillaries and basement membrane results

•  NFP favors filtration as GHP is greater than sum of forces •  Inflammation increases blood flow and capillary
that oppose filtration (GCOP + CHP) permeability; increases GHP; causes filtration
membrane to become excessively leaky; leads to loss of
blood cells and proteins to urine

FACTORS THAT AFFECT THE •  Hormonal effects on GFR are part of a larger system
that involves regulation of systemic blood pressure and
GLOMERULAR FILTRATION RATE includes angiotensin-II and natriuretic peptides
Autoregulation – internal kidney mechanisms that work to §  Renin-angiotensin-aldosterone system (RAAS) –
maintain GFR complex system that maintains systemic blood
•  ___________ mechanism – constriction of smooth muscle pressure
in blood vessel walls in response to increases in blood
§  Atrial natriuretic peptide (ANP) – hormone
pressure
released by heart cells in atria in response to
•  Tubuloglomerular feedback – uses macula densa of increasing fluid volume; lowers blood volume and
distal renal tubule to control pressure in glomerulus in blood pressure to reduce workload of the heart
response to NaCl concentration of filtrate
o  ANP increases GFR by dilating afferent arterioles
and constricting efferent arterioles; increases
glomerular hydrostatic pressure
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•  Neural regulation of GFR primarily involves

___________ _________ of autonomic nervous system

RENAL FAILURE RENAL FAILURE

•  If GFR decreases, kidneys may be unable to carry out •  ___________ – condition that can develop when GFR
their vital functions; called renal failure is less than 50% of normal; leads to buildup of waste
products, fluid, electrolytes, as well as acid-base
§  Renal failure may be a short-term condition known as
acute renal failure or acute kidney injury; resolves
imbalances, all of which can lead to coma, seizures,
with treatment and death if untreated

§  Renal failure may become chronic after three or more •  ___________ can be used to treat the signs and
months of decreased GFR; commonly seen with long- symptoms of uremia
standing diabetes mellitus and hypertension
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THE RAAS AND

HYPERTENSION
•  Three classes of drugs have been developed that act on
RAAS to reduce blood pressure:
§  ACE inhibitors – developed from snake venom; block ACE;
therefore inhibit conversion of angiotensin I to II 24.5 RENAL PHYSIOLOGY II: TUBULAR
§  Angiotensin-receptor blockers – block receptors on blood
vessels and proximal tubule cells; prevents vasoconstriction REABSORPTION AND SECRETION
and reabsorption of water and sodium
§  Aldosterone antagonists – block effects of aldosterone on
distal tubule; decrease reabsorption of sodium and water;
leads to diuretic effect
•  Drugs may decrease GFR in patients with pre-existing renal
disease; must be monitored

PRINCIPLES OF TUBULAR
REABSORPTION AND SECRETION
•  In ___________ ___________ , substances pass from •  ___________ ___________ – substances move from
filtrate into interstitial fluid then into peritubular blood into interstitial fluid then into tubule with filtrate
capillaries to re-enter blood
§  Secretion is an active process
•  In tubular secretion, substances move in opposite
direction

REABSORPTION AND SECRETION

IN THE PROXIMAL TUBULE
•  Reabsorption is the main function of proximal tubule
§  Large quantity of ions, sodium, potassium, chloride,
sulfate, and phosphate; vital to electrolyte homeostasis
§  Almost 100% of nutrients including glucose, amino
acids, water-soluble vitamins, and lactic acid
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GLYCOSURIA
•  Transport maximum – especially important with ___________ in proximal tubule
substances such as glucose §  Ammonium ions (NH4+), creatinine, and small amounts of
urea are also secreted
•  If too much glucose is present in filtrate, TM will be §  Drugs such as penicillin and morphine have significant renal
reached before all glucose is reabsorbed; excess will secretion; must be taken often (typically 3–5 times per day),
appear in urine (glycosuria) because amount lost through renal secretion must be replaced
in order to maintain relatively consistent blood levels
•  Commonly seen in diabetes mellitus – due to defects
in production of or response to insulin; causes inability
of cells to take up glucose; leads to high circulating
blood glucose (hyperglycemia), high filtrate glucose
content, and therefore glucose remaining in urine

