Chapter 26: The Urinary System

Chapter Objectives
OVERVIEW OF KIDNEY FUNCTION
1. List and describe the functions of the kidneys.
NEPHRONS
2. Describe the two major portions of a nephron and the capillaries that surround a
nephron.
3. In the order that fluid passes through them, list the three main sections of the renal
tubule.
4. Distinguish between cortical and juxtamedullary nephrons.
5. Describe the components of the glomerular capsule.
6. Describe the location, structure, and function of the juxtaglomerular apparatus.
OVERVIEW OF RENAL PHYSIOLOGY
7. Describe three major functions carried out by nephrons and where each of these
processes occurs.
8. Describe the parts of the filtration membrane and explain which parts do not allow
which substances to go through.
9. List and name the forces that contribute to net filtration pressure (NFP) and explain
how NFP is calculated.
10. Define glomerular filtration rate and discuss its relation to the pressures that
determine net filtration pressure.
11. List three mechanisms that regulate glomerular filtration rate (GFR).
12. Discuss the myogenic mechanism and tubuloglerular feedback as contribution to
renal autoregulation.
13. Explain the role of the ANS in the neural regulation of GFR.
14. Discuss the roles of angiotensin II and ANP in the regulation of GFR.
TUBULAR REABSPOPTION AND SECRETION
15. Define tubular reabsorption and tubular secretion and list some of the reabsorbed and
secreted substances, respectively.
16. Describe the two routes a substance being reabsorbed from the tubule lumen fluid can
take before entering a peritubular capillary.
17. Explain why reabsorption of sodium ions (Na+) is particularly important.
18. Explain the role of the sodium pump in reabsorption of Na+.
19. Review primary and secondary active transport processes.

20. Define and compare obligatory and facultative water absorption.

21. Discuss the role of Na+ symporters in reabsorption, especially of glucose.
22. Describe the role of Na+/H+ antiporters in achieving Na+ reabsorption, returning
filtered HCO3- and water to the peritubular capillaries, and secreting H+.
23. Explain how the reabsorption of Na+ and other solutes promotes reabsorption of
water by osmosis.
24. Discuss the independent regulation of both the volume and osmolarity of body fluids
in the loop of Henle.
25. Discuss the location where parathyroid hormone influences the reabsorption of Ca2+.
26. Describe what is secreted or reabsorbed in the distal convoluted tubules and
collecting ducts.
27. List the four hormones that affect the extent of Na+, Cl-, and water reabsorption and
K+ secretion by renal tubules.
28. Describe the three main ways angiotensin II affects renal physiology. Include the role
of Aldosterone.
29. Explain the role of ADH in regulating facultative water reabsorption.
30. Discuss the role of ANP in the regulation of tubular function.
PRODUCTION OF DILUTE AND CONCENTRATED URINE
31. Explain how the kidneys produce dilute urine.
32. Explain how the kidneys produce concentrated urine using both the countercurrent
mechanism and urea recycling.
URINE STORAGE, TRANSPORTATION, AND ELIMINATION
33. Describe pathway that urine travels within the kidneys, as it leaves the kidneys and as
it proceeds out of the body.
34. Explain the activation of the micturition reflex.

Chapter Lecture Notes

Overview of Kidney Functions
Regulation of blood ionic composition
Na+, K+, Ca+2, Cl- and phosphate ions
Regulation of blood pH, osmolarity & glucose
Regulation of blood volume

conserving or eliminating water

Regulation of blood pressure
secreting the enzyme renin
adjusting renal resistance
Release of erythropoietin & calcitriol
Excretion of wastes & foreign substances
Nephrons
The nephron is the functional unit of the kidney. (Fig 26.5)
A nephron consists of a
Renal corpuscle
glomerulus is a capillary ball
glomerular (Bowmans) capsule is double-walled epithelial cup
Renal tubule
proximal convoluted tubule
loop of Henle (nephron loop)
descending limb permeable to water, but impermeable to solutes
thin ascending limb
thick ascending limb - impermeable to water and solutes
distal convoluted tubule variable permeability to water
collecting duct variable permeability to water
distal convoluted tubules of several nephrons drain into to a single collecting duct
many collecting ducts drain into a small number of papillary ducts
papillary ducts drain urine to the renal pelvis and ureter.
Blood Vessels around the Nephron (Fig 26.5)
Glomerular capillaries are formed between the afferent & efferent arterioles
Efferent arterioles give rise to the peritubular capillaries and vasa recta

