Chapter 26: Introduction to the

Urinary System

Copyright 2009, John Wiley & Sons, Inc.

Overview of kidney functions
 Regulation of blood ionic composition
 Regulation of blood pH
 Regulation of blood volume
 Regulation of blood pressure
 Maintenance of blood osmolarity
 Production of hormones (erythropoietin)
 Regulation of blood glucose level
 Excretion of wastes from metabolic reactions and
foreign substances (drugs or toxins)

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Gross anatomy of the urinary system

1. Left and right Kidneys

2. Left and right Ureter
3. Bladder
4. Urethra

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Gross anatomy of the kidney

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External anatomy of the kidney
 Renal hilium – indent where ureter emerges along
with blood vessels, lymphatic vessels and nerves
 Surrounded by layers of adipose tissue and fat
that protect it and from external trauma 3

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Internal anatomy of the kidneys
Superficial - Renal cortex ; inner region – renal medulla

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Blood and nerve supply of the
kidneys
 kidneys are 0.5% of total body mass BUT they receive
20-25% of resting cardiac output
 Left and right renal artery enters kidney
 Each nephron receives one afferent arteriole which divides into a
capillary ‘ball’ called a glomerulus which then forms the efferent
arteriole (!)
 Divide to form peritubular capillaries, peritubular venule,
interlobar vein and renal vein exits kidney

 Renal nerves are part of the sympathetic autonomic nervous

system
 Most are vasomotor nerves regulating blood flow

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Blood supply of the kidneys

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Anatomy of the kidneys

 Nephron = microscopic functional units of kidney

involved in urine formation
 Urine formed by nephron drains into
 Renal pelvis
 Ureter
 Urinary bladder

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 Structures and functions of a nephron
Renal corpuscle Renal tubule and collecting duct

Afferent Glomerular
arteriole capsule

Fluid in Urine
1 Filtration from blood renal tubule (contains
plasma into nephron excreted
substances)
2 Tubular reabsorption 3 Tubular secretion
Efferent from fluid into blood from blood into fluid
arteriole

Blood
(contains
reabsorbed
Peritubular capillaries substances)

Copyright 2009, John Wiley & Sons, Inc.

The nephron – functional unit of
kidney
 2 parts
 Renal corpuscle – filters blood plasma to
produce fluid
 Glomerulus – capillary network
 Glomerular (Bowman’s) capsule – double-walled
cup surrounding glomerulus

 Filtered fluid passes into renal tubule and then

into collecting duct

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The structure of nephrons and associated
blood vessels

Copyright 2009, John Wiley & Sons, Inc.

Overview of renal physiology
1. Glomerular filtration
 Water and most solutes in blood plasma move across the wall of the
glomerular capillaries into glomerular capsule and then renal tubule
2. Tubular reabsorption
 As filtered fluid moves along tubule and through collecting duct,
about 99% of water and many useful solutes reabsorbed – returned
to blood
3. Tubular secretion
 As filtered fluid moves along tubule and through collecting duct,
other material secreted into fluid such as wastes, drugs, and excess
ions – removes substances from blood

 Solutes in the fluid that drains into the renal pelvis remain in the
fluid and are excreted

 Excretion of any solute = glomerular filtration + secretion - reabsorption

Copyright 2009, John Wiley & Sons, Inc.

 Structures and functions of a nephron
Renal corpuscle Renal tubule and collecting duct

Afferent Glomerular
arteriole capsule

Fluid in Urine
1 Filtration from blood renal tubule (contains
plasma into nephron excreted
substances)
2 Tubular reabsorption 3 Tubular secretion
Efferent from fluid into blood from blood into fluid
arteriole

Blood
(contains
reabsorbed
Peritubular capillaries substances)

Copyright 2009, John Wiley & Sons, Inc.

Copyright 2009, John Wiley & Sons, Inc.
Glomerular filtration rate
 Glomerular filtration rate (GFR) – amount of
filtrate formed in all the renal corpuscles of both
kidneys each minute - needs to be maintained
constant (homeostasis)
 Too high – substances pass too quickly and
are not reabsorbed
 Too low – nearly all reabsorbed and some
waste products not adequately excreted

Copyright 2009, John Wiley & Sons, Inc.

Glomerular filtration rate
GFR can be increased or decreased by increasing
(vasodilatation) or decreasing (vasoconstriction) the blood
flow in the afferent arteriole. This can be regulated by

1. Sympathetic NS activation – decreases GFR

2. Hormonal regulation
 Angiotensin II (circulating) reduces GFR
 Atrial natriuretic peptide (from heart) increases GFR

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Tubular reabsorption and tubular
secretion
 Reabsorption – return of most of the filtered
water and many solutes to the bloodstream
 About 99% of filtered water reabsorbed
 Both active and passive processes
 Secretion – transfer of material from blood
into tubular fluid
 Helps control blood pH
 Helps eliminate substances from the body

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Hormonal regulation of tubular reabsorption
and secretion
When blood volume and blood pressure decrease, Angiotension II
and aldosterone (from adrenal gland) stimulate increased
reabsorption of salt and water in the renal tubule. These help to
support blood pressure and volume.

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Summary of regulation of Sodium and
Water Balance
Three major hormones are involved in regulating sodium and water
balance in the body at the level of the kidney.

1.ADH (antidiuretic hormone) from the posterior pituitary acts on the

kidney to promote water reabsorption, thus preventing its loss in the urine.

2.Aldosterone from the adrenal gland acts on the kidney to promote

sodium reabsorption, thus preventing its loss in the urine.

