Physiology of Urinary System LEARNING OBJECTIVES‫أھﺪاف اﻟﺘﻌﻠﻢ‬

‫ﻓﺴﯿﻮﻟﻮﺟﯿﺎ اﻟﺠﮭﺎز اﻟﺒﻮﻟﻲ‬ At the end of this section, the student will be able to: ‫ ﺳﯿﻜﻮن اﻟﻄﺎﻟﺐ‬، ‫ﻓﻲ ﻧﮭﺎﯾﺔ ھﺬا اﻟﻘﺴﻢ‬
:‫ﻗﺎدرا ﻋﻠﻰ‬
 List the structures of the urinary system..‫ﺿﻊ ﻗﺎﺋﻤﺔ ﺑﺘﺮاﻛﯿﺐ اﻟﺠﮭﺎز اﻟﺒﻮﻟﻲ‬
 List the major functions of the kidneys..‫ﻗﺎﺋﻤﺔ اﻟﻮظﺎﺋﻒ اﻟﺮﺋﯿﺴﯿﺔ ﻟﻠﻜﻠﻰ‬
 Describe the gross anatomy of the kidney and its coverings. ‫وﺻﻒ‬
.‫اﻟﺘﺸﺮﯾﺢ اﻹﺟﻤﺎﻟﻲ ﻟﻠﻜﻠﯿﺔ وأﻏﻄﯿﺘﮭﺎ‬
 Describe the ureters, urinary bladder, and urethra. ‫وﺻﻒ اﻟﺤﺎﻟﺐ واﻟﻤﺜﺎﻧﺔ‬
.‫اﻟﺒﻮﻟﯿﺔ واﻹﺣﻠﯿﻞ‬
 Trace the blood supply through the kidney..‫ﺗﺘﺒﻊ إﻣﺪادات اﻟﺪم ﻣﻦ ﺧﻼل اﻟﻜﻠﻰ‬
 Describe the anatomy of a nephron..‫وﺻﻒ ﺗﺸﺮﯾﺢ اﻟﻨﻔﺮون‬
 Define the three major renal processes‫ﺗﺤﺪﯾﺪ اﻟﻌﻤﻠﯿﺎت اﻟﻜﻠﻮﯾﺔ اﻟﺮﺋﯿﺴﯿﺔ اﻟﺜﻼث‬
 Identify the principal factors that influence filtration pressure. ‫ﺗﺤﺪﯾﺪ‬
.‫اﻟﻌﻮاﻣﻞ اﻟﺮﺋﯿﺴﯿﺔ اﻟﺘﻲ ﺗﺆﺛﺮ ﻋﻠﻰ ﺿﻐﻂ اﻟﺘﺮﺷﯿﺢ‬
 Describe the micturition reflex‫وﺻﻒ ﻣﻨﻌﻜﺲ اﻟﺘﺒﻮل‬
Prepared By: Medical-Surgical Nursing Staff
INTRODUCTION‫ﻣﻘﺪﻣﺔ‬ Anatomical Structure of the Urinary System:
 The urinary system is the major excretory system of the body. :‫اﻟﺘﺮﻛﯿﺐ اﻟﺘﺸﺮﯾﺤﻲ ﻟﻠﺠﮭﺎز اﻟﺒﻮﻟﻲ‬
Some organs in other systems also eliminate wastes, but they are
not able to compensate in case of kidney failure. Every day the  Paired kidneys
kidneys filter nearly 200 liters of fluid from our bloodstream,  A ureter for each kidney
allowing toxins, metabolic wastes, and excess ions to leave the
body in urine while returning needed substances to the blood.  Urinary bladder
‫ ﺑﻌﺾ اﻷﻋﻀﺎء‬.‫اﻟﺠﮭﺎز اﻟﺒﻮﻟﻲ ھﻮ ﺟﮭﺎز اﻹﺧﺮاج اﻟﺮﺋﯿﺴﻲ ﻟﻠﺠﺴﻢ‬   Urethra