There are two types of nephrons that have differing structure and function.
A cortical nephron usually has its glomerulus in the outer portion of the cortex and a short
loop of Henle that penetrates only into the outer region of the medulla (Fig 26.5a)
80-85% of nephrons are cortical nephrons
A juxtamedullary nephron usually has its glomerulus deep in the cortex close to the medulla;
its long loop of Henle stretches through the medulla and almost reaches the renal
papilla (Fig 26.5b)
15-20% of nephrons are juxtamedullary nephrons
Allow excretion of dilute or concentrated urine
Histology of the Glomerular Capsule
Glomerular (Bowmans) capsule
The glomerular capsule consists of visceral and parietal layers (Fig 26.6)
The visceral layer consists of modified simple squamous epithelial cells called podocytes
The parietal layer consists of simple squamous epithelium and forms the outer wall of the
capsule
Fluid filtered from the glomerular capillaries enters the capsular space, the space between the
two layers of the glomerular capsule.
Juxtaglomerular Apparatus
Structure where afferent arteriole makes contact with ascending limb of loop of Henle (Fig 26.6)
macula densa is thickened part of ascending limb
juxtaglomerular cells are modified muscle cells in arteriole
the JGA helps regulate blood pressure and the rate of blood filtration by the kidneys
Overview of Renal Physiology
Nephrons and collecting ducts perform 3 basic processes (Fig 26.7)
glomerular filtration
a portion of the blood plasma is filtered into the glomerular capsule

Location - renal corpuscle

tubular reabsorption
water & useful substances are reabsorbed into the blood
Location renal tubules and collecting duct
tubular secretion
wastes are removed from the blood & secreted into urine
Location renal tubules and collecting duct
Glomerular Filtration
Glomerular filtrate - the fluid that enters the capsular space (Fig 26.20)
48 Gallons/day filtrate reabsorbed to 1-2 qt. urine
Filtration fraction - the fraction of plasma in the afferent arterioles that becomes filtrate
Filtration fraction is ~20% of plasma
Filtration enhanced by:
thinness of membrane
large surface area of glomerular capillaries
glomerular capillary blood pressure is high due to small size of efferent arteriole
Endothelial-capsular membrane - the filtering unit of a nephron (Fig 26.8)
glomerular endothelium
stops all cells and platelets
glomerular basement membrane
stops large plasma proteins
slit membranes between pedicels of podocytes
stops medium plasma proteins
The principle of filtration - force fluids and solutes through a membrane by pressure
is similar in glomerular capillaries as in capillaries elsewhere in the body.
Net Filtration Pressure

Glomerular filtration depends on three main pressures

Promotes filtration
Glomerular blood hydrostatic pressure (GBHP)
GBHP is higher (55 60 mmHg) than BHP (35 mmHg at arteriole end) in a standard
capillary due to the relatively small diameter of the efferent arteriole compared
with the diameter of the afferent arteriole
Opposes filtration
Capsular hydrostatic pressure (CHP)
back pressure caused by fluid that has entered the capsular space
15 mmHg
Blood colloid osmotic pressure (BCOP)
Pressure exerted by plasma proteins, which are not able to be filtered
30 mmHg
Net Filtration Pressure (NFP) = GBHP - (CHP + BCOP)
10 mmHg = 55 mmHg (15 mmHg + 30 mmHg)
Glomerular Filtration Rate
Glomerular Filtration Rate (GFR) = Amount of filtrate formed in all renal corpuscles of both
kidneys / minute
average adult male rate is 125 mL/min
Changes in net filtration pressure affects GFR
filtration stops if GBHP drops to 45mm Hg
functions normally with mean arterial pressures 80-180
Regulation of GFR
The mechanisms that regulate GFR adjust blood flow into and out of the glomerulus and alter the
glomerular capillary surface area available for filtration. (Table 26.2)
The three principal mechanisms that control GFR are

Renal autoregulation
Mechanisms that maintain a constant GFR despite changes in arterial BP
myogenic mechanism
systemic increases in BP, stretch the afferent arteriole
smooth muscle contraction reduces the diameter of the arteriole returning the GFR to
its previous level in seconds
tubuloglomerular feedback (Fig 26.10)
elevated systemic BP raises the GFR so that fluid flows too rapidly through the renal
tubule & Na+, Cl- and water are not reabsorbed
macula densa detects that difference & releases a vasoconstrictor from the
juxtaglomerular apparatus
afferent arterioles constrict & reduce GFR
Neural regulation
Blood vessels of the kidney are supplied by sympathetic fibers that cause
vasoconstriction of afferent arterioles
At rest, renal blood vessels are maximally dilated because sympathetic activity is
minimal
renal autoregulation prevails
With moderate sympathetic stimulation, both afferent & efferent arterioles constrict
equally
decreasing GFR equally
With extreme sympathetic stimulation (exercise or hemorrhage), vasoconstriction of
afferent arterioles reduces GFR
lowers urine output & permits blood flow to other tissues
Hormonal regulation
Atrial natriuretic peptide (ANP) increases GFR