REABSORPTION IN THE NEPHRON REABSORPTION AND SECRETION-DISTAL

LOOP TUBULE AND COLLECTING SYSTEM
•  Once filtrate reaches nephron loop, 60–70% of water Facultative water reabsorption – water is reabsorbed
and electrolytes and most organic solutes have been based on body’s needs
reabsorbed (returned to blood) •  ___________ –from adrenal cortex; increases reabsorption
of sodium ions from filtrate and secretion of potassium ions
•  About 20% of water and 25% of sodium and chloride into filtrate
ions are reabsorbed from loop
•  ___________ hormone (ADH) – from hypothalamus and
secreted by posterior pituitary; causes water reabsorption;
reduces urine output
•  Atrial natriuretic peptide (ANP) – stimulates urinary
excretion of sodium ions while it also inhibits release of
both aldosterone and ADH
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•  Cells of proximal tubule secrete hydrogen ions to

maintain blood pH
Medullary collecting system – last chance for regulation
of fluid, electrolyte, and acid-base balance before filtrate
becomes urine
•  Impermeable to water in absence of ___________
•  Permeable to urea; allows urea to be reabsorbed passively
into interstitial fluid

24.6 RENAL PHYSIOLOGY III:

REGULATION OF URINE
CONCENTRATION AND VOLUME
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PRODUCTION OF DILUTE URINE

•  Kidneys produce dilute urine when solute concentration
of extracellular fluid is too low
§ 

§  Distal tubule and collecting duct become impermeable to

water

COUNTERCURRENT MECHANISM AND

PRODUCTION OF CONCENTRATED URINE
•  Kidneys effectively conserve water by producing very •  Countercurrent multiplier proceeds in following
concentrated urine (reaching nearly 1200 mOsm) using steps
two mechanisms:
§  NaCl is actively transported ___________ limb filtrate
§  into interstitial fluid
§  Countercurrent mechanism creates and maintains §  Hypertonic fluid then pulls water out of filtrate in
osmotic gradient by exchanging materials in opposite ___________ limb
directions between filtrate and interstitial fluids
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PUTTING IT ALL TOGETHER: THE BIG

PICTURE OF RENAL PHYSIOLOGY
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URINE COMPOSITION AND

URINALYSIS
•  Urine normally contains:
§  §  Sulfates

24.8 URINE AND RENAL §  §  Metabolic wastes

CLEARANCE such as urea,
§  Potassium
creatinine, ammonia,
§  Chloride and uric acid
§  §  Small amounts of
bicarbonate, calcium,
§  Phosphates and magnesium may
also be present

URINE COMPOSITION AND URINALYSIS URINE COMPOSITION AND

§  Urine color URINALYSIS
o  ___________ ; breakdown product of hemoglobin •  Renal clearance:
o  Darker urine is more concentrated; has less water §  Measurement of rate at which kidneys remove a
o  Lighter urine is less concentrated; has more water substance from blood
§  Urine should be ___________ §  For a substance to provide an accurate measure of renal
clearance and GFR, substance should be completely
§  Mild odor; strong odor may be caused by diseases, filtered and neither reabsorbed nor secreted
infections, or by ingesting certain foods
§  ___________ –not totally accurate (5–50% in urine
§  Normal pH (6.0); ranges from ___________ arrived via secretion, not filtration)
§  Specific gravity 1.001 (very dilute) to 1.035 (very §  More accurate assessment of GFR can be obtained using
concentrated) ________; neither secreted or absorbed; must be injected