‫ ﻟﻜﻨﮭﺎ ﻏﯿﺮ ﻗﺎدرة‬، ‫ﻓﻲ أﻧﻈﻤﺔ أﺧﺮى ﺗﻘﻀﻲ أﯾﻀﺎ ﻋﻠﻰ اﻟﻨﻔﺎﯾﺎت‬ ‫ اﻟﻜﻠﻰ اﻟﻤﻘﺘﺮﻧﺔ‬
‫ ﺗﻘﻮم اﻟﻜﻠﻰ ﻛﻞ ﯾﻮم ﺑﺘﺼﻔﯿﺔ‬.‫ﻋﻠﻰ اﻟﺘﻌﻮﯾﺾ ﻓﻲ ﺣﺎﻟﺔ اﻟﻔﺸﻞ اﻟﻜﻠﻮي‬ ‫ ﺣﺎﻟﺐ ﻟﻜﻞ ﻛﻠﯿﺔ‬
‫ ﻣﻤﺎ ﯾﺴﻤﺢ‬، ‫ ﻟﺘﺮ ﻣﻦ اﻟﺴﻮاﺋﻞ ﻣﻦ ﻣﺠﺮى اﻟﺪم‬200 ‫ﻣﺎ ﯾﻘﺮب ﻣﻦ‬
‫ اﻟﻤﺜﺎﻧﺔ اﻟﺒﻮﻟﯿﺔ‬
‫ﻟﻠﺴﻤﻮم واﻟﻨﻔﺎﯾﺎت اﻷﯾﻀﯿﺔ واﻷﯾﻮﻧﺎت اﻟﺰاﺋﺪة ﺑﻤﻐﺎدرة اﻟﺠﺴﻢ ﻓﻲ‬
.‫اﻟﺒﻮل أﺛﻨﺎء إﻋﺎدة اﻟﻤﻮاد اﻟﻼزﻣﺔ إﻟﻰ اﻟﺪم‬ ‫ اﻹﺣﻠﯿﻞ‬
 Anatomical Structure of the Urinary System: The opening between the bladder and the urethra
:‫اﻟﺘﺮﻛﯿﺐ اﻟﺘﺸﺮﯾﺤﻲ ﻟﻠﺠﮭﺎز اﻟﺒﻮﻟﻲ‬ is closed by two rings of muscle:
 Ureters: Paired tubes that transport urine from the kidneys to the
 Internal urethral sphincter: A
urinary bladder.
 Urinary bladder: A temporary storage reservoir for urine. Made of
thickened, smooth muscle, fibers at
elastic fibers and involuntary muscles the junction of the urinary bladder
Bladder Capacity: 500 - 800 ml. and the urethra, involuntary
 Urethra: A tube that carries urine from the bladder to the body control kept it contracted.
exterior.  External urethral sphincter: A
 Urinary meatus: Opening to the outside of the body. circular band of skeletal muscle
.‫ أﻧﺎﺑﯿﺐ ﻣﻘﺘﺮﻧﺔ ﺗﻨﻘﻞ اﻟﺒﻮل ﻣﻦ اﻟﻜﻠﯿﺘﯿﻦ إﻟﻰ اﻟﻤﺜﺎﻧﺔ اﻟﺒﻮﻟﯿﺔ‬:‫ اﻟﺤﺎﻟﺐ‬ which is under voluntary control. involuntr
‫ ﻣﺼﻨﻮﻋﺔ ﻣﻦ أﻟﯿﺎف ﻣﺮﻧﺔ وﻋﻀﻼت ﻻ إرادﯾﺔ‬.‫ ﺧﺰان ﺗﺨﺰﯾﻦ ﻣﺆﻗﺖ ﻟﻠﺒﻮل‬:‫ اﻟﻤﺜﺎﻧﺔ اﻟﺒﻮﻟﯿﺔ‬ These fibers remain contracted, as a
.‫ ﻣﻞ‬800 - 500 :‫ ﺳﻌﺔ اﻟﻤﺜﺎﻧﺔ‬ result of central nervous system
.‫ أﻧﺒﻮب ﯾﻨﻘﻞ اﻟﺒﻮل ﻣﻦ اﻟﻤﺜﺎﻧﺔ إﻟﻰ اﻟﺠﺰء اﻟﺨﺎرﺟﻲ ﻣﻦ اﻟﺠﺴﻢ‬:‫ ﻣﺠﺮى اﻟﺒﻮل‬ stimulation, except during
shellto
.‫ ﯾﻔﺘﺢ ﻋﻠﻰ ﺧﺎرج اﻟﺠﺴﻢ‬:‫ اﻟﺼﻤﺎخ اﻟﺒﻮﻟﻲ‬ micturition when they relax. spursut