3.ANH (atrial natriuretic hormone) from the atrium of the heart acts on the
kidney to promote sodium excretion so that it is excreted in the urine

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Production of dilute and concentrated
urine
 Even though your fluid intake can be highly
variable, total fluid volume in your body
remains stable
 Depends in large part on the kidneys to
regulate the rate of water loss in urine
 ADH controls whether dilute or concentrated
urine is formed
 Absent or low ADH = dilute urine
 Higher levels = more concentrated urine through
increased water reabsorption

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Evaluation of kidney function

 Urinalysis
 Analysis of the volume and physical, chemical
and microscopic properties of urine
 Water accounts for 95% of total urine volume
 Typical solutes are filtered and secreted
substances that are not reabsorbed
 If disease alters metabolism or kidney function,
traces of substances normally not present or
normal constituents in abnormal amounts may
appear

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Evaluation of kidney function
 Blood tests
 Blood urea nitrogen (BUN) – measures blood nitrogen that
is part of the urea resulting from catabolism and
deamination of amino acids
 Plasma creatinine results from catabolism of creatine
phosphate in skeletal muscle and it is removed from the
body only by the kidneys– measure of renal function
 Renal plasma clearance
 More useful in diagnosis of kidney problems than above
 Volume of blood cleared of a substance per unit time
 High renal plasma clearance indicates efficient excretion of
a substance into urine

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Urine transportation, storage, and
elimination
 Ureters
 Each of 2 ureters transports urine from renal
pelvis of one kidney to the bladder
 Peristaltic waves, hydrostatic pressure and gravity
move urine
 No anatomical valve at the opening of the ureter
into bladder – when bladder fills it compresses the
opening and prevents backflow

Copyright 2009, John Wiley & Sons, Inc.

Ureters, urinary bladder, and urethra in a
female The bladder is a
stretchy
muscular bag
that collects and
stores urine.

It is located in the
pelvis at the
lowest point in
the abdomen,
immediately
behind the pubic
bone

Copyright 2009, John Wiley & Sons, Inc.

 Urinary bladder and urethra
 Urinary bladder
 Hollow, distensible muscular organ; Capacity 700-800mL
 Micturition – discharge of urine from bladder
 Combination of voluntary and involuntary muscle contractions
 When volume increases stretch receptors send signals to
micturition center in spinal cord triggering spinal reflex – micturition
reflex. In early childhood we learn to initiate and stop it voluntarily
 Urethra
 Small tube leading from internal urethral orifice in floor of bladder to
exterior of the body

Copyright 2009, John Wiley & Sons, Inc.

Urinary Incontinence

 Urinary incontinence is the unintentional passing of

urine. It is a very common problem that is thought to
affect about three million people in the UK.
 Anyone can experience urinary incontinence, although it
is more common in older people. The condition affects
far more women than men, and it is thought to occur in

one in five women who are over 40 years of age.

Copyright 2009, John Wiley & Sons, Inc.

Types of Urinary Incontinence
 Two main types
 Stress incontinence occurs when the pelvic floor muscles are
too weak to prevent urination.
 Urge incontinence is thought to occur as a result of incorrect
signals being sent between the brain and the bladder.

 These two types of urinary incontinence are responsible

for 90% of all cases of the condition. It is also possible to
have a mixture of both types.

Copyright 2009, John Wiley & Sons, Inc.

Symptoms of Stress Incontinence
 Most common type particularly among women who have
had children or been through the menopause.
 Not related to feeling stressed
 Occurs when your bladder is put under an extra amount
of sudden pressure.
 Symptoms include urine leakage during physical
activities such as: Coughing, Sneezing, Laughing, Heavy
lifting, Exercise.
 The amount of urine that is passed is usually small, but
stress incontinence can also cause you to pass larger
amounts, particularly if your bladder is very full.

Copyright 2009, John Wiley & Sons, Inc.

Symptoms of Urge Incontinence
 It is the second most common type of urinary incontinence.
 Urge incontinence is where you have an unstable, or overactive bladder.  
 Symptoms include: sudden and very intense need to pass urine before
quickly releasing large amounts of urine. There is often only a few
seconds between the need to urinate and the release of urine.
 Your need to pass urine may be triggered by a sudden change of
position, or even by the sound of running water.
 If you have urge incontinence you may need to pass urine very
frequently. You may need to get up several times during the night.

Copyright 2009, John Wiley & Sons, Inc.

Treatment of Incontinence
 Depend on the type of incontinence you have and the severity of your symptoms.
 If caused by an underlying condition, such as an enlarged prostate gland (in
men), you will receive treatment for this first.

Lifestyle changes
 Your GP may suggest that you make some simple changes to your lifestyle in

order to reduce your incontinence. These changes can help improve your
condition regardless of the type of urinary incontinence that you have.
 For example, your GP may recommend:

 Reducing your caffeine intake.

 Changing the amount you drink, that is reducing it if it is too much, or
increasing it if it is too little.
 Losing weight if you are overweight or obese.

Copyright 2009, John Wiley & Sons, Inc.

Treatment of Incontinence
 Initial treatment for stress incontinence involves making
simple lifestyle changes, such as those described above,
and doing exercises in order to strengthen your pelvic
floor muscles.

 If lifestyle changes and pelvic floor exercises prove to be

unsuccessful in treating your stress incontinence,
surgery may be recommended.

Copyright 2009, John Wiley & Sons, Inc.

End of Chapter 26
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