URINARY SYSTEM ➢ Renal pyramids - The medulla has many

basically triangular regions with a striped

appearance, the renal, or medullary pyramids; the
Functions of the Respiratory System broader base of each pyramid faces toward the
cortex while its tip, the apex, points toward the
1. Filter inner region of the kidney.
2. Waste processing
➢ Renal columns - The pyramids are separated
3. Elimination by extensions of cortex-like tissue, the renal
columns.
4. Regulation
➢ Renal pelvis - Medial to the hilum is a flat,
5. Other regulatory functions
basin like cavity, the renal pelvis, which is
6. Conversion continuous with the ureter leaving the hilum.

➢ Calyces - Extensions of the pelvis, calyces,

form cup-shaped areas that enclose the tips of the
❑ THE KIDNEYS
pyramid and collect urine, which continuously
➢ Location - These small, dark red organs with drains from the tips of the pyramids into the renal
a kidney-bean shape lie against the dorsal body pelvis.
wall in a retroperitoneal position (beneath the
➢ Renal artery - The arterial supply of each
parietal peritoneum) in the superior lumbar
kidney is the renal artery, which divides into
region; they extend from the T12 to the L3
segmental arteries as it approaches the hilum, and
vertebra; thus they receive protection from the
each segmental artery gives off several branches
lower part of the rib cage.
called interlobar arteries.
➢ Positioning - Because it is crowded by the
➢ Arcuate arteries - At the cortex-medulla
liver, the right kidney is positioned slightly lower
junction, interlobar arteries give off arcuate
than the left.
arteries, which curve over the medullary
➢ Size - An adult kidney is about12 cm (5 pyramids.
inches) long,6 cm (2.5 inches) wide, and3 cm(1
➢ Cortical radiate arteries - Small cortical
inch) thick, about the size of a large bar of soap.
radiate arteries then branch off the arcuate
➢ Adrenal gland – A top each kidney is an arteries and run outward to supply the cortical
adrenal gland, which is part of the endocrine tissue.
system is a distinctly separate organ functionally.

➢ Fibrous capsule - A transparent fibrous ❑ NEPHRONS

capsule encloses each kidney and gives a fresh
kidney a glistening appearance. ➢ Nephrons - Each kidney contains over a
million tiny structures called nephrons, and they
➢ Perirenal fat capsule - A fatty mass, the
are responsible for forming urine.
perirenal fat capsule, surrounds each kidney and
acts to cushion it against blows. ➢ Glomerulus - One of the main structures of a
nephron, a glomerulus is a knot of capillaries.
➢ Renal fascia - The renal fascia, the outer most
capsule anchors the kidney and helps hold it in ➢ Renal tubule - Another one of the main
place against the muscles of the trunk wall. structures in a nephron is the renal tubule.
➢ Renal cortex – The outer region, which is ➢ Bowman’s capsule - The closed end of the
light in color, is the renal cortex. renal tubule is enlarged and cup-shaped and
completely surrounds the glomerulus, and it is
➢ Renal medulla - Deep to the cortex is a
called the glomerular or Bowman’s capsule.
darker, reddish-brown area, the renal medulla.
➢ Podocytes - The inner layer of the capsule is ➢ Location - Each ureter runs behind the
made up of highly modified octopus-like cells peritoneum from the renal hilum to the posterior
called podocytes. aspect of the bladder, which it enters at a slight
angle.
➢ Foot processes - Podocytes have long
branching processes called foot processes that ➢ Function - Essentially, the ureters are
intertwine with one another and cling to the passageways that carry urine from the kidneys to
glomerulus. the bladder through contraction of the smooth
muscle layers in their walls that propel urine into
➢ Collecting duct - As the tubule extends from the bladder by peristalsis and is prevented from
the glomerular capsule, it coils and twists before flowing back by small valve-like folds of bladder
forming a hairpin loop and then again becomes mucosa that flap over the ureter openings.
coiled and twisted before entering a collecting
tubule called the collecting duct, which receives
urine from many nephrons.
❑ URINARY BLADDER
➢ Proximal convoluted tubule - This is the part
➢ Location - It is located retroperitoneally in the
of the tubule that is near to the glomerular
pelvis just posterior to the symphysis pubis.
capsule.
➢ Function - The detrusor muscles and the
➢ Loop of Henle - The loop of Henle is the
transitional epithelium both make the bladder
hairpin loop following the proximal convoluted
uniquely suited for its function of urine storage.
tubule.
➢ Trigone - The smooth triangular region of the
➢ Distal convoluted tubule - After the loop of
bladder base outlined by these three openings is
Henle, the tubule continues to coil and twist
called the trigone, where infections tend to
before the collecting duct, and this part is called
persist.
the distal convoluted tubule.
➢ Detrusor muscles - The bladder wall contains
➢ Cortical nephrons - Most nephrons are called
three layers of smooth muscle, collectively called
cortical nephrons because they are located almost
the detrusor muscle, and its mucosa is a special
entirely within the cortex.
type of epithelium, transitional epithelium.
➢ Juxtamedullary nephrons - In a few cases,
the nephrons are called juxtamedullary nephrons
because they are situated next to the cortex- ❑ URETHRA
medullary junction, and their loops of Henle dip
deep into the medulla. ➢ Internal urethral sphincter - At the bladder-
urethral junction, a thickening of the smooth
➢ Afferent arteriole - The afferent arteriole, muscle forms the internal urethral sphincter, an
which arises from a cortical radiate artery, is the involuntary sphincter that keeps the urethra
“feeder vessel”. closed when the urine is not being passed.
➢ Efferent arteriole - The efferent arteriole ➢ External urethral sphincter - A second
receives blood that has passed through the sphincter, the external urethral sphincter, is
glomerulus. fashioned by skeletal muscle as the urethra
passes through the pelvic floor and is voluntarily
➢ Peritubular capillaries - They arise from the
controlled.
efferent arteriole that drains the glomerulus.
➢ Female urethra - The female urethra is about
3 to 4 cm (1 1/2 inches) long, and its external
❑ URETERS orifice, or opening, lies anteriorly to the vaginal
opening.
➢ Size - The ureters are two slender tubes each
25 to 30 cm (10 to 12 inches) long and 6 mm (1/4
inch) in diameter.
➢ Male urethra - In me, the urethra is ❖ Solutes - Solutes normally found in urine
approximately20 cm (8 inches) long and has include sodium and potassium ions, urea, uric
three named regions: the prostatic, membranous, acid, creatinine, ammonia, bicarbonate ions, and
and spongy (penile)urethrae; it opens at the tip of various other ions.
the penis after traveling down its length.