:‫ﯾﺘﻢ إﻏﻼق اﻟﻔﺘﺤﺔ ﺑﯿﻦ اﻟﻤﺜﺎﻧﺔ واﻹﺣﻠﯿﻞ ﺑﻮاﺳﻄﺔ ﺣﻠﻘﺘﯿﻦ ﻣﻦ اﻟﻌﻀﻼت‬ Different Functions of the Kidneys:
1. Regulate water & electrolyte balance.
‫ ﻋﻀﻠﺔ‬:‫اﻟﻌﻀﻠﺔ اﻟﻌﺎﺻﺮة اﻟﺪاﺧﻠﯿﺔ ﻟﻺﺣﻠﯿﻞ‬ 
‫ﺳﻤﯿﻜﺔ وﻧﺎﻋﻤﺔ وأﻟﯿﺎف ﻋﻨﺪ ﺗﻘﺎطﻊ اﻟﻤﺜﺎﻧﺔ‬ 2. Regulate arterial pressure.
‫ واﻟﺘﺤﻜﻢ اﻟﻼإرادي‬، ‫اﻟﺒﻮﻟﯿﺔ واﻹﺣﻠﯿﻞ‬
3. Regulate extracellular fluid pH (acid-base balance).
.‫أﺑﻘﺎھﺎ ﻣﺘﻘﻠﺼﺔ‬
:‫اﻟﻌﻀﻠﺔ اﻟﻌﺎﺻﺮة اﻟﺨﺎرﺟﯿﺔ ﻟﻺﺣﻠﯿﻞ‬  4. Regulate red blood cell synthesis (erythropoietin).
‫ﺷﺮﯾﻂ داﺋﺮي ﻣﻦ اﻟﻌﻀﻼت اﻟﮭﯿﻜﻠﯿﺔ ﺗﺤﺖ‬ 5. Excrete metabolic wastes and foreign substances
‫ ﺗﻈﻞ ھﺬه اﻷﻟﯿﺎف‬.‫اﻟﺴﯿﻄﺮة اﻹرادﯾﺔ‬
‫ ﻧﺘﯿﺠﺔ ﻟﺘﺤﻔﯿﺰ اﻟﺠﮭﺎز اﻟﻌﺼﺒﻲ‬، ‫ﻣﺘﻘﻠﺼﺔ‬ such as drugs or toxins.
‫ إﻻ أﺛﻨﺎء اﻟﺘﺒﻮل ﻋﻨﺪﻣﺎ‬، ‫اﻟﻤﺮﻛﺰي‬ 6. Converting vitamin D to its active form.
.‫ﺗﺴﺘﺮﺧﻲ‬
7. Gluconeogenesis: During prolonged fasting.
 :‫وظﺎﺋﻒ ﻣﺨﺘﻠﻔﺔ ﻣﻦ اﻟﻜﻠﻰ‬ Anatomy of the kidney
 The kidney is the most important excretory organ
.‫ ﺗﻨﻈﯿﻢ ﺗﻮازن اﻟﻤﺎء واﻟﻜﮭﺎرل‬.1
 A bean-shaped organ located between peritoneum and the
.‫ ﺗﻨﻈﯿﻢ اﻟﻀﻐﻂ اﻟﺸﺮﯾﺎﻧﻲ‬.2 back muscles (retroperitoneal)
 Enclosed in an adipose capsule
‫ ﺗﻨﻈﯿﻢ درﺟﺔ اﻟﺤﻤﻮﺿﺔ اﻟﺴﺎﺋﻞ ﺧﺎرج اﻟﺨﻠﯿﺔ )اﻟﺘﻮازن اﻟﺤﻤﻀﻲ‬.3  Protected by the ribs
.(‫اﻟﻘﺎﻋﺪي‬  Internal structures

