TOPIC:

URINARY SYSTEM or
RENAL SYSTEM or
URINARY TRACT
URINARY SYSTEM OR RENAL SYSTEM OR URINARY TRACT.
Function of the urinary system.
Anatomy and histology of kidney, ureters, urinary bladder and
Urethra.
Urine production.
Regulation of urine concentration and volume.
Urine movement.
Urine color analysis of hydration status.
Effects of diseases/aging/injury/disorder on the urinary system
UNIT 6.8 Sistem Urinari
a. Menyatakan komponen utama sistem urinari dan fungsinya.
b.Menghuraikan fungsi sistem urinari.
c. Menghubung kait warna air kencing atau urin dengan status
hidrasi.
 Facts about
urine

• Normal, healthy urine is a pale straw or

clear yellow color.
• Darker yellow or honey-colored urine often
means you need more water.
• A darker, brownish color may mean a liver
problem or severe dehydration.
• Pinkish or red urine may mean blood in the
urine.
Function of the urinary system.

➢Filter blood plasma, excrete toxic wastes.

➢Regulate blood volume, pressure, and osmolarity.
➢Regulate electrolytes and acid-base balance .
➢Secrete erythropoietin, which stimulates the production of red
blood cells.
➢Help regulate calcium levels by participating in calcitriol synthesis.
➢Clear hormones from blood.
➢Detoxify free radicals .
➢In starvation, they synthesize glucose from amino acids.
Anatomy and histology of kidney,
ureters, urinary bladder and Urethra.
Histology of kidney
• The kidneys are two organs in the abdomen • They regulate the amount of water and
of vertebrates which are shaped like beans. salts in the blood.
• Position, weight, and size. • They make urine so it can be removed from
➢ Lie against posterior abdominal wall at the body.
level of T12 to L3 • The adjective which is used for kidneys is
renal. For example, renal failure is when
➢ Right kidney is slightly lower due to
large right lobe of liver. the kidneys are sick and do not work.
• The prefix nephro- is also used in words to
➢ Rib 12 crosses the middle of the left mean "kidneys".
kidney
• A nephrologist is a specialist who studies
➢ Retroperitoneal along with ureters, kidneys.
urinary bladder, renal artery and vein,
and adrenal glands.
• Position, weight, and size
• Lie against posterior abdominal wall at level of T12
• to L3
• Right kidney is slightly lower due to large right lobe of
liver
• Rib 12 crosses the middle of the left kidney
• Retroperitoneal along with ureters, urinary bladder,
renal artery and vein, and adrenal glands
External Anatomy
• The paired kidneys lie on either side of the spine in the
retroperitoneal space between the parietal peritoneum and
the posterior abdominal wall, well protected by muscle, fat,
and ribs.
• The left kidney is located at about the T12 to L3 vertebrae,
whereas the right is lower due to slight displacement by the
liver.
• Upper portions of the kidneys are somewhat protected by
the eleventh and twelfth ribs .
• Each kidney weighs about 125–175 g in males and 115–155 g in
females.
• They are about 11–14 cm in length, 6 cm wide, and 4 cm
thick, and are directly covered by a fibrous capsule
composed of dense, irregular connective tissue that helps to
hold their shape and protect them.
• This capsule is covered by a shock-absorbing layer of
adipose tissue called the renal fat pad, which in turn is
encompassed by a tough renal fascia.
• The fascia and, to a lesser extent, the overlying peritoneum
serve to firmly anchor the kidneys to the posterior
abdominal wall in a retroperitoneal position.
Internal Anatomy
A frontal section through the kidney
reveals an outer region called the renal
cortex and an inner region called
the renal medulla.
In the medulla, 5-8 renal pyramids are
separated by connective tissue renal
columns.
Each pyramid creates urine and
terminates into a renal papilla.
Each renal papilla drains into a collecting
pool called a minor calyx; several minor
calyces connect to form a major calyx; all
major calyces connect to the single renal
pelvis which connects to the ureter.
Blood Flow in the Kidney.
▪ The kidneys are well vascularized and receive about 25 percent of the cardiac
output at rest.
▪ Blood enters the kidney via the paired renal arteries that form directly from the
descending aorta and each enters the kidney at the renal hila.
▪ Once in the kidney, each renal artery first divides into segmental arteries,
followed by further branching to form interlobar arteries that pass through the
renal columns to reach the.
▪ The interlobar arteries, in turn, branch into arcuate arteries, cortical radiate
arteries, and then into afferent arterioles.
▪ The afferent arterioles deliver blood into a modified capillary bed called the
glomerulus which is a component of the “functional unit” of the kidney called the
nephron.
▪ There are about 1.3 million nephrons in each kidney and they function to filter
the blood.
▪ Once the nephrons have filtered the blood, renal veins return blood directly to
the inferior vena cava.
▪ A portal system is formed when the blood flows from the glomerulus to the
efferent arteriole through a second capillary bed, the peritubular capillaries (and
vasa recta), surrounding the proximal and distal convoluted tubules and the loop
of Henle.
▪ Most water and solutes are recovered by this second capillary bed.
▪ This filtrate is processed and finally gathered by collecting ducts that drain into
the minor calyces, which merge to form major calyces; the filtrate then proceeds
to the renal pelvis and finally the ureters.
Ureters
The ureters are bilateral thin (3 to 4 mm) tubular
structures that connect the kidneys to the urinary
bladder, transporting urine from the renal
pelvis into the bladder.
The muscular layers are responsible for the
peristaltic activity that the ureter uses to move
the urine from the kidneys to the bladder.
Urinary bladder
• The urinary bladder is a
temporary storage reservoir for
urine.
• It is located in the pelvic cavity,
posterior to the symphysis
pubis, and below the parietal
peritoneum.
• The size and shape of the
urinary bladder varies with the
amount of urine it contains and
with the pressure it receives
from surrounding organs.
Urethra.
❑ The urethra is the tube that
lets urine leave your bladder
and your body.
❑ If you were assigned male at
birth, your urethra passes
through your prostate and
into your penis.
❑ If you were assigned female
at birth, your urethra is much
shorter. It runs from your
bladder to open in front of
your vagina.
Urine production.
URINE COMPOSITION:-
inorganic salts, urea, organic
compounds, and organic
ammonium salts.

