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The Urinary System

Kidney
 Introduction
 Components of Urinary system
a. kidneys
b. ureters
c. urinary bladder
d. urethra
 Urine formation
 Body fluid is collected via filtration thru selective
permeable membrane via Hydrostatic pressure
forcing water and small solutes thru it, large
molecules are retained= filtrate
 Selective reabsorption and secretion of solutes.
Active transport reabsorb solutes as glucose,
salts and amino acids.Large molecules are
actively secreted into the filtrate.
 Active and passive concentration of filtrate
expells an ultrafiltrate fluid = urine.
 Functions of Urinary system
 Removes metabolic waste ( nitrogenous from protein
and nucleic acid breakdown)
 Regulates the body water and solute (electrolyte)
composition including osmoregulation of pH.
 Endocrine function:
Erythropoietin to regulate erythropoietic cells in blood
marrow.
Renin (RAA system) to control blood pressure and
volume
* Vitamin D synthetic pathway occurs in the kidney.
 Development
      The urinary and genital systems are
closely tied through development which
explains their use of common ducts.  Both
systems originate from intermediate
mesoderm which gives rise to the
urogenital ridge from which the two organ
systems emerge.
 Kidneys (Gross Structure)
 The kidney is an encapsulated bean-shaped organ.  The
hilum is a depression on the medial surface that serves
as portal for the renal vessels, nerves and ureter. The
renal sinus is the cavity deep to hilum that is occupied
by the renal pelvis and vessels.  The renal pelvis (L,
basin) is simply an expansion of the ureter which
receives urine from the major calyces. 

 The capsule of the kidney in humans is bi-laminar,

consisting of an outer layer of dense connective tissue
and an inner layer composed of myfibroblasts.  The
function of the inner layer is debated.
 Cortex
 The cortex (outer region) is grossly
divisible into alternating medullary rays
(which appear striated to the eye) and
cortical labyrinths.  The medullary rays are
rich in straight tubules and collecting
ducts; the cortical labyrinths are rich in
renal corpuscles, convoluted tubules and
collecting tubules.                                  
 Medulla
 The medulla (inner region) is divisible into alternating
pyramids and renal columns.  Renal columns are simply
extensions of cortex into the medullary region and their
composition is the same as the cortex.  The renal
pyramids are variable in number and contain straight
tubules (thick and thin),  collecting ducts and  vasa
recta.  The apex of each pyramid terminates in a papilla
The papilla is perforated by numerous openings of the
terminal collecting ducts and its surface is described as
the area cribosa

        
 Medullary pyramid
   The tubular composition of a medullary
pyramid varies between its inner and outer
portions . In the outer portion (adjacent to the
cortex) thick tubules predominate; conversely, in
the inner portion thin tubules are more
commonly found.

  Each pyramid drains at its papillae into a minor

calyx; several minor calyxes unite to form a
major calyx.  In turn,  major calyxes unite to
form the renal pelvis which is drained by ureter. 
 Nephron
 Types of Nephrons
 Renal Corpuscles
 Renal tubule
 Proximal convoluted tubule
 Proximal Straight tubule
 Descending thin tubule
 Ascending thin tubule
 Distal straight tubule
 Distal convoluted tubule
 The Kidney
   The tubular composition of a
medullary pyramid varies
between its inner and outer
portions . In the outer portion
(adjacent to the cortex) thick
tubules predominate;
conversely, in the inner portion
thin tubules are more commonly
found.
 
    Each pyramid drains at its
papillae into a minor calyx;
several minor calyxes unite to
form a major calyx.  In turn, 
major calyxes unite to form the
renal pelvis which is drained by
ureter. 
 