É
Og
 Renal cortex
.(‫ ﺗﻨﻈﯿﻢ ﺗﺨﻠﯿﻖ ﺧﻼﯾﺎ اﻟﺪم اﻟﺤﻤﺮاء )إرﯾﺜﺮوﺑﻮﯾﺘﯿﻦ‬.4  Renal medulla

.‫ ﺗﻔﺮز اﻟﻨﻔﺎﯾﺎت اﻷﯾﻀﯿﺔ واﻟﻤﻮاد اﻟﻐﺮﯾﺒﺔ ﻣﺜﻞ اﻷدوﯾﺔ أو اﻟﺴﻤﻮم‬.5  Renal pelvis
 External structures:
.‫ ﺗﺤﻮﯾﻞ ﻓﯿﺘﺎﻣﯿﻦ )د( إﻟﻰ ﺷﻜﻠﮫ اﻟﻨﺸﻂ‬.6  Renal capsule
 Renal fascia
.‫ أﺛﻨﺎء اﻟﺼﯿﺎم ﻟﻔﺘﺮات طﻮﯾﻠﺔ‬:‫ ﺗﻜﻮﯾﻦ اﻟﺴﻜﺮ‬.7
 Renal hilum at
‫ﺗﺸﺮﯾﺢ اﻟﻜﻠﻰ‬ Internal structures of the kidney:
‫اﻟﻜﻠﻰ ھﻲ أھﻢ ﻋﻀﻮ إﺧﺮاﺟﻲ‬ 
Internal kidney:
(‫ﻋﻀﻮ ﻋﻠﻰ ﺷﻜﻞ ﺣﺒﺔ اﻟﻔﻮل ﯾﻘﻊ ﺑﯿﻦ اﻟﺼﻔﺎق وﻋﻀﻼت اﻟﻈﮭﺮ )ﺧﻠﻒ اﻟﺼﻔﺎق‬ 
 Renal cortex: Outer layer that
‫ﻣﺤﺎطﺔ ﺑﻜﺒﺴﻮﻟﺔ دھﻨﯿﺔ‬ 
made up of nephrons. kidney cells
‫ﻣﺤﻤﯿﺔ ﻣﻦ ﻗﺒﻞ اﻷﺿﻼع‬ 
 Renal medulla: Inner layer
‫اﻟﮭﯿﺎﻛﻞ اﻟﺪاﺧﻠﯿﺔ‬ 
(triangle looking areas) cone-
‫اﻟﻘﺸﺮة اﻟﻜﻠﻮﯾﺔ‬ 
shaped medullary or A renal
‫اﻟﻨﺨﺎع اﻟﻜﻠﻮي‬  S im 9
pyramids: Parallel bundles of
‫اﻟﺤﻮض اﻟﻜﻠﻮي‬ 
urine-collecting tubules.
:‫اﻟﮭﯿﺎﻛﻞ اﻟﺨﺎرﺟﯿﺔ‬  in
 Renal pelvis: Collecting area in
‫ﻛﺒﺴﻮﻟﺔ ﻛﻠﻮﯾﺔ‬ 
center that acts as a funnel for
‫اﻟﻠﻔﺎﻓﺔ اﻟﻜﻠﻮﯾﺔ‬ 
urine flowing to the ureter.
6

‫ھﯿﻠﻮم ﻛﻠﻮي‬ 
 ‫اﻟﮭﯿﺎﻛﻞ اﻟﺪاﺧﻠﯿﺔ ﻟﻠﻜﻠﯿﺔ‪:‬‬ ‫‪BLOOD AND NERVE SUPPLY TO THE KIDNEYS‬‬
‫‪ ‬اﻟﻜﻠﻰ اﻟﺪاﺧﻠﯿﺔ‪:‬‬ ‫‪ Approximately‬‬ ‫‪one-fourth (1200 ml) of systemic cardiac‬‬
‫‪output flows through the kidneys each minute.‬‬
‫‪ ‬اﻟﻘﺸﺮة اﻟﻜﻠﻮﯾﺔ‪ :‬اﻟﻄﺒﻘﺔ اﻟﺨﺎرﺟﯿﺔ اﻟﺘﻲ‬

