Urinary System

Chapter 15

URINARY SYSTEM

Ureters
Slender tubes that extend behind the peritoneum from the hilus of the kidney to enter the bladder Transport urine to the bladder by peristaltic waves of smooth muscle The ureterovesicular junction prevents backflow of urine

Bladder
Smooth, collapsible, muscular sac located retroperitoneally in the pelvis that has openings to the ureters and urethra Serves as a reservoir for urine until it is excreted from the body

Urethra
Extends from the base of the bladder to the urinary meatus Approximately 18 cm long in males and 4 cm long in females Carries urine by peristalsis from the bladder to the outside of the body

Urinary meatus

External opening of the urethra

Urine formation
Result of 3 processes: Filtration, reabsorption and secretion
Glomerulus filters the blood which results in a filtrate that includes waste products and useful substances such as water, glucose, ions, and amino acids The useful substances in the filtrate are reabsorbed into the blood by the proximal and distal convoluted tubules

Urine formation
Tubular secretion is reabsorption in reverse. The waste products are secreted into the filtrate in the tubules and excreted in the urine

Micturition
Voiding Under voluntary and involuntary control The urge to void normally occurs when 150 to 300 ml urine has accumulated The bladder normally contains no urine after voiding

KIDNEYS

Kidneys
Paired organs located on either side of the vertebral column Between the 12th thoracic and 3rd lumbar vertebrae in the posterior abdomen behind the peritoneum Weighs about125 g 12.5 cm (5 inches) long 7.5 cm (3 inches) wide 2.5 cm (1 inch ) thick

External structures of the kidney

Hilum

Medial border of the kidney is indented by the hilum Area where nerves, blood vessels, and the ureter enter the kidney Gives the kidney its bean shaped appearance

Renal capsule
Fibrous, transparent outer covering of the kidneys (except hilum) Gives the kidney a glistening appearance A layer of adipose tissue surrounds the kidney

Internal structures of the kidney

Cortex

Outer portion containing the glomerules, tubules, and part of the loop of henle

Medulla

Middle portion containing the Loop of Henle and the collecting ducts
Renal pyramids
Collecting ducts with bases on the border between the cortex and medulla Separated by renal columns which are extensions of the cortex tissue

Papillae
Apices of pyramids, which extend toward the renal pelvis Urine travels through the papillae to the renal pelvis

Renal Pelvis

Inner portion where urine is collected

Narrowed portion becomes the proximal aspect of the ureter as it approaches the hilum Minor and major calyces are recesses of the pelvis that receive urine from papillae of the collecting ducts

Nephron
Functional unit of the kidney Contains the glomerulus, tubules and collecting ducts

Nephron

Glomerulus
Beginning of the nephron Tuft of capillaries supplied by afferent arterioles and drained by efferent arterioles within the Bowman capsule

Nephron

Proximal tubule
Is the convoluted portion with a border of microvilli lining the lumen

Nephron

Loop of Henle
2 major portions: Descending and ascending limbs The descending loop narrows as it dips from the cortex to the medulla

Nephron

Distal tubule
Passes between afferent and efferent arterioles of glomerulus as it moves back into the cortex

Nephron

Collecting duct
Passes through the cortex and medulla receiving the terminal end of several nephrons

Renal circulation
The renal artery branches from the abdominal aorta Subdivisions of interlobular arteries carry blood into the corticomedullary zone Arcuate arteries form arches around bases of pyramids Interlobular arteries, subdivisions of the arcuate arteries, supply the renal capsule

Neurologic control

Renal innervation is supplied through sympathetic and parasympathetic nerves. Adrenergic fibers also are in proximity to juxtaglumerular apparatus

Overall functions of the renal system

Blood pressure regulation by renin secretion RBC production by erythropoietin secretion Metabolism of vitamin D

Major functions

Glomerulus
Filtration

Proximal tubule

65% Na+ and H20 reabsorbed (ADH not required) Glucose, K+, amino acids reabsorbed HC03- reabsorbed H+ secreted Urea reabsorbed Filtrate leaves isotonic

Major functions

Loop of Henle
Countercurrent multiplying and exchange mechanisms established between long, thin loops of Henle of juxtamedullary nephrons and adjacent vasa recta Filtrate leaves hypotonic

Major functions

Distal tubule
Na reabsorbed and K secreted in presence of aldosterone opposite occurs in absence of aldosterone Water reabsorbed with Na, ADH also influences water reabsorption Filtrate leaves hypotonic or isotonic

Major functions

Collecting duct
Na and K regulated by aldosterone Acid base regulation H- secretion HCo3 reabsorption ADH determines final urine volume

Fig. 18.6

LAB AND DIAGNOSTICS

Lab and Diagnostics

Urinalysis
Involves assessment of urine color, opacity, odor, specific gravity, osmolality and pH Identifies presence of glucose, ketones, proteins, RBC WBC, sediments, bacteria

Urine C/S
Requires midstream clean catch urine specimen, detects infective microorganisms

Lab and Diagnostics

Blood analysis
Plasma creatinine
Indication for renal function

BUN
Analysis evaluates renal function Blood urea nitrogen

Lab and Diagnostics

Creatinine clearance
Evaluates glomerular filtration rate GFR Creatinine clearance increases as renal function diminishes

Intravenous and Retrograde Pyelography

Provide info re: size, shape, position of urinary tract structures

DISORDERS

d/o

Urinary retention
Urine retained in the bladder

Urinary incontinence
Inability of the urinary sphincters to control release of urine

Neurogenic Bladder dysfunction

Dysuncton of the bladder

d/o

UTI
Inflammation and infection of the the urinary tract structures Upper uti
Pyelonephritis (kidney)

Lower uti
Ureteritis Cystitis urethritis

d/o

Urolithiasis
Renal calculi Calculi in the bladder, ureter, or kidney

Acute Renal Failure /ARF

Sudden, rapid, potenstially reversible deterioration of renal function

Chronic Renal Failure /CRF

End result of progressive irreversible loss of functioning renal tissue