 The Nephron
 The nephron is the functional
unit of the kidney.  It consists
of (1) a renal corpuscle
(filtration) and (2) renal tubule
(selective resorption and
secretion).  The tubule can be
subdivided into several
portions (starting from the
renal corpuscle): proximal
convoluted tubule, proximal
straight tubule (descending
thick limb; thin descending
limb; thin ascending limb,
distal straight tubule (thick
ascending limb; and distal
convoluted tubule. 
 Types of Nephron
 (1) Cortical (sub-capsular) nephrons are the most
common type of nephron.  Their renal corpuscles are
found in the outer cortex and their short loops are
formed by distal straight tubules in the outer medulla.
 (2) Juxtamedullary nephrons account for
approximately 20% of all nephrons; their corpuscles are 
found adjacent to the medulla.  They are long looped
nephrons whose loop is formed by thin limbs.  These
nephrons are responsible for producing the urine-
concentrating mechanism of the kidney. 
 (3) Intermediate nephrons have their renal corpuscles
in the mid-region of the cortex and their loops are
intermediate in length. 
 Renal Corpuscle – site of
filtration = Glomerulus
 200 um dm. with tufts
of capillaries within an
epithelial capsule,
Glomerular capsule
 The capillaries of the
glomerulus are fed by
an afferent arteriole
and drained by an
efferent arteriole at
the vascular pole
 Bowmans capsule
 Bi-laminar consisting of a visceral layer
which covers the glomerulus and a
parietal layer of simple squamous
epithelium which defines the perimeter of
the corpuscle.  Between the parietal and
visceral layers is the urinary space
(Bowman’s space) which opens to a
proximal convoluted tubules at the urinary
pole.
 Glomerular capsule…..
 The glomerulus forms the filter apparatus of the
nephron and is comprised of 3 components: 
 (1) The endothelium of the glomerular capillaries
is highly fenestrated without diaphragms
 (2) the glomerular basement membrane is a
thick basal lamina produced by both the
endothelial cells and podocytes
 (3)  the visceral layer of Bowman’s capsule
comprised of podocytes and mesangial cells. 
 Visceral layer of Bowman’s capsule
 The podocytes possess processes called pedicles
that wrap around the capillaries and interdigitate
to form filtration slits approximately 25nm wide. 
 The mesangial cells serve a phagocytic function
and keep the basement membrane clear of
debris.  All 3 components combine to retains
cells and macromolecules (proteins > 70 kd) but
permit the passage of water and small solutes
(salts, glucose, amino acids, nitrogenous wastes)
into the urinary space as filtrate.
 Renal tubule – site of selective re-
absorption / secretion of solutes
 The renal tubule serves to recover water
and other desirable solutes (sugar, ions,
small proteins) from the filtrate. 
 The proximal convoluted tubule receives
filtrate from the urinary space and is the
site of the selective re-absorption of most
solutes including all the glucose and amino
acids and most of the water and salts. 
 Renal tubule

 Proteins are absorbed by pinocytosis,

broken down by lysosomal degradation
and released as amino acids to the
peritubular capillary network.  This is also
the site of pH balancing and elimination
(active transport) of creatine. 
 Histology of tubules
 Structurally the proximal convoluted tubule is formed by
a simple cuboidal to low columnar epithelium. 
 The apical surface is covered with microvilli creating a
light microscopic brush border that increases the surface
area for ion absorption. 
 The cells are tightly bound to one another to seal off the
intercellular spaces from the lumen using junctional
processes apically and interdigitating plicae (folds)
laterally. 
 Basally, interdigitating processes contain numerous
mitochondria which create light microscopic basal
striations that are associated with ion transport.
 Histology…
 Proximal convoluted tubules are the most abundant
tubule in the cortex. 
 They have a eosinophilic cytoplasm with a basal
nucleus. 
 The brush border is rarely preserved and the indistinct
cells margins are due to basal and lateral border
interdigitations.
 The proximal straight tubules are located within or near
the medulla, depending upon the type of nephron. 
 They are formed by lower cuboidal epithelium and their
microvilli and basal and lateral interdigitations are less
well developed.  Histologically they are similar to
proximal convoluted tubules
 Histology….
 Descending thin tubules are located within the medulla
and are formed by low cuboidal to squamous epithelium.
 The microvilli are poorly developed as are the basal and
lateral interdigitations creating a very leak cell that
serves as the site of passive transport of ions (inward)
and water (outward) between the lumen and
interstitium.
 The ascending thin tubules are also located within the
medulla and are similar in appearance to descending
thin tubules. 
 However, these tubes are impermeable to water and
permit passive transport of NaCl into the interstitium.
 