‫‪It‬‬
‫‪ Blood enter the kidney through the renal artery‬‬
‫ﺗﺘﻜﻮن ﻣﻦ اﻟﻨﯿﻔﺮون‪.‬‬
‫‪ The nerve supply is via the renal plexus‬‬
‫‪ ‬اﻟﻨﺨﺎع اﻟﻜﻠﻮي‪ :‬اﻟﻄﺒﻘﺔ اﻟﺪاﺧﻠﯿﺔ )ﻣﻨﺎطﻖ‬
‫ﻣﺜﻠﺜﺔ اﻟﻤﻈﮭﺮ( اﻷھﺮاﻣﺎت اﻟﻨﺨﺎﻋﯿﺔ أو‬
‫‪R‬‬ ‫‪D‬‬ ‫‪I‬‬
‫اﻟﻜﻠﻮﯾﺔ اﻟﻤﺨﺮوطﯿﺔ اﻟﺸﻜﻞ‪ :‬ﺣﺰم ﻣﺘﻮازﯾﺔ‬ ‫‪D‬‬ ‫‪o‬‬
‫‪as‬‬ ‫‪I‬‬
‫ﻣﻦ اﻷﻧﺎﺑﯿﺐ اﻟﺘﻲ ﺗﺠﻤﻊ اﻟﺒﻮل‪.‬‬
‫‪ ‬اﻟﺤﻮض اﻟﻜﻠﻮي‪ :‬ﻣﻨﻄﻘﺔ ﺗﺠﻤﯿﻊ ﻓﻲ اﻟﻤﺮﻛﺰ‬
‫ﺗﻌﻤﻞ ﻛﻘﻤﻊ ﻟﺘﺪﻓﻖ اﻟﺒﻮل إﻟﻰ اﻟﺤﺎﻟﺐ‪.‬‬
‫)‪Renal blood flow (RBF‬‬
‫‪Is the volume of blood delivered to the kidneys per unit‬‬
‫‪time. In humans, the kidneys together receive roughly 25%‬‬
‫‪of cardiac output.‬‬

‫إﻣﺪاد اﻟﻜﻠﻰ ﺑﺎﻟﺪم واﻷﻋﺼﺎب‬

‫‪ ‬ﯾﺘﺪﻓﻖ ﻣﺎ ﯾﻘﺮب ﻣﻦ رﺑﻊ )‪ 1200‬ﻣﻞ( اﻟﻨﺘﺎج اﻟﻘﻠﺒﻲ اﻟﺠﮭﺎزي ﻋﺒﺮ اﻟﻜﻠﻰ ﻛﻞ‬
‫دﻗﯿﻘﺔ‪.‬‬
‫‪ ‬ﯾﺪﺧﻞ اﻟﺪم إﻟﻰ اﻟﻜﻠﻰ ﻣﻦ ﺧﻼل اﻟﺸﺮﯾﺎن اﻟﻜﻠﻮي‬
‫‪ ‬ﯾﺘﻢ إﻣﺪاد اﻟﻌﺼﺐ ﻋﺒﺮ اﻟﻀﻔﯿﺮة اﻟﻜﻠﻮﯾﺔ‬

‫• ﺗﺪﻓﻖ اﻟﺪم اﻟﻜﻠﻮي ) )‪(RBF‬‬

‫• ھﻮ ﺣﺠﻢ اﻟﺪم اﻟﺬي ﯾﺘﻢ ﺗﻮﺻﯿﻠﮫ إﻟﻰ اﻟﻜﻠﯿﺘﯿﻦ ﻟﻜﻞ وﺣﺪة زﻣﻨﯿﺔ‪ .‬ﻓﻲ اﻟﺒﺸﺮ ‪،‬‬
‫ﺗﺘﻠﻘﻰ اﻟﻜﻠﻰ ﻣﻌﺎ ﻣﺎ ﯾﻘﺮب ﻣﻦ ‪ ٪ 25‬ﻣﻦ اﻟﻨﺘﺎج اﻟﻘﻠﺒﻲ‪.‬‬
 Nephron: :‫ﻧﯿﻔﺮون‬
The functional unit of the kidney ‫اﻟﻮﺣﺪة اﻟﻮظﯿﻔﯿﺔ ﻟﻠﻜﻠﯿﺔ‬
There are about one million ‫ ھﻨﺎك ﺣﻮاﻟﻲ ﻣﻠﯿﻮن ﻧﯿﻔﺮون ﻓﻲ ﻛﻞ ﻛﻠﯿﺔ‬
nephrons in each human kidney. .‫ﺑﺸﺮﯾﺔ‬
:‫ ﯾﺘﻜﻮن اﻟﻨﻔﺮون ﻣﻦ‬
Nephron consists of:
:‫ اﻟﻜﺮﯾﺎت اﻟﻜﻠﻮﯾﺔ‬.1 
1. Renal corpuscle:
‫ اﻟﻜﺒﯿﺒﺔ‬
 Glomerulus II is
‫ ﻛﺒﺴﻮﻟﺔ ﺑﻮﻣﺎن‬
 Bowman’s capsule :‫ اﻟﻨﺒﯿﺐ اﻟﻜﻠﻮي‬.2 
2. Renal tubule: (‫ اﻟﻨﺒﯿﺒﺎت اﻟﻤﻠﺘﻮﯾﺔ اﻟﻘﺮﯾﺒﺔ )اﻟﻘﺮﯾﺒﺔ‬
 Proximal (near) convoluted U) ‫ﻋﻠﻰ ﺷﻜﻞ ﺣﺮف‬Henle ( ‫ ﺣﻠﻘﺔ ﻣﻦ‬
tubule (‫ اﻟﻨﺒﯿﺐ اﻟﻤﻠﺘﻮي اﻟﺒﻌﯿﺪ )اﻟﺒﻌﯿﺪ‬
 Loop of Henle (U- shaped ) ‫ ﺟﻤﻊ اﻷﻧﺎﺑﯿﺐ‬
 Distal (far) convoluted tubule
17 18
 Collecting tubules

