CHAPTER 20: URINARY SYSTEM OBJECTIVES: 1. 2. 3. !. &. (. ). *. ,. 10. 11. 12. 13. 1!. 1&. 1(. 1). 1*.

1,. 20. Name the major function of the urinary system, and name and locate (on a diagram) the organs that compose the system. Explain what the term renal refers to. efine the term retroperitoneal. "sing a cross#section diagram of a $idney, locate the renal capsule, renal cortex, renal medulla, renal pyramids, minor calyces, major calyces, renal sinus, renal pel%is, and ureter. iscuss the many ways in which the $idney maintains the 'lood. Name the functional unit of the $idney. istinguish 'etween a renal corpuscle and renal tu'ule, and identify each component on a microscopic section of the $idney. +race a drop of 'lood from the heart through a nephron and 'ac$ to the heart. Explain -"../ the structure and the significance of the juxtaglomerular apparatus. .ist the three major steps in%ol%ed in urine formation, name the portion of the nephron where each occurs, and discuss each process fully. Explain why proteins are not filtered out of the 'lood in the glomerulus. Name the force responsi'le for glomerular filtration. -"../ discuss the negati%e feed'ac$ mechanisms in%ol%ed in the regulation of the glomerular filtration rate (1-2). Explain the process 'y which most rea'sorption occurs in the 34+, and list the su'stances that are rea'sor'ed here. Explain the significance of anti#diuretic hormone (5 6) and what it targets. .ist the wastes excreted in urine, and explain the origin of the 'y#products. Explain the structure, location, and function of the ureters and urinary 'ladder. efine the term micturition. iscuss the differences 'etween male and female urethras. +race a drop of urine from its initial collection point as the 7glomerular filtrate7.

20#1

CHAPTER 20: URINARY SYSTEM 8. INTRODUCTION +he major function of the urinary system to remove metabol ! "a#te# $rom bloo%, and direct them out of the 'ody. +he organs of the urinary system include the $idneys, ureters, urinary 'ladder, and urethra. 9ee -ig. 20.1 and -ig 20.2, page ))3. URINARY OR&ANS 5. ' %(e) *Re(al+ 1. ,o!at o(: -ig 20.1, page ))3 and -ig 20.3, page ))!. a. '. c. 2. high on posterior a'dominal wall; retroperitoneal; right $idney lies just 'elow left. <hy= -ig 20.!a, page ))&. > > > > > >

88.

Str-!t-re: a. '. c. d. e. f. g. h.

renal capsule renal cortex renal medulla renal pyramids ureter renal pel%is

tough fi'rous shell around $idney; outer portion of $idney; inner portion of $idney; cone shaped masses of tissue in renal medulla; tu'e leading from $idney; superior end of ureter which is expanded to form a funnel shape; major calyces > di%isions of renal pel%is (2#3 tu'es); minor calyces > di%isions of major calyces.

3.

.-(!t o(# o$ ' %(e): a. '. to remo%e meta'olic wastes from 'lood ? excrete them to outside (urine). @aintenance of 'lood: o regulation of 2A4 formation (hormone er)t/ro0o et (); o 'lood pressure (enByme re( (); o 'lood %olume (hormone 5 6); o 'lood composition; o 'lood p6.

20#2

CHAPTER 20: URINARY SYSTEM 88. URINARY OR&ANS 5. ' %(e) *Re(al+ !. Bloo% $lo": @acroscopic > -ig 20.&, page ))& and -ig 20.(, page ))); @icroscopic > -ig 20.10, page )),, and -ig 20.1!, page )*3; 9ummary -ig 20.1&, page )*3 5orta $idney) 8nterlo'ar arteries ('etween each pyramid) 2enal 5rtery (to each

5rcuate arteries ('etween medulla ? cortex)

8nterlo'ular arteries (within cortex)

5fferent arteriole (leading to glomerulus)

1lomerular capillaries (site of filtration)

Efferent arteriole (leading away from glom)

3eritu'ular capillariesC%asa recta (around renal tu'ule)

8nterlo'ular %eins

5rcuate %eins

8nterlo'ar %eins 88. URINARY OR&ANS

2enal %ein

8D4.