 Histology….
 Distal straight tubules are located within both the
medulla and cortex . 
 Histologically these appear as a simple cuboidal
epithelium with sparse microvilli and lacking lateral
interdigitations. 
 The nucleus is apical and basal interdigitations with
abundant mitochondria are present. 
 These tubes are impermeable to water and are the site
of ion transport from the lumen to the interstitium that
establishes the ion gradient of medullary interstitium. 
 
 Histology….
 Distal convoluted tubules are located
within the cortex.  They are approximately
1/3rd as long as their proximal
counterparts.  They contact the renal
corpuscle forming a macula densa which is
part of the juxtaglomerular apparatus (see
below).  Histologically they are similar to
the distal straight tubules and also
function in ion exchange.
 Collecting tubules….
 The collecting system starts in the cortex as a continuation
of the distal convoluted tubules and descend through the
medulla. 
 As the ducts coalesce and increase in size, the cells of the
tubes change from somewhat squamous to cuboidal to
columnar and similarly become increasing stratified. 
 They terminate at the tip of the renal pyramid as the
papillary ducts . 
 Histologically they appear as tubes with distinguishable
cells margins, central nuclei and poorly staining cytoplasm. 
 At the EM level many posses a single cilium and sparse
microvilli. 
 The collecting system functions to concentrate urine
through ADH-regulated and ADH-independent water
channels
 Juxtaglomerular apparatus
 The juxtaglomerular apparatus is the site of blood
pressure regulation via the renin-angioensin-aldosterone
system.  They are located at the vascular pole of
Bowman’s capsule and are formed by the conjunction of
cells of (1) the macula densa (distal straight tubule),
 (2) juxtaglomerular cells of the afferent arteriole,
 (3) extraglomerular mesangial cells.
 The macula densa is a portion of terminal distal straight
tubule adjacent to the renal corpuscle.  These cells
monitor the NaCl levels in the afferent arteriole and
regulate the juxtaglomerular cells within that vessel. 
The juxtaglomerular cells are specialized smooth muscle
cells of the afferent arteriole which synthesize and
secrete renin.  The extraglomerular mesangial cells are
of unknown function.
 How does the Juxtaglomerular
apparatus work
 The macula densa cells monitor NaCl levels in the fluid
of the afferent arteriole. 
 Renin secretion of the juxtaglomerular cells is stimulated
by paracrine activity from the macula densa.  Renin is a
protease that cleaves plasma angiotensinogen into
angiotensin I. 
 Angiotensin I is converted to angiotensin II in the lung
(by an enzyme in the capillaries). 
 Angiotensin II promotes vascular smooth muscle
contraction and release of aldosterone from the
suprarenal cortex. 
 Aldosterone stimulates absorption of NaCl and water in
the distal convoluted tubule thus increasing blood
volume resulting in an increase in blood pressure
 Interstitium…..
 The interstitium is the connective tissue
matrix of the kidney. [Yes. it is the stroma
of the kidney, but remember not all
stromas are connective tissue.]  It is
sparse in the cortex and most abundant
the deep medulla.  The extracellular
matrix consists of collagen fibers and
glycosamionglycans (GAGs) and the cells
are fibroblasts and macrophages.
 Blood supply…
 Arterial:  renal artery > inter-lobar arteries >
arcuate arteries > inter-lobular arteries >
afferent arterioles > renal corpuscle (capillaries!)
> efferent arteriole > peritubular capillary
network (for cortical nephrons) --or-- > vasa
recta (for juxtamedullary nephrons).
 Venous::  Peritubular capillary network >
interlobular veins > arcuate veins > interlobar
veins > renal vein.
 The vasa recta (L. straight vessels) are
comprised of arteriolae rectae and venulae
rectae and their associated capillaries. 
 Nerve Supply
 The smooth muscle of the glomerular
arterioles receives sympathetic innervation.  
 Vasoconstriction of afferent arteriole
decreases filtration rate (lowers pressure)
whereas vasoconstriction of the efferent
arterioles increases filtration rate. 
 Neither innervation is neither for normal
function.
 