The renal corpuscle has several unique characteristics that

make it particularly efficient at filtration:
 Porous capillaries: The glomerular capillaries are highly
permeable due to the presence of pores.
 Porous inner layer of Bowman capsule.

 High pressure: The glomerular capillaries have much higher

pressure than other capillaries due to the smaller diameter of
C the efferent arteriole compared to the afferent arteriole.
just y'd jw
‫ ﯾﺤﺘﻮي اﻟﺠﺴﯿﻢ اﻟﻜﻠﻮي ﻋﻠﻰ اﻟﻌﺪﯾﺪ ﻣﻦ اﻟﺨﺼﺎﺋﺺ اﻟﻔﺮﯾﺪة اﻟﺘﻲ ﺗﺠﻌﻠﮫ ﻓﻌﺎﻻ ﺑﺸﻜﻞ‬
:‫ﺧﺎص ﻓﻲ اﻟﺘﺮﺷﯿﺢ‬
‫ اﻟﺸﻌﯿﺮات اﻟﺪﻣﻮﯾﺔ اﻟﻜﺒﯿﺒﯿﺔ ﻋﺎﻟﯿﺔ اﻟﻨﻔﺎذﯾﺔ ﺑﺴﺒﺐ وﺟﻮد‬:‫ اﻟﺸﻌﯿﺮات اﻟﺪﻣﻮﯾﺔ اﻟﻤﺴﺎﻣﯿﺔ‬
.‫اﻟﻤﺴﺎم‬
.‫ طﺒﻘﺔ داﺧﻠﯿﺔ ﻣﺴﺎﻣﯿﺔ ﻣﻦ ﻛﺒﺴﻮﻟﺔ ﺑﻮﻣﺎن‬
Glomerular filtrate collects in capsular space, flows into renal tubule ‫ اﻟﺸﻌﯿﺮات اﻟﺪﻣﻮﯾﺔ اﻟﻜﺒﯿﺒﯿﺔ ﻟﮭﺎ ﺿﻐﻂ أﻋﻠﻰ ﺑﻜﺜﯿﺮ ﻣﻦ اﻟﺸﻌﯿﺮات‬:‫ اﻟﻀﻐﻂ اﻟﻌﺎﻟﻲ‬
‫ وﯾﺘﺪﻓﻖ إﻟﻰ اﻟﻨﺒﯿﺐ اﻟﻜﻠﻮي‬، ‫ﯾﺘﺠﻤﻊ اﻟﻤﺮﺷﺢ اﻟﻜﺒﯿﺒﻲ ﻓﻲ اﻟﻔﻀﺎء اﻟﻤﺤﻔﻈﻲ‬ .‫اﻟﺪﻣﻮﯾﺔ اﻷﺧﺮى ﺑﺴﺒﺐ اﻟﻘﻄﺮ اﻷﺻﻐﺮ ﻟﻠﺸﺮﯾﺎن اﻟﺼﺎدر ﻣﻘﺎرﻧﺔ ﺑﺎﻟﺸﺮﯾﺎن اﻟﻮارد‬
 Renal Processes‫ﻋﻤﻠﯿﺎت اﻟﻜﻠﻰ‬ Basic Mechanisms of Urine Formation
The formation of urine involves three major processes: ‫اﻵﻟﯾﺎت اﻷﺳﺎﺳﯾﺔ ﻟﺗﻛوﯾن اﻟﺑول‬
1. Glomerular filtration: Takes place in Glomeruli.
producing a cell- and protein-free filtrate.
2. Tubular reabsorption: Take place in the renal
tubules.
3. Tubular secretion: Also take place in the renal
tubules.
:‫ ﯾﺘﻀﻤﻦ ﺗﻜﻮﯾﻦ اﻟﺒﻮل ﺛﻼث ﻋﻤﻠﯿﺎت رﺋﯿﺴﯿﺔ‬.4
‫ إﻧﺘﺎج ﺗﺮﺷﯿﺢ ﺧﺎل ﻣﻦ اﻟﺨﻼﯾﺎ‬.‫ ﯾﺤﺪث ﻓﻲ اﻟﻜﺒﯿﺒﺎت‬:‫ اﻟﺘﺮﺷﯿﺢ اﻟﻜﺒﯿﺒﻲ‬.5
.‫واﻟﺒﺮوﺗﯿﻦ‬
.‫ ﺗﺤﺪث ﻓﻲ اﻷﻧﺎﺑﯿﺐ اﻟﻜﻠﻮﯾﺔ‬:‫ إﻋﺎدة اﻻﻣﺘﺼﺎص اﻷﻧﺒﻮﺑﻲ‬.6
.‫ ﯾﺤﺪث أﯾﻀﺎ ﻓﻲ اﻷﻧﺎﺑﯿﺐ اﻟﻜﻠﻮﯾﺔ‬:‫ إﻓﺮاز أﻧﺒﻮﺑﻲ‬.7
Figure 26-8;
Guyton and Hall