stretching of the atria that occurs with an increase in blood volume causes ANP
release
relaxes glomerular mesangial cells, cells between the glomerular capillaries,
increasing capillary surface area and increasing GFR
Angiotensin II reduces GFR
potent vasoconstrictor that narrows both afferent & efferent arterioles reducing GFR
Tubular Reabsorption & Secretion
Normal GFR is so high that volume of filtrate in capsular space in half an hour is greater than the
total plasma volume
Nephron must reabsorb 99% of the filtrate (Table 26.3)
Another important function of nephrons is tubular secretion
Reabsorption Routes
A substance being reabsorbed can move between adjacent tubule cells or through an individual
tubule cell before entering a peritubular capillary. (Fig 26.11)
Paracellular reabsorption - 50% of reabsorbed material moves between cells by diffusion in
some parts of tubule
Transcellular reabsorption - material moves through both the apical and basal membranes of
the tubule cell by passive and active transport
Transport Mechanisms
Transport across membranes can be either active or passive.
Passive mechanisms
simple diffusion
facilitated diffusion
osmosis
filtration

Primary active transport - energy derived from ATP is used to pump a substance across a
membrane
Secondary active transport - energy stored in an ions electrochemical gradient drives another
substance across the membrane
Apical and basolateral membranes of tubule cells have different types of transport proteins
Reabsorption of Na+ is important
several transport systems exist to reabsorb Na+
Na+/K+ ATPase pumps sodium from tubule cell cytosol through the basolateral membrane
only (Fig 26.11)
Water is only reabsorbed by osmosis
obligatory water reabsorption - water is obliged to follow the solutes being reabsorbed
facultative water reabsorption reabsorption of water in the late distal convoluted tubule and
collecting duct under the control of antidiuretic hormone (ADH)
Reabsorption and Secretion in the Proximal Convoluted Tubule
Sodium levels are kept low in PCT cells due to Na+/K+ pump in basolateral membranes
The majority of solute and water reabsorption from filtered fluid occurs in the PCT and most
reabsorption involves Na+ (Fig 26.20)
Normally, 100% of filtered glucose, amino acids, lactic acid, water-soluble vitamins, and other
nutrients are reabsorbed in the first half of the PCT by Na+ symporters (Fig 26.12)
Na+/H+ antiporters achieve additional Na+ reabsorption, HCO3- reabsorption, and water
reabsorption (Fig 26.13)
PCT cells continually produce the H+ needed to keep the antiporters running by combining
CO2 with water to produce H2CO3 which dissociates into H+ and HCO3-.
Caffeine inhibits Na+ reabsorption
Na+/H+ antiporters also achieve H+ secretion

Diffusion of Cl- into interstitial fluid via the paracellular route leaves tubular fluid more positive
than interstitial fluid. This electrical potential difference promotes passive paracellular
reabsorption of Na+, K+, Ca+2, and Mg+2 (Fig 26.14)
Reabsorption of Na+ and other solutes creates an osmotic gradient that promotes reabsorption of
water by osmosis
PCT and descending loop of Henle are especially permeable to water due to numerous
aquaporin-1 channels (membrane transport pores for water)
NH4+ can substitute for H+ aboard Na+/H+ antiporters and be secreted into tubular fluid
Urea and ammonia in the blood are both filtered at the glomerulus and secreted by the proximal
convoluted tubule cells into the tubules
Reabsorption in the Loop of Henle
Thick limb of loop of Henle has Na+- K+- Cl- symporters that reabsorb these ions
Because K+ leakage channels return much of the K+ back into tubular fluid, the main effect of the
Na+-K+-Cl- symporters is reabsorption of Na+ and Cl- plus the interstitial fluid and blood
are negatively charged (Fig 26.15)
Cations passively move to the vasa recta, the peritubular capillaries around the Loop of Henle
Filtered water is reabsorbed in the descending limb, but little or no water is reabsorbed in the
ascending limb
No transport molecules for water
Ions continue to be reabsorbed
Tubular fluid osmolarity (ratio of solutes to water) increases as it goes down the descending
limb and decreases in the thick ascending limbs (Fig 26.20)
Reabsorption in the DCT
As fluid flows along the DCT, reabsorption of Na+ and Cl- continues due to Na+-Cl- symporters.
Na+ and Cl- then reabsorbed into peritubular capillaries (Fig 26.20)
The DCT serves as the major site where parathyroid hormone stimulates reabsorption of Ca+2.