Urine also contains proteins,

hormones, and a wide range of
metabolites, varying by what is
introduced into the body.

The total solids in urine are on

average 59 g (2.1 oz) per day per
person.
Hormones

The two most important ones that it makes are erythropoetin and renin.

1. Erythropoetin is made by the kidneys if there is less oxygen in the kidney.

Erythropoetin signals the bone marrow to make more red blood cells. This
means there will be more oxygen carried in the blood.

2. Renin is made by the kidney if there is low blood pressure, low volume
of blood, or too low salts in the blood. Renin makes the blood
vessels smaller and tells the adrenal gland to make aldosterone (which tells
the kidneys to save salts). It also makes a person feel thirsty. ***** All of this
makes the blood pressure go up.
Urine production. How does the urinary system work?

• The body takes nutrients from food and changes them to energy.
• After the body has taken the food components that it needs, waste products are left
behind in the bowel and in the blood.
• The kidney and urinary systems help the body to get rid of liquid waste called urea.
• They also help to keep chemicals (such as potassium and sodium) and water in
balance.
• Urea is made when foods containing protein (such as meat, poultry, and certain
vegetables) are broken down in the body.
• Urea is carried in the blood to the kidneys.
• This is where it is removed, along with water and other wastes in the form of urine.

**** The kidneys have other important functions.

• They control blood pressure and make the hormone erythropoietin.
• This hormone controls red blood cell production in the bone marrow.
• The kidneys also control the acid-base balance and conserve fluids.
Renal Circulation
Urine movement.
 Regulation of urine concentration and volume.