GLOMERULAR FILTRATION::‫اﻟﺘﺮﺷﯿﺢ اﻟﻜﺒﯿﺒﻲ‬ GLOMERULAR FILTRATION‫اﻟﺘﺮﺷﯿﺢ اﻟﻜﺒﯿﺒﻲ‬

Definition: Glomerular filtration is a passive process in which  Molecules smaller than 3 nm in diameter (such as water, glucose, amino
acids, and nitrogenous wastes) pass freely from the blood into the
hydrostatic pressure forces fluids and solutes through a membrane.
glomerular capsule. As a result, these substances usually have similar
The glomeruli can be viewed as simple mechanical filters because concentrations in the blood and the glomerular filtrate.
filtrate formation does not directly consume metabolic energy. Weitner  Larger molecules pass with greater difficulty.
passive
The Filtration Membrane: Lies between the blood and the  Molecules larger than 5 nm are generally barred from entering the
interior of the glomerular capsule. It is a porous membrane that tubule.
allows free passage of water and solutes smaller than plasma  The hydrostatic pressure in glomerular capillaries is the chief force (The
proteins. blood pressure in the glomerulus is approximately 55 mm Hg compared to
an average of 26 mm Hg in other capillary beds).
‫ اﻟﺘﺮﺷﯿﺢ اﻟﻜﺒﯿﺒﻲ ﻋﻤﻠﯿﺔ ﺳﻠﺒﯿﺔ ﯾﺪﻓﻊ ﻓﯿﮭﺎ اﻟﻀﻐﻂ اﻟﮭﯿﺪروﺳﺘﺎﺗﯿﻜﻲ اﻟﺴﻮاﺋﻞ‬:‫ﺗﻌﺮﯾﻒ‬