20#3

CHAPTER 20: URINARY SYSTEM 5. ' %(e) *Re(al+ &. T/e $-(!t o(al -( t o$ a 1 %(e) 2 t/e (e0/ro(. -ig 20.!c, page ))&. a. o o 9tructure: 5 nephron is composed of a renal corpuscle and a renal tu'ule. Re(al Cor0-#!le > glomerulus (filtration unit) within AowmanEs capsule. Re(al T-b-le > 1. proximal con%oluted tu'ule; 2. descending loop of 6enle; 3. ascending loop of 6enle; !. distal con%oluted tu'ule; &. collecting duct. Each collecting duct empties into a minor calyx, which leads to a major calyx and into the renal pel%is. 2efer to -ig 20.) page ))* to see a scanning electron micrograph of glomeruli within the renal tu'ules, and -ig 20.11, page )*0, illustrating light micrographs of the $idney, which you will o'ser%e in la'. (. J-3ta4lomer-lar A00arat-# *J&A+ > point of contact 'etween the afferent arteriole and distal con%oluted tu'ule ( 4+). 9ee -ig. 20.12, page )*1. a. '. c. ). Ma!-la De(#a > cells in 4+ in contact with afferent arteriole. J-3ta4lomer-lar !ell# > smooth muscle cells in afferent arteriole. +he F15 is %ery important in the regulation of glomerular filtration (see 'elow)G

Cort !al a(% J-3tame%-llar) Ne0/ro(# a. *0H of nephrons are found mostly in the cortex and are therefore termed 4ortical Nephrons '. 20H of nephrons ha%e a .oop of 6enle the extends deep into the renal medulla and are therefore termed Fuxtamedullary Nephrons o Dery important in the production of % l-te -r (e at times of dehydration as will 'e discussed later. o 9ee -igure 20.13 page )*2.

20#!

CHAPTER 20: URINARY SYSTEM 88. URINARY OR&ANS 5. ' %(e) *Re(al+ *. Ur (e .ormat o(: +he nephrons function to remo%e wastes from 'lood and regulate water ? electrolyte concentrations. "rine is the end#product of these functions. Ur (e $ormat o( (volve# t/ree ma5or #te0# (!l-% (4 4lomer-lar $ ltrat o(6 t-b-lar reab#or0t o(6 a(% t-b-lar #e!ret o(7 "rine excreted > 1lomerular -iltration I +u'ular 9ecretion J +u'ular 2ea'sorption a7 &lomer-lar . ltrat o( -ig 20.1(, page )*! and -ig 20.1), page )*&. o +he $e(e#trate% 4lomer-lar !a0 llar e# (9ee -ig 20.,, page )),) filter water ? dissol%ed materials (remem'er plasma components) from 'lood. +his 8$ ltrate8 is collected in AowmanEs 4apsule. Prote (# are (ot $ ltere% o-t o$ bloo%G

o '.

. ltrat o( Pre##-re 9ee -igure 20.1) page )*&. o -iltration is due to a force (et $ ltrat o( 0re##-re 1. outward I (0 mm6g called 4lomer-lar /)%ro#tat ! 0re##-re (1693) inside glomerular capillaries. 2. inward # 1* mm6g in AowmanKs capsule. 3. inward J 32 mm6g colloid osmotic pressure in glomerular capillaries. !. Net -iltration 3ressure > 10 mm6g outward . ltrat o( Rate o Lidneys produce (glomerular filtration rateC1-2 > ) 12& ml fluid per minute; 1. most of this is rea'sor'ed in tu'ule. 2. 9ee -ig 20.1*, page )*(. Re4-lat o( o$ &lomer-lar . ltrat o( Rate *&.R+ Normal 1-2 is approximately 12&mlCminute ()0 $g adult male, 'oth $idneys) primarily due to glomerular hydrostatic pressure (1693). 1-2 remains relati%ely constant through two mechanisms, which include: 1. 5utoregulation 'y %asomotor center in medulla 2. 2enin#angiotensin system.

c.

d.

: 88.