There are a few complex systems involved

in regulating blood volume and urine
production, such as the intricate renin–
angiotensin system, and the simpler
anti-diuretic hormone (ADH) feedback
system.
Anti-Diuretic Hormone Feedback
• An anti-diruetic is a substance that decreases urine volume, and ADH is the
primary example of it within the body. ADH is a hormone secreted from the
posterior pituitary gland in response to increased plasma osmolarity (i.e.,
increased ion concentration in the blood), which is generally due to an
increased concentration of ions relative to the volume of plasma, or decreased
plasma volume.
• The increased plasma osmolarity is sensed by osmoreceptors in the
hypothalamus, which will stimulate the posterior pituitary gland to release
ADH. ADH will then act on the nephrons of the kidneys to cause a decrease in
plasma osmolarity and an increase in urine osmolarity.
• ADH increases the permeability to water of the distal convoluted tubule and
collecting duct, which are normally impermeable to water. This effect causes
increased water reabsorption and retention and decreases the volume of urine
produced relative to its ion content.
• After ADH acts on the nephron to decrease plasma osmolarity (and leads to
increased blood volume) and increase urine osmolarity, the osmoreceptors in
the hypothalamus will inactivate, and ADH secretion will end. Due to this
response, ADH secretion is considered to be a form of negative feedback.
Diuretics
• A diuretic is any substance that has the opposite effect of ADH— they
increase urine volume, decrease urine osmolarity, lead to an increased
plasma osmolarity, and often reduced blood volume.
• Many substances can act as diuretics, albeit with different mechanisms.
• A common example is alcohol and water ingestion, which directly
inhibit ADH secretion in the pituitary gland.
• Alternatively caffeine is a diuretic because it interferes with sodium
reabsorption (reducing the amount of water reabsorbed by sodium
cotransport) and increases the glomerular filtration rate by temporarily
increasing blood pressure.
• Many medications are diuretics because they inhibit the ATPase pumps,
thus slowing water reabsorption further.
UNDERSTANDING THE IMPORTANCE OF URINE COLOR
Dehydration

• Urine colour is the best identifier of how hydrated you are. Urine
changes colour based on its concentration.
• When you’re hydrated, your pee will be light yellow and clear.
• However, when you haven’t drunk enough water, your kidneys try to
conserve as much fluid as possible.
• This turns your pee a dark yellow or dark brown colour.
• Dehydration can be caused by drinking alcohol, sweating a lot, vomiting or
having diarrhoea.
• If you’re dehydrated for too long, it could be serious.
• So if you notice your pee is a little dark, ensure you increase your fluid intake.
Hydration
• Is the process of replacing water in the body.
• This can be done through drinking water, eating ice
chips, eating foods that have high water content,
drinking other fluids or an intravenous or IV line.
• Being dehydrated is when your body is lacking the
water levels necessary to function optimally.
Is dehydration and hydration the same?

Even though dehydration describes the state of body

water deficit, some scientists have suggested
that dehydration refers to the process of losing water,
while hypohydration is the state of water deficit, and
rehydration is the process of gaining water from a
hypohydrated state towards euhydration.
Effects of diseases/aging/injury/disorder on the
urinary system
Ureteroscopy:
✓ A procedure to look inside the ureter and
renal pelvis to check for abnormal areas.
✓ A ureteroscope is a thin, tube-like
instrument with a light and a lens for
viewing.
✓ The ureteroscope is inserted through the
urethra into the bladder, ureter, and renal
pelvis.
✓ A tool may be inserted through the
ureteroscope to take tissue samples to be
checked under a microscope for signs of
disease.
Urine Flow Test
How do I get ready for a urine flow test?
•Your healthcare provider will explain the procedure and you can ask questions.
•Generally, no prior preparation, such as fasting (not eating or drinking) is
needed.
•You may be told to drink about 4 glasses of water several hours before the test
to be sure that your bladder is full. Don't empty your bladder before arriving for
the procedure.
•If you are pregnant or think you may be, tell your healthcare provider.
•Make sure your healthcare provider has a list of all medicines (prescription and
over-the-counter), herbs, vitamins, and supplements that you are taking.
Based on your health condition, your healthcare provider may request other
specific preparation
What happens during a urine flow
test?
• A urine flow test may be done on an outpatient basis. This means you will go home the same
day. Or it may be done as part of your hospital stay. Procedures may vary depending on your
condition and your healthcare provider's practices.
• Generally, a urine flow test follows this process:
1. You will be taken into the procedure area and told how to use the urine flow test device, called
a flowmeter.
2. When you are ready to urinate, you will press the flowmeter start button and count for 5
seconds before beginning urination.
3. You will start to urinate into the funnel device that is attached to a regular toilet or portable
commode. The flowmeter will record information as you are urinating.
4. You should not push or strain as you urinate. You should stay as still as possible.
5. When you are done urinating, count for 5 seconds and press the flowmeter button again.
6. Don't put any toilet paper into the funnel device.
7. The test will be done at this point. Depending on your condition, you may be asked to repeat
the test over several days.
How to read Uroflow results?
• What is Uroflow?
• Uroflow vs. Uroflowmeter vs. Uroflowmetry vs. ?
• Firstly, yes it is a bit confusing. But, these are all the same. Uroflowmetry is a
diagnostic assessment of the urinary tract functionality. Your Urologist or physical
therapist suggest performing a uroflow test, in case they suspect that you are
suffering while urinating, or have a weak flow rate (stream).