‫ ﻧﺎﻧﻮﻣﺘﺮ )ﻣﺜﻞ اﻟﻤﺎء واﻟﺠﻠﻮﻛﻮز واﻷﺣﻤﺎض اﻷﻣﯿﻨﯿﺔ واﻟﻨﻔﺎﯾﺎت‬3 ‫ ﺗﻤﺮ اﻟﺠﺰﯾﺌﺎت اﻟﺘﻲ ﯾﻘﻞ ﻗﻄﺮھﺎ ﻋﻦ‬
‫ ﯾﻤﻜﻦ اﻟﻨﻈﺮ إﻟﻰ اﻟﻜﺒﯿﺒﺎت ﻋﻠﻰ أﻧﮭﺎ ﻣﺮﺷﺤﺎت ﻣﯿﻜﺎﻧﯿﻜﯿﺔ‬.‫واﻟﻤﻮاد اﻟﻤﺬاﺑﺔ ﻋﺒﺮ ﻏﺸﺎء‬
‫ ﻋﺎدة ﻣﺎ ﯾﻜﻮن ﻟﮭﺬه اﻟﻤﻮاد‬، ‫ ﻧﺘﯿﺠﺔ ﻟﺬﻟﻚ‬.‫اﻟﻨﯿﺘﺮوﺟﯿﻨﯿﺔ( ﺑﺤﺮﯾﺔ ﻣﻦ اﻟﺪم إﻟﻰ اﻟﻜﺒﺴﻮﻟﺔ اﻟﻜﺒﯿﺒﯿﺔ‬
.‫ﺑﺴﯿﻄﺔ ﻷن ﺗﻜﻮﯾﻦ اﻟﺘﺮﺷﯿﺢ ﻻ ﯾﺴﺘﮭﻠﻚ اﻟﻄﺎﻗﺔ اﻷﯾﻀﯿﺔ ﻣﺒﺎﺷﺮة‬ .‫ﺗﺮﻛﯿﺰات ﻣﻤﺎﺛﻠﺔ ﻓﻲ اﻟﺪم واﻟﺘﺮﺷﯿﺢ اﻟﻜﺒﯿﺒﻲ‬
‫ إﻧﮫ ﻏﺸﺎء ﻣﺴﺎﻣﻲ ﯾﺴﻤﺢ ﺑﻤﺮور‬.‫ ﯾﻘﻊ ﺑﯿﻦ اﻟﺪم وداﺧﻞ اﻟﻜﺒﺴﻮﻟﺔ اﻟﻜﺒﯿﺒﯿﺔ‬:‫ﻏﺸﺎء اﻟﺘﺮﺷﯿﺢ‬ .‫ ﺗﻤﺮ اﻟﺠﺰﯾﺌﺎت اﻷﻛﺒﺮ ﺑﺼﻌﻮﺑﺔ أﻛﺒﺮ‬
.‫اﻟﻤﺎء ﺑﺤﺮﯾﺔ واﻟﻤﻮاد اﻟﻤﺬاﺑﺔ أﺻﻐﺮ ﻣﻦ ﺑﺮوﺗﯿﻨﺎت اﻟﺒﻼزﻣﺎ‬ .‫ ﻧﺎﻧﻮﻣﺘﺮ ﻣﻦ دﺧﻮل اﻟﻨﺒﯿﺒﺎت‬5 ‫ ﻋﺎدة ﻣﺎ ﺗﻤﻨﻊ اﻟﺠﺰﯾﺌﺎت اﻟﺘﻲ ﯾﺰﯾﺪ ﺣﺠﻤﮭﺎ ﻋﻦ‬
‫ اﻟﻀﻐﻂ اﻟﮭﯿﺪروﺳﺘﺎﺗﯿﻜﻲ ﻓﻲ اﻟﺸﻌﯿﺮات اﻟﺪﻣﻮﯾﺔ اﻟﻜﺒﯿﺒﯿﺔ ھﻮ اﻟﻘﻮة اﻟﺮﺋﯿﺴﯿﺔ )ﯾﺒﻠﻎ ﺿﻐﻂ اﻟﺪم ﻓﻲ‬
.(‫ ﻣﻠﻢ زﺋﺒﻖ ﻓﻲ اﻷﺳﺮة اﻟﺸﻌﺮﯾﺔ اﻷﺧﺮى‬26 ‫ ﻣﻠﻢ زﺋﺒﻖ ﻣﻘﺎرﻧﺔ ﺑﻤﺘﻮﺳﻂ‬55 ‫اﻟﻜﺒﯿﺒﺔ ﺣﻮاﻟﻲ‬
 GLOMERULAR FILTRATION RATE (GFR): GFR):) ‫ﻣﻌﺪل اﻟﺘﺮﺷﯿﺢ اﻟﻜﺒﯿﺒﻲ‬
Definition: The GFR is the volume of filtrate formed each ‫ھﻮ ﺣﺠﻢ اﻟﺘﺮﺷﯿﺢ اﻟﺬي ﯾﺘﻜﻮن ﻛﻞ دﻗﯿﻘﺔ ﻣﻦ اﻟﻨﺸﺎط‬GFR :‫ﺗﻌﺮﯾﻒ‬
minute by the combined activity of all 2 million glomeruli ‫ ﻣﻠﯿﻮن ﻛﺒﯿﺒﺔ ﻣﻦ اﻟﻜﻠﻰ‬2 ‫اﻟﻤﺸﺘﺮك ﻟﺠﻤﯿﻊ‬
of the kidneys
x o .‫ ﺳﯿﺆدي إﻟﻰ ﻋﺪم ﻛﻔﺎءة وﺗﺮاﻛﻢ ﻓﻀﻼت اﻟﺠﺴﻢ واﻟﺴﻤﻮم‬GFR: 
 GFR: will lead to the inefficient elimination and
j accumulation of the body waste products and toxins. ‫