URINARY SYSTEM

Introduction
• Group of organs that performs the function of excretion of metabolic waste from the
body.
– Skin
– Lungs
– Large intestine
• The urinary system, also known as the renal system, produces, stores and eliminates
urine, the fluid waste excreted by the kidneys.
• The kidneys make urine by filtering wastes and extra water from blood.
• Urine travels from the kidneys through two thin tubes called ureters and fills the
bladder. When the bladder is full, a person urinates through the urethra to eliminate the
waste.
 Functions of the renal system.
• Functions of the Renal System
• Excretion & Elimination:
• Removal of organic waste products from body fluids (Urea, Creatinine, Uric Acid)
• Homeostatic Regulation:
Water – Salt Balance
Acid – Base Balance
• Endocrine function like Hormones Secretion
• Erythropoietin - Production of red blood cells
• Calcitriol - Regulates calcium in the body
• Enzymes :
• Rennin - regulates the body's water balance and blood pressure level
 Locations of Kidneys
• The kidneys are bean-shaped organs
• the kidneys are located in the abdominal cavity one on each side of the spine and
lie in a retroperitoneal position at a slightly oblique angle
• The right kidney is slightly lower than the left because of the position of the Liver
in the abdominal cavity.
• On top of each kidney is an adrenal gland.
• The upper parts of the kidneys are partially protected by the 11th and 12th ribs.
• Kidneys are attached to ureters, renal blood vessels, and nerves at renal hilus.
 Regions of Kidney
• Renal cortex: The renal cortex is the outer part of the kidney and has a reddish color. It
contains about one million blood filtering nephrons.
• Renal medulla – The renal medulla is the inner part of the kidney. " colour. Medulla" means
"inner portion". This area is a striated (striped) red-brown colour.
• Renal Pyramid: It is triangular structures that are found within the medulla. Some 10-25
openings of papillary ducts occur on its tip called papilla.
• Calyces – cup-shaped structures that funnel urine towards the renal pelvis.
• There are:
– major Calyx
– minor calyx
• The minor calyces are a funnel shaped structure that surrounds the tip of each pyramid. The
minor calyces integrate to constitute the major calyces.
• The renal pelvis is the large collecting funnel that is formed by a bunch of major calyces.
 Anatomy
• Renal columns – extensions of cortex-like material
inward
• The renal capsule – This is a tough fibrous layer
surrounding the kidney and covered in a layer of
perirenal fat known as the adipose capsule of kidney. It
provides some protection from trauma and damage.
• Renal Hilum: The hilum is the concave part of the bean-
shape where blood vessels (Artery and vein )and nerves
enter and exit the kidney; it is also the point of exit for the
Ureters. The urine-bearing tubes that exit the kidney and
empty into the urinary bladder.
• Renal Artery- Renal arteries carry blood from the heart
to the kidneys. They branch directly from the aorta (the
main artery coming off the heart) on either side and
extend to each kidney. These arteries take a very large
volume of blood to the kidneys to be filtered.
• Aorta- The aorta is the main artery that carries blood
away from your heart to the rest of your body.
• Renal Vein- They connect the kidney to the inferior vena
cava. They carry the blood filtered by the kidney.
• The inferior vena cava (or IVC) is a large vein that
carries the deoxygenated blood from the lower and
middle body into the right atrium of the heart.
 Nephrons
• It is found in the cortex region
• Functional unit of the kidney
• It is responsible for forming urine
• It remove waste and excess substances from the blood.
• There are about 1 million units in each kidney.
• Main structures of the nephrons
• Glomerulus
• Renal tubule

Glomerulus- Blind , cup-shaped and Cluster/ball of capillaries, with the filtering

membrane forms Bowman’s capsule. The glomerulus sits within a glomerular
capsule (the first part of the renal tubule). The normal Glomerular Filtration Rate
is 90-120mL/min
 Renal Tubule

• Proximal convoluted tubule (PCT)- composed of cuboid cells with numerous microvilli.
Effective reabsorption of sodium takes place
• Loop of Henle –Descending and ascending - a heparin-shaped loop of the renal tubule.
The principal function of the loop of Henle appears to be the recovery of water and sodium
chloride from the urine

• Distal convoluted tubule (DCT) - reabsorption of sodium ions and water into blood vessels
.only urea and some waste is excreted.
• And this leads to collecting duct - Collecting duct is a long, straight tube where H+ and
K+ ions are secreted to maintain the electrolyte balance of the blood. This is also the region
where the maximum reabsorption of water takes place to produce concentrated urine
 Ureters
• 2 tubes, 15-18 inches long
• 1⁄2 inch diameter
• Ureteral orifice (at bladder), prevents reflux of urine in ureters and the renal pelvis
• Carry urine from renal pelvis to bladder
• Muscles in the ureter walls tighten and relax to force urine down and away from
the kidneys
• Small amounts of urine flow from the ureters into the bladder about every 10 to 15
seconds
 Bladder