• Uroflow, or Uroflowmetry is a test to measure the flow (rate) of micturition. During

the test, the uroflow device, a Uroflowmeter, tracks urine flow in mL/sec. It reports
Urination volume, meaning, how much urine flows out. It is that simple. Urination
Time in seconds, means, How long it takes to urinate.
Interpretation of uroflowmetry results
What is Qmax?
While we measure the total volume of the urination is in mL (milliliter), the flow rate is
measured in mL/second, and the Qmax is the value of the highest flow rate measured
during the test. In other words, Qmax is the fastest stream measured in mL/s.

• Weak flow = Low Qmax

• Slow urination speed = Low Qmax

• Flat urination chart = Low Qmax

• High Qmax, it is unlikely to be a curve Flow time and Qmax values.
from someone with a blockage or
obstruction of the urinary tract and
weak flow. Qmax Interpretation *

is higher than
• Low Qmax value is commonly a sign Normal
15ml/sec
of obstruction. It is a common
symptom of BPH. In men – Benign 10-15ml/sec Equivocal
prostatic hypertrophy. Enlargement of
the prostate gland, or block of the is lower than Obstruction or
urethra. Also, it can point to another 10ml/sec weak detrusor
abnormality related to the Lower
Urinary Tract.
Can you describe the normal flow rate of urine?
• Visually it is a bell-shape-like chart.
• During normal voiding, the initial stream starts
slowly. It accelerates until the bladder is almost
empty.
• The flow then slows until the bladder is empty. In
patients with a urinary tract obstruction, this pattern
of urine flow is changed, and increases and decreases
more slowly.
Practical uroflowmetry BJUI (Thomas R. Jarvis, Lewis Chan, Vincent Tse, 2012)
How exactly is a urine flow test performed?
• In a clinic, with the conventional method, a nurse will ask you
to urinate into a funnel-shaped container placed on a scale-
like electronic device. It is important to know that you can not
put any toilet paper in the toilet or device.

• After your bladder is full, you’ll need to pee normally without

manipulating the speed. A conventional electric
uroflowmeter hooked up to the toilet record the flow rate
and quantity of urination. And of course, never urinate until
the machine is on and ready.
• Then, when you’ve finished the machine will send or print
your results to your doctor. The uroflow test can help the
doctor in identifying the causes of urinary difficulties.
Conventional in-clinic
Uroflow
iUFlow Uroflowmeter vs. in clinic Uroflow
• As you may noticed, this is normally a bother,
iUFlow Uroflowmeter is the solution to get more
accurate data about your bladder behavior.

• iUFlow is a wireless and disposable

uroflowmeter
• iUFlow is a uroflowmeter for home use. iUFlow
uses built-in sensors to easily and objectively
measure volume, flow rates and frequency of a
patient’s voiding activities during a prescribed
interval. An easy urine Uroflowmetry test at
home.
• Yes, iUFlow was designed to make life easier.
iUFlow was built especially for those who suffer
from BPH, Overactive bladder, Nocturia, Pelvic
floor related issues, or other LUTS (Lower
Urinary Tract Symptoms).
How do I get the measurements results of
iUFlow? Can it measure Qmax and Volume?
• Of course, the iUFlow
Uroflowmeter syncs the result in
real-time to the iUFlow Bladder
Diary app (free and supported on
both Android® and Apple®
platforms) and iUFlow dashboard.
So, your doctor can interpret the
result at the same moment that
the measurement is completed
and bladder data is synced.
iUFlow dashboard
•Does exercise affect urine output?
•Why does the urine flow rate decrease
during exercise?
•Is urine more concentrated after exercise?
•How does the urinary system play a role in
physical activity?