ANATOMY OF THE URINARY TRACT

Urinary tract consists of two ureters, urinary bladder, and
urethra
•  Ureter is 25–30 cm long and empties into bladder
24.9 URINE TRANSPORT, 1. ___________ – most superficial layer; made of
STORAGE, AND ELIMINATION fibrous connective tissue
2. ___________ – middle layer; made of smooth
muscle cells that contract rhythmically (peristalsis) to
propel urine toward urinary bladder
3. ___________ – deepest layer; mucous membrane
composed of transitional epithelium
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Urinary bladder – hollow, distensible organ found on

pelvic cavity floor
•  _________ – triangular region on bladder floor; openings
of two ureters are found at each posterior corner
•  Bladder wall:
1. Adventitia – most superficial layer; made of areolar
connective tissue
2. Detrusor muscle – middle layer; squeeze bladder;
(internal urethral sphincter) is found at opening of
urethra
3. ___________ – innermost layer; made of transitional
epithelium

•  ___________ –drains urine from urinary bladder to •  Male and female urethra differ structurally and
outside of body; walls are similar to ureters functionally

§  A second external urethral sphincter is formed by §  Female – about four cm in length; opens at external
levator ani muscle – skeletal muscle of pelvic floor; urethral orifice between vagina and clitoris
allows for voluntary control of urination
§  Male – about 20 cm, consists of following three
regions:
1. ___________ urethra

2. ___________ urethra

3. ___________ (penile) urethra

ANATOMY OF THE URINARY

MICTURITION
TRACT
•  Micturition – ___________ ; discharge of urine from
urinary bladder to outside of body
•  Micturition reflex – reflex arc mediated by
parasympathetic nervous system when urine fills
bladder and stretches walls:
§  Stretch receptors send a signal to sacral region of the
spinal cord via sensory afferent fibers
§  ________________ efferent fibers stimulate detrusor
muscle to contract and internal urethral sphincter to
Figure 24.26 Comparison of urinary tract anatomy in the male and female. relax; allows for micturition
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MICTURITION
•  Micturition center – found in pons (central nervous
system); given time and training makes micturition a
voluntary process

ERIN C. AMERMAN 25.1 OVERVIEW

SANTA FE COMMUNITY COLLEGE OF FLUID, ELECTROLYTE, AND
ACID-BASE HOMEOSTASIS

INTRODUCTION TO BODY FLUIDS •  Water that is gained must equal water that is lost
•  Multiple factors impact fluid balance including:
Body fluids – blood plasma, interstitial fluid, cytosol,
cerebrospinal fluid, lymph and exocrine secretions §  Amount ingested

- Mostly water § 

•  Fluid balance –maintaining volume and concentration § 

of body’s intracellular and extracellular fluids §  Medications

§  Digestive activities
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ELECTROLYTES ACIDS, BASES, AND PH

•  Electrolytes – substances that dissociate into ions, or •  An acid is a chemical that dissociates in water to release a
charged particles ___________ (H+)

§  Electrolytes obtained from diet equals those lost §  H+ ion plays a role in: digestion of food, inactivation of
microbes and pathogens, and intracellular digestion in
§  Controlled mostly ___________ lysosomes
§  Ion concentration is dependent not only on number of
ions in a body fluid, but also on amount of water in body
•  A ___________ , or alkali, is a chemical that accepts
fluid
a hydrogen ion or releases a hydroxide ion (______)

§  Fluid balance is a critical factor that determines §  Bicarbonate and other bases are components of buffer
electrolyte balance systems

•  pH scale – used to measure hydrogen ion

concentration of a solution
§  An increase in hydrogen ion concentration results in a
solution with a lower pH
§  Solutions with a lower hydrogen ion concentration has a
higher pH 25.2 FLUID HOMEOSTASIS

pH less than 7 are ___________

pH greater than 7 are ___________
pH of 7 are ___________

FLUID COMPARTMENTS
•  Intracellular fluid (ICF); accounts for about 60% of
body’s fluids
•  Extracellular fluid (ECF) composed of a variety of
body fluids
§  ___________ – about 8% of total body water
§  ___________ – about 32% of total body water
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WATER LOSSES AND GAINS