 The nephronic loop (of Henle)
of the juxtamedullary
nephrons creates an osmotic
gradient in interstitium of
medulla.  The most import
component of the loop is the
thick ascending limb where
active transport of solutes
occurs.  The vasa recta
maintains the osmotic gradient
by its counter-current flow
thru medulla.  The collecting
duct is the site of osmotic
concentration; modulated by
ADH secreted by the
hypophysis:  ADH increases
the water permeability of
collecting duct cells allowing
water into the interstitium and
back into blood via vasa recta
resulting in a more
concentrate urine. 
 
 The histological structure of the calyces,
renal pelvis, ureter and urinary bladder
 is broadly similar and consists of 3 layers. 
 (1) The mucosa is lined by transitional
epithelium over a lamina propria of dense
irregular connective tissue.  The transitional
epithelium is impermeable to water and salts. 
 (2) The muscularis is a bilaminar smooth muscle
layer with inner longitudinal and outer circular
bundles.  It produces peristalsis to move the
urine.
 (3) The adventitia is the outer connective tissue
coat.  If it is covered with peritoneum
(mesothelium) it is referred to as serosa.
 Ureter and Urinary bladder
 The ureters are muscular tubes connecting
the renal pelvis to the urinary bladder.
 The urinary bladder [vesica] is a
distensible reservoir. 
 It receives the bilateral ureters and
empties via the  midline urethra. 
 The muscularis layer forms a detrussor
muscle which is thickened distally to form
the internal urethral sphincter
 Urethra
 The urethra is a fibromuscular tube connecting
the bladder to the external urethral orifice.  It is
sexually dimorphic.  In the males it is the
terminal duct for both the urinary and genital
systems.  In the female it empties only the
bladder.  In the sexes the lining grades from a
transitional epithelium adjacent to the bladder to
a stratified squamous epithelium at the orifice. 
Males often have a stratified columnar or
pseudostratified columnar epithelium in the
middle portion.
 urinary space of Bowman's
capsule ---

---
Urine flow
> convoluted proximal tubule

 > descending, thick, straight,

proximal tubule ---
 > descending, thin, straight,
proximal tubule --
 > ascending, thin, straight
proximal tubule ---
 > ascending, thick, straight,
distal tubule ----
 > convoluted, distal tubule
---
 > collecting tubule ----
 > collecting ducts ----
 > papillary ducts of Bellini
-----
 > minor calyx ------
 > major calyx ----
 > renal pelvis -----
 > ureter -----
 > bladder -----
 > urethra -----
 > outside
 Nephrolithiasis
 Concretions of calcium
and uric acid that can
form in the renal pelvis
when the concentration is
high.
 Can be removed by
sound waves or
lithotripsy
 by surgery,
 Urinary bladder
 Three layers of
smooth muscles and
the outer serosa /
adventitia.
 The outer layer may
contain Pacinian
corpuscles.
 URETHRA
 Lined by stratified
squamous epithelium.
 urinary space of Bowman's capsule
(neonatal or just born urine) ---
 > convoluted proximal tubule (infantile
urine) ---
 > descending, thick, straight, proximal
tubule (toddlerish urine) ---
 > descending, thin, straight, proximal
tubule (childish urine) --
 > ascending, thin, straight proximal tubule
(pre-pubescentish urine) ---
 > ascending, thick, straight, distal tubule
(pubescentish urine) ----
 > convoluted, distal tubule (post-
pubescentish urine) ---
 > collecting tubule (Gen Xish urine) ---- 

 > collecting ducts (midlife urine) ---- 

 > papillary ducts of Bellini (old fart urine)
-----
 > minor calyx ------
 > major calyx ----
 > renal pelvis -----
 > ureter -----
 > bladder -----
 > urethra -----
 > outside (in the grave urine)
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