❑ MICTURITION
PHYSIOLOGY OF THE URINARY
SYSTEM Micturition or voiding is the act of emptying the
bladder.
❑ URINE FORMATION
❖ Accumulation - Ordinarily, the bladder
Urine formation is a result of three processes: continues to collect urine until about 200 ml have
accumulated.
❖ Glomerular filtration - Water and solutes
smaller than proteins are forced through the ❖ Activation - At about this point, stretching of
capillary walls and pores of the glomerular the bladder wall activates stretch receptors.
capsule into the renal tubule.
❖ Transmission - Impulses transmitted to the
❖ Tubular reabsorption - Water, glucose, sacral region of the spinal cord and then back to
amino acids, and needed ions are transported out the bladder via the pelvic splanchnic nerves
of the filtrate into the tubule cells and then enter cause the bladder to go into reflex contractions.
the capillary blood.
❖ Passage - As the contractions become
❖ Tubular secretion - Hydrogen, potassium, stronger, stored urine is forced past the internal
creatinine, and drugs are removed from the urethral sphincter into the upper part of the
peritubular blood and secreted by the tubule cells urethra.
into the filtrate.
❖ External sphincter - Because the lower
external sphincter is skeletal muscle and
❑ CHARACTERISTICS OF URINE voluntarily controlled, we can choose to keep it
closed or it can be relaxed so that urine is flushed
In 24 hours, the marvelously complex kidneys from the body.
filter some 150 to 180 liters of blood plasma
through their glomeruli into the tubules.
PATHOPHYSIOLOGY OF THE URINARY
❖ Daily volume - In 24 hours, only about1.0 to
SYSTEM
1.8 liters of urine are produced.
An abnormally low urinary output:
❖ Components - Urine contains nitrogenous
wastes and unneeded substances. • Oliguria - if it is between 100 and 400
ml/day.
❖ Color - Freshly voided urine is generally clear • Anuria - it is less than 100 ml/day.
and pale to deep yellow.

❖ Odor - When formed, urine is sterile and

slightly aromatic, but if allowed to stand, it takes * Low urinary output usually indicates that
on an ammonia odor caused by the action of glomerular blood pressure is too low to cause
bacteria on the urine solutes. filtration, but anuria may also result from
transfusion reactions and acute inflammation or
❖ pH - Urine pH is usually slightly acidic from crushing injuries to the kidneys.
(around 6), but changes in body metabolism and
Renal calculi or kidney stones- When urine
certain foods may cause it to be much more acidic
becomes extremely concentrated, solutes such as
or basic.
uric acid salts form crystals that precipitate in the
❖ Specific gravity - Whereas the specific renal pelvis.
gravity of pure water is 1.0, the specific gravity
of urine usually ranges from1.001 to 1.035
Urethritis - inflammation of the urethra - In the rarer, infantile form of the disease, the
kidney has blind pouches into which the filtrate
Cystitis - bladder inflammation
flows, totally blocking drainage. The disease
Pyelonephritis - kidney inflammation progresses rapidly, resulting in death by 2 years
of age.
Hypospadias - condition found in male babies
* Symptoms of urinary tract infection (UTI) only - occurs when the urethral orifice is located
include dysuria (painful urination), urinary on the ventral surface of the penis. Corrective
urgency and frequency, fever, and sometimes surgery is generally done when the child is
cloudy or blood-tinged urine. When the kidneys around 12 months old.
are involved, back pain and a severe headache are
common.
INTRODUCTION TO URINALYSIS