URINARY OR&ANS 20#&

CHAPTER 20: URINARY SYSTEM 5. ' %(e) *Re(al+ *. Ur (e .ormat o(: d. Re4-lat o( o$ &lomer-lar . ltrat o( Rate *&.R+ A-tore4-lat o( *AR+ b) Va#omotor Ce(ter 1. +he %asomotor center in the medulla regulates arteriole smooth muscle allowing for 52. 2. "nder normal conditions, the parasympathetic autonomic ner%ous system (5N9) maintains 52 through %asoconstriction of the afferent arteriole to decrease 1-2 when ele%ated or %asoconstriction of the efferent arteriole to increase 1-2 when low. 3. 52 can 'e o%erridden 'y the sympathetic 5N9 during significant %olume loss or gain. a. 5 large 'lood %olume loss, which mar$edly decreases 'lood pressure causes %asoconstriction of afferent arterioles, decreasing 1-2, which decreases urine output to conser%e water. '. 5 large 'lood %olume gain, which mar$edly increases 'lood pressure causes %asodilation of afferent arterioles, increasing 1-2, which increases urine output to eliminate the excess water.

20#(

CHAPTER 20: URINARY SYSTEM 88. URINARY OR&ANS 5. ' %(e) *Re(al+ *. Ur (e .ormat o(: d. Re4-lat o( o$ &lomer-lar . ltrat o( Rate *&.R+ Re( (9A(4 ote(# ( S)#tem 9ee -ig 20.1,, page )*). 1. 5 decrease in 'lood %olume (AD) causes a decrease in 'lood pressure (A3), which in turn decreases the glomerular hydrostatic pressure (1693) and 1-2. 2. 2eceptors in the Fuxtaglomerular 5pparatus (F15) detect this decrease: a. Aaroreceptors in the F1 cells of the afferent arteriole (55) detect a decrease in stretch and secrete the enByme re( (. '. +he macula densa cells in the distal con%oluted tu'ule ( 4+) detect a decrease in the le%els of sodium (NaI), potassium (LI), and chloride (4l#), and further stimulate the F1 cells of the 55 to secrete the enByme renin. c. 8n 'lood, renin con%erts the plasma protein, angiotensinogen to angiotensin 8. d. 3rimarily in the lungs where endothelial capillaries produce a(4 ote(# ( !o(vert (4 e(:)me *ACE+, 54E con%erts angiotensin 8 to 5ngiotensin 88 e. A(4 ote(# ( II targets four sites that wor$ together to ma (ta ( #o% -m bala(!e6 "ater bala(!e a(% bloo% 0re##-re *"/ !/ % re!tl) a$$e!t# &.R+7 +he e$$ere(t arter ole# %asoconstrict, increasing 1693, which directly increases 1-2 'ac$ to normal. +he a%re(al !orte3 secretes the hormone aldosterone, which targets the 4+, causing rea'sorption of NaI (and 620). +his increases AD, which increases A3, which increases 1693, and restores 1-2 'ac$ to normal. +he 0o#ter or 0 t- tar) gland secretes the antidiuretic hormone (5 6), which targets the 4+, causing rea'sorption 620. +his increases AD, which increases A3, which increases 1693, and restores 1-2 'ac$ to normal. +he /)0ot/alam-# triggers thirst, which increases fluid inta$e. +his increases AD, which increases A3, which increases 1693, and restores 1-2 'ac$ to normal.

88. URINARY OR&ANS

20#)

CHAPTER 20: URINARY SYSTEM 5. ' %(e) *Re(al+ *. Ur (e .ormat o(: e. T-b-lar Reab#or0t o(: o 9ee -ig 20.20, page )*).

efinition > the process 'y which su'stances are transported from the glomerular filtrate (through the walls of the renal tu'ule) to 'lood in the peritu'ular caps. @ost occurs in the 34+ through the process of a!t ve tra(#0ort; 2ea'sorption of water > osmosis. 9ee -ig 20.21, page )*,. 2ea'sor'ed su'stances pass from the lumen of the renal tu'ule through the epithelial cells (34+) and into the lumen of a peritu'ular capillary where they are returned to 'loodstream. 2ea'sor'ed su'stances include: 1. glucose 2. amino acids 3. water !. ions (sodium, chloride, phosphate, sulfate, potassium) &. others (creatine, lactic acid. citric acid, urea, uric acid, ascor'ic acid) 9u'stances that remain in filtrate 'ecome concentrated as water is rea'sor'ed.

o f.