•  Solute composition of ECF
and ICF varies •  Factors that influence water loss – majority of water
•  ___________ , chloride, lost daily is in urine via kidneys
calcium, and bicarbonate 1. Obligatory water loss – (500 ml) urine produced daily
ions are higher in ECF
irrespective of fluid intake
•  ___________ ,
magnesium, sulfate, and §  Required to prevent toxic buildup of molecules and
monohydrogen phosphate electrolyte imbalances
ions higher in cytosol

Water Gains:
2. Sensible water loss – usually about 100 ml in feces
1.  Water ingested from foods (750 ml)
(noticeable amount of water lost)
2.  Metabolic water (250 ml)
3. Insensible water loss – usually 600 ml from skin in
form of sweat and evaporation 3.  Drinking liquid (1500 ml)
300 ml lost in expired humidified air (an unnoticed
amount of daily water loss)
§  Most people lose about ___________ of water daily

Fluctuates with water intake, physical activity, and food

intake

§  Water intake driven by thirst mechanism:

1. Osmoreceptors in hypothalamus
2. Decreased plasma volume that results in a blood
pressure drop detected by baroreceptors à
Stimulates juxtaglomerular cells à
renin-angiotensin-aldosterone system à
angiotensin-II à
___________ ___________ ___________
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HORMONAL REGULATION OF
FLUID BALANCE
•  ADH (antidiuretic hormone) plays most important role in
balancing water intake with water loss, or fluid balance
§  Produced in hypothalamus and released from posterior
pituitary;
§  ______________ and ______________ reabsorb water

§  Increased ADH leads to more water reabsorption that

decreases urine volume
§  Decreased ADH leads to more water elimination that
increases urine volume

IMBALANCES OF FLUID
HOMEOSTASIS
•  ___________ – decreased volume and increased
concentration of ECF
§  Common causes include: profuse sweating, diarrhea and/
or vomiting, some endocrine conditions, and diuretic
overuse
§  Water loss decreases plasma volume and increases solute
concentration; increases osmotic pressure

•  Overhydration (hypotonic hydration) – when ECF

volume increases; decreases its osmotic pressure
§  ADH secretion is abnormal or an extreme amount of
water is consumed in a brief time period (___________
___________ )
25.3 ELECTROLYTE
§  Electrolyte imbalances, especially sodium ion
decreases (hyponatremia) result from diluted ECF HOMEOSTASIS
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SODIUM
•  Sodium ions are most abundant in ECF
•  Regulation of sodium ion concentration:
§  Angiotensin-II and aldosterone are two main hormones
that increase Na+ retention
§  ANP decreases Na+ and water reabsorption

POTASSIUM
§  Hypernatremia – elevated Na+ concentration; greater
than 145 mEq/l; commonly caused by dehydration •  Potassium ions are most abundant in ICF
•  Regulation of potassium ion concentration:
§  Hyponatremia – decreased Na+ concentration; less than §  Insulin, aldosterone, and epinephrine are hormones that
135 mEq/l; commonly caused by overhydration stimulate uptake of K+ by cells
§  Excess K+ is secreted into urine and excreted from body
(___________)

POTASSIUM
•  Hyperkalemia – high K+ in plasma
§  Potentially fatal; resting membrane potential more
positive (cells incapable of functioning)
25.4 ACID-BASE HOMEOSTASIS
•  Hypokalemia – low K+ in plasma
§  Commonly caused by diuretics that lead to excess K+
loss in urine
§  Resting membrane potential more negative (less
responsive to stimuli)
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HYDROGEN IONS AND BUFFERING ACID-BASE IMBALANCES

SYSTEMS
•  Normal H+ level in body fluids equals a pH range of •  Acidosis - body fluid pH of less than 7.35,
about 7.35–7.45 §  More H+ are added
•  pH is maintained by: §  Acidosis causes neurons to become less excitable;
§  Respiratory and urinary system using two types of leads to signs and symptoms of nervous system
buffer systems depression

1. Chemical buffer systems •  Alkalosis - body fluid pH greater than 7.45

§  more base ions are added
2. Physiological buffer systems
§  Increases excitability of neurons causing them to
fire action potentials inappropriately