Incontinence - occurs when a person is unable to

voluntarily control the external sphincter.
A urinalysis, or urine test, is a common
* It may also occur in older children who sleep medical test in which the urine is examined to
so soundly that they are not awakened by the diagnose and monitor various illnesses.
stimulus. However, after the toddler years,
• During a urinalysis, a clean urine sample is
incontinence is usually a result of emotional
collected into a specimen cup and analyzed with
problems, pressure (as in pregnancy), or nervous
a visual exam, a dipstick test, and a microscopic
system problems (stroke or spinal cord injury).
exam. The presence of cells, bacteria, and other
chemicals is detected and measured in a
urinalysis.
Urinary retention - bladder is unable to expel its
contained urine- opposite of incontinence.
Various causes for urinary retention. Urinalysis are useful because they can often
detect medical problems before additional
- occurs after surgery in which general anesthesia symptoms arise. They are most often performed
has been given, because it takes a little time for to monitor overall health, to diagnose a medical
the smooth muscles to regain their activity. problem, or to monitor a medical condition,
- occurring primarily in older men, is including:
enlargement, or hyperplasia, of the prostate, • Urinary tract infections
which surrounds the neck of the bladder.
• Diabetes
When urinary retention is prolonged, a slender
flexible drainage tube called a catheter must be • Kidney problems
inserted through the urethra to drain the urine and
• Liver problems
prevent bladder trauma from excessive
stretching. • Pregnancy

Adult polycystic kidney disease- degenerative

condition that appears to run in families. One or Why Is a Urinalysis Conducted?
both kidneys enlarge, sometimes to the size of a
Urinalyses are typically conducted when
football, and have many blister-like sacs (cysts) someone is admitted to the hospital or before
containing urine. These cysts interfere with renal they have surgery. Your doctor may also order
function by obstructing but initially not stopping a urinalysis if you experience symptoms such
urine drainage. Currently, little can be done for as:
this condition except to prevent further kidney • Blood in urine
damage by avoiding infection. • Back or abdominal pain
• Painful urination
- Renal failure is the eventual outcome, but • Frequent urination
kidney transplants improve chances for survival. • Cloudy urine
 Ketones in urine - emerge when the body
How Is a Urine Sample Collected for a begins to break down fat as a source of energy.
Urinalysis?
Ketones may be a sign of uncontrolled diabetes,
alcohol abuse, or a condition known as diabetic
• Clean the urinary opening with a sterile wipe
to remove bacteria. Men should wipe the tip of ketoacidosis
the penis. Women can clean their labia from Glucose (sugar) in urine - can indicate
front to back. diabetes or high blood sugar.
• Start to urinate into the toilet. Do not collect
the initial urine stream. Bilirubin in urine - is a type of waste
• In midstream, begin to collect urine into the produced when old red blood cells break down.
sample container. Bilirubin can indicate liver disease.
• Make sure that you collect at least 1 to 2
ounces.
• Finish urinating in the toilet.
Microscopic Exam: What Test Results Can
Reveal
What Does a Urinalysis Measure, and What Before examining under a microscope,
Do the Results Mean? technicians spin the urine in a centrifuge in order
to concentrate the solid particles and make them
A typical urinalysis involves a visual exam, a easy to examine. A microscopic examination
dipstick test, and a microscopic exam. might reveal the following:
Visual Exam - For the visual exam, the urine • White blood cells may indicate infection or
will be examined for its color and clarity. Dark inflammation.
urine, abnormal colors, blood in urine, cloudy
urine, or foamy urine can indicate kidney • Red blood cell may indicate kidney disease, a
problems, dehydration , or other medical blood disorder, or bladder cancer
problems. Normal urine should range in color • Bacteria can indicate infection
from clear to dark yellow.
• Skin cells can indicate infection or kidney
disease.
• Crystals may be a sign of kidney stones
DIPSTICK TEST
• Casts, or tube-shaped proteins, may be a sign
Chemical testing usually involves inserting a thin of a kidney disorder.
strip of plastic known as a dipstick into the urine
• Parasites can indicate parasitic disease in
sample. Chemicals on the stick react with urine
various parts of the body.
and change color to measure the following:
Urine acidity (pH) level may indicate kidney
stones or urinary infections. The level of acidity Sometimes a healthcare provider will also order
can be affected by diet, chemical imbalances, and a urine culture to be performed with a urinalysis.
certain metabolic disorders. A urine culture is used to grow bacteria found in
the urine sample to diagnose an infection.
Concentration - is a measure of the
concentration of various molecules in urine. It usually takes several hours to get the results of
Highly concentrated urine can be a sign of a urinalysis test, and one to three days for a urine
dehydration. culture to be complete.
Nitrites in urine - can indicate a bacterial
infection such as a urinary tract infection.
Proteins in urine - can indicate kidney disease
or kidney damage. They may also be present in
urine after strenuous exercise and when
dehydrated.