DCT is not very permeable to water so the solutes are reabsorbed with little accompanying water.
Reabsorption and Secretion in the Collecting Duct
By end of DCT, 95% of solutes & water have been reabsorbed and returned to the bloodstream
Cells in the collecting duct make the final adjustments (Fig 26.16)
Na+ reabsorbed
K+ may be secreted or reabsorbed depending upon blood concentration
Bicarbonate ions are reabsorbed and H+ secreted
Hormonal Regulation of Urine Excretion
Rate of excretion of any substance = rate of filtration + rate of secretion - rate of reabsorption
Hormones affect Na+, Cl- & water reabsorption and K+ secretion in the tubules (Table 26.4)
renin-angiotensin-aldosterone
angiotensin II decreases GFR by vasoconstricting afferent arteriole
angiotensin II enhances absorption of Na+ by activating the Na+/H+ antiporters in the PCT
aldosterone stimulates the principal cells in the collecting duct to reabsorb more Na+ and
Cl- and secrete K+ which causes the collecting duct to reabsorb more water
increases blood volume by increasing water reabsorption
decreases urine output
atrial natriuretic peptide
inhibits reabsorption of Na+ and water in PCT & suppresses secretion of aldosterone &
ADH
increase excretion of Na+ which increases urine output and decreases blood volume
antidiuretic hormone (Fig 26.17)
Increases water permeability of collecting duct - regulates facultative water reabsorption
Stimulates the insertion of aquaporin-2 channels into the membrane of a collecting duct
water molecules move more rapidly

When osmolarity of plasma & interstitial fluid decreases, more ADH is secreted and
facultative water reabsorption increases.
The rate at which water is lost from the body depends mainly on ADH, when ADH levels
are very low, the kidneys produce dilute urine and excrete excess water; in other
words, renal tubules absorb more solutes than water.
Alcohol inhibits secretion of ADH
Formation of Dilute Urine
Dilute = having fewer solutes than plasma (300 mOsm/liter). (Fig 26.18)
water is reabsorbed in descending limb increasing the osmolarity of the tubular fluid, but as ions
are reabsorbed in thick ascending limb of loop of the fluid becomes more dilute than
plasma
can be 4x as dilute as plasma
The collecting duct does not reabsorb water if ADH is low and urine stays dilute
Formation of Concentrated Urine
Urine can be up to 4 times greater osmolarity than plasma (Fig 26.19)
Long loop juxtamedullary nephrons make that possible
Countercurrent multiplication and exchange
The descending and ascending limb of the nephron loop run countercurrent to one another
opposite directions
The vasa recta is running countercurrent to the tubules
The ions being reabsorbed by the ascending limb are picked up by the vasa recta and
transported to the deepest portion of the medulla
The buildup of ions encourages water to be reabsorbed in the descending limb
The net effect is to establish an osmotic gradient in the renal medulla lower osmolarity near
the cortex and much higher in the deepest part of the medulla
Urea recycling

The descending limb and thin ascending limb are permeable to urea and it will enter the
tubular fluid (secreted)
The thick ascending limb is impermeable to urea and the urea will remain in the tubules until
it can leave near the end of the collecting duct
Contributes to osmotic gradient
Formation of concentrated urine occurs when ADH levels are high
Water will be reabsorbed by the collecting duct by facultative reabsorption
The osmolarity gradient established by the countercurrent mechanism and urea recycling
drives the movement of water out of the collecting duct once aquaporin-2 molecules
are inserted
The urine becomes more and more concentrated as more water leaves
It is possible to remove water from urine to that extent, if interstitial fluid surrounding the
loop of Henle has high osmolarity
Urine Storage, Transportation and Elimination
Urine flow pathway
Nephrons collecting ducts papillary ducts minor calyces major calyces renal
pelvis ureters urinary bladder urethra
Micturition Reflex
Micturition or urination (voiding)
Stretch receptors signal spinal cord and brain
when volume exceeds 200-400 mL
Impulses sent to micturition center in sacral spinal cord (S2 and S3) & reflex is triggered
parasympathetic fibers cause detrusor muscle in the urinary bladder to contract, external &
internal sphincter muscles to relax
Filling causes a sensation of fullness that initiates a desire to urinate before the reflex actually
occurs

conscious control of external sphincter

cerebral cortex can initiate micturition or delay its occurrence for a limited period of time