• The urinary bladder is a muscular sac in the pelvis, just above and behind the
pubic bone. When empty, the bladder is about the size and shape of a pear.
• The bladder stores urine, allowing urination to be infrequent and controlled.
• The bladder is lined by layers of muscle tissue that stretch to hold urine.
• The normal capacity of the bladder is 400-600 mL.
• During urination, the bladder muscles squeeze, and two sphincters (valves) open
to allow urine to flow out.
• When the bladder is empty, the mucosa has numerous folds called rugae. This
bladder empty or void is called Micturate
 Urethra

• Urine exits the bladder into the urethra, which carries urine out of the body.
• Because it passes through the penis, the urethra is longer in men (8 inches) than in
women (1.5 inches).
 Disease and Treatments
• Diseases and Disorders of the Urinary System
• Polyuria: production of abnormally large volumes of dilute urine.
• Dysuria: painful or difficult urination.
• Nocturia: is a condition in which you wake up during the night because you have to urinate.
• Oliguria: the production of abnormally small amounts of urine.
• Pyuria: is the condition of urine containing white blood cells or pus.
• Urethral stricture: is a narrowing of the urethra caused by injury, instrumentation, infection
and certain non-infectious forms of urethritis.
• Urinary retention: is also known as ischuria, is an inability to completely empty the
bladder. It is a common complication of benign prostatic hyperplasia (BPH), though it can
also be caused by: Nerve dysfunction.
• Glomerulonephritis: A type of kidney disease that involves glomeruli. During
glomerulonephritis, the glomeruli become inflamed and impair the kidney's ability to filter
urine. Glomerulonephritis may lead to chronic renal failure in some individuals.
• Symptoms – Hematuria, Foamy urine, High Blood Pressure,
• Fluid retention
• Treatment – Diuretics, ACE Inhibitors.
• Interstitial nephritis or pyelonephritis: is • Prostatitis: is a swelling of the prostate gland and,
defined as an inflammation to the small therefore, can only occur
internal structures in one or both the kidney. It • in men. Often caused by advanced age,
is also known as Kidney infection. symptoms include urinary
• Urinary tract infections (UTIs): occur when • urgency and frequency, pelvic pain and pain
bacteria enters the urinary tract and can affect during urination
the urethra, bladder or even the kidneys. While • Kidney stones: are clumps of calcium oxalate that
UTIs are more common in women, they can can be found anywhere in the urinary tract. Kidney
stones form when chemicals in the urine become
occur in men.
concentrated enough to form a solid mass. They can
• Symptoms – Blood in urine, Frequency in cause pain in the back and sides, as well as blood in
Urination, the urine. It is otherwise known as Nephrolithiasis.
• Pain during Urination. • Treatment : Many kidney stones can be treated with
• Treatment – Antibiotics is recommended. minimally invasive therapy, such as extracorporeal
• shock wave lithotripsy, which disintegrates the
Interstitial cystitis: also called painful bladder
kidney stones with shock waves.
syndrome, is a chronic bladder condition,
• Ureteral Calculus: Ureteric calculi or stones are
primarily in women, that causes bladder
ones that lie in the
pressure and pain and, sometimes, pelvic pain
• ureter, at any point from the pelvicoureteric
to varying degrees. It can cause bladder
junction to the vesicoureteric junction. They are the
scarring, and can make the bladder less classic cause of renal colic type abdominal pain. It is
elastic. also known as Ureterolithiasis.
 Kidney Failure

• Kidney failure: also called renal • Etiology – Diabetes and Hypertension

failure and chronic kidney • Treatment – Dialysis and Kidney
Transplant
disease, can be a temporary (often
Chronic Kidney Disease:
acute) condition or can become a – Chronic kidney disease, also known
chronic condition resulting in the as chronic renal failure, chronic renal
inability of the kidneys to filter disease, or chronic kidney failure, is a
slow progressive loss of kidney function
waste from the blood. Other
over a period of several years.
conditions, such as diabetes and Eventually the patient has
hypertension, can cause chronic permanent kidney failure. There are 5
kidney disease. Acute cases may stages in CKD and ESRD.
• Signs and symptoms: Anemia, Blood in
be caused by trauma or other
Urine, Decreased Urine Output, Fatigue,
damage, and may improve over Hypertension, Pain on the side or mid to
time with treatment. However, lower back. Protein in urine, Muscle
renal disease may lead to chronic cramps.
kidney failure. • Causes: Diabetes, Hypertension, Kidney
Disease, Kidney Stones, Tumor etc.,