T-b-lar #e!ret o(: 9ee -ig 20.20', page )*)7 o o efinition > the process 'y which su'stances are transported from the 'lood in the peritu'ular caps into the 4+. @aintains ion concentrations in 'lood (i.e. if the 'lood is high in LI, LI will 'e secreted into urine).

88.

URINARY OR&ANS 5. ' %(e) *Re(al+

20#*

CHAPTER 20: URINARY SYSTEM *. Ur (e .ormat o(: g. Re4-lat o( o$ -r (e !o(!e(trat o( < vol-me o +he hormone a(t 9% -ret ! /ormo(e *ADH+ promotes the rea'sorption of water through the 4+ and collecting ducts, pre%enting excessi%e amounts of water from 'eing lost in the urine. +his negati%e feed'ac$ mechanism pre%ents dehydration. Co-(ter!-rre(t Me!/a( #m J juxtamedullary nephrons acti%ely resor' Na4l in the ascending loop causing /)0erto( ! medullary interstitial fluid Co-(ter!-rre(t M-lt 0l er J descending loop loses water to /)0erto( ! medulla, further increasing tonicity of medulla Va#a re!ta ensures Na4l stays in the medulla ADH opens water channels in 4+ and 4 that allows water to 'e re#orbe% b) o#mo# #, due to the osmotic pressure set up 'y the juxtamedullary nephrons 9ee +a'le 20.3, page ),3. h. E3!ret o( o$ "a#te# ("rea ? "ric 5cid) o <astes are 'y#products of meta'olism: urea from amino acid meta'olism; uric acid from nucleotide meta'olism. <astes are rea'sor'ed 'y tu'ules, 'ut are then secreted 'ac$ into urine ? excreted.

o o o o

o i.

Ur (e Com0o# t o( o o ,&H water; other &H includes: urea, uric acid, trace amino acids, electrolytes.

88.

URINARY OR&ANS 5. ' %(e) *Re(al+ *. Ur (e .ormat o(: j. Re(al Cleara(!e 20#,

CHAPTER 20: URINARY SYSTEM o 2ate at which a particular chemical is remo%ed from the plasma 8nulin test 4reatinine clearance test "sed to calculate 1-2 and efficiency 'y comparing 'lood and urine %alues

o $.

"se +a'le 20.1, page )*! to compare the le%els of %arious su'stances present in o plasma, o glomerular filtrate, and o urine.

9"@@52/ +5A.E (Leyed at the end of this outline) @ajor 9tep in "rine -ormation

.ocation in Nephron

9u'stances +ransported and @ode of +ransport

-rom where to where= (i.e. from 'lood to glomerular filtrate) 88. URINARY OR&ANS A. Ureter# are small tu'es that carry urine from each $idney to the urinary 'ladder through peristaltic mo%ements. 1. 2& # 3, cm in length; 9ee -ig 20.1 and 20.2, page ))3. 20#10

CHAPTER 20: URINARY SYSTEM 2. 3. retroperitoneal; +hree layers: a. 8nner m-!o#a > tra(# t o(al e0 t/el -m; '. @iddle m-#!-lar # > inner circular layer of smooth muscle and outer longitudinal layer (peristalsis); c. Muter #ero#a 2 fi'rous 4+. 9ee -ig 20.2(, page ),&. 4. Ur (ar) Bla%%er 1. 2. .ocation: 9tructure: a. '. c. d. 3. . hollow, distensi'le, muscular organ; lined 'y tra(# t o(al e0 t/el -m; %etr-#or m-#!le > 3 layers of smooth muscle; co%ered 'y fi'rous 4+. 9ee -ig 20.2), page ),( and -ig 20.2*, page ),). within pel%ic ca%ity, 'ehind symphysis pu'is;

-unction: storage of urine.

+he -ret/ra is a tu'e that carries urine from the urinary 'ladder to the outside. 9ee -ig 20.30 and -ig 20.31, page ),*. 1. 2. .ength depends on sex: a. female > ! cm; '. male > 20 cm. 6istology depends on sex: a. female > 3 layers; '. males > 2 layers.

20#11

CHAPTER 20: URINARY SYSTEM 888. E,IMINATION O. URINE 5. M !t-r t o( > the process 'y which urine is expelled from urinary 'ladder to outside. 9ee +a'le 20.&, page ),,. 1. @icturition reflex center is in #a!ral spinal cord 2. 3arasympathetics cause %etr-#or m-#!le to contract in response to stretch of the urinary 'ladder. 3. External urethra sphincter (s$eletal muscle) is last NdoorwayO to pass, and therefore micturition can 'e (and usually is) inhi'ited until released 'y conscious control. A. 9tarts at glomerulus where glomerular filtrate is collected in AowmanEs capsule 34+ loop of 6enle 4+ collecting duct (urine) minor calyx major calyx renal pel%is ureter (peristalsis) urinary 'ladder (micturition) urethra outside "se this flow chart as a re%iew 'y adding $ey points where they 'elong (i.e. rea'sorption, rea'sorption of water under influence of 5 6, secretion, etc.)

20#12

8D.

,I.E SPAN CHAN&ES 5. A. 4. . E. 5s one ages, the following changes are seen in the urinary system: +he $idneys 'ecome grainy and scarred. 1-2 decreases significantly as glomeruli atrophy, fill with connecti%e tissue, or unwind. -at accumulates on the exterior of the renal tu'ules, ma$ing them asymmetric. 1. 2ea'sorption and secretion 'ecome slow or impaired. 2. +he rate of drug clearance decreases. 4ardio%ascular changes lead to decreased rates through urinary system. 1. +he $idney: a. slows in its response to changes. '. 8s less efficient at acti%ating Ditamin . Elasticity of urinary organs declines. 1. 4hanges in urination patterns result.

-.

8D.

Homeo#tat ! Imbala(!e#=D #or%er o$ t/e Ur (ar) S)#tem 1. 6. 8. F. L. .. @. N. M. 3. 6emolytic uremic anemia. 9ee introduction on page ))2. 8nherited $idney a'normalities. 9ee purple 'ox on page ))3. 4hronic 2enal -ailure. 9ee 4linical 5pplication 20.1, page ))(. 1lomerulonephritis. 9ee 4linical 5pplication 20.2, page )*0. Nephrotic 9yndrome. 9ee 4linical 5pplication 20.3, page )*,. 1out. 9ee purple 'ox on page ),3. 4ystitisC"reteritis. 9ee purple 'ox on page ),&. Lidney 9tones. 9ee purple 'ox on page ),(. Aladder 4ancer. 9ee purple 'ox on page ),(. 8ncontinence. 9ee purple 'ox on page *00.

D.

Ot/er I(tere#t (4 To0 !# Co(!er( (4 t/e Ur (ar) S)#tem 5. A. ialysis. 9ee 'lue 'ox on page ))!. "rinalysis: 4lues to 6ealth. 9ee 4linical 5pplication 20.!, page ),,.

D8. D88.

I((er!o((e!t o(# o$ t/e Ur (ar) S)#tem: 9ee page *01. Cl ( !al Term# Relate% to t/e Ur (ar) S)#tem. 9ee page *02

"rine -ormation 9"@@52/ +5A.E @ajor 9tep in "rine -ormation .ocation in Nephron glomerular filtration tu'ular rea'sorption tu'ular secretion

glomerulus

primarily through proximal con%oluted tu'ule (34+) glucose, amino acids, water, ions, creatine, lactic acid, urea, uric acid, ascor'ic acid, etc.

primarily through distal con%oluted tu'ule ( 4+) excess ions, trace amino acids, urea, uric acid

9u'stances +ransported and @ode of +ransport

5ll plasma constituents except proteins (i.e. glucose, amino acids, water, ions, creatine, lactic acid, urea, uric aid, ascor'ic acid, etc)

-rom where to where= (i.e. from 'lood to glomerular filtrate)

from 'lood in glomerulus to NfiltrateO in AowmanKs capsule

from NfiltrateO in 34+ to 'lood in peritu'ular capillaries

from 'lood in peritu'ular capillaries to NurineO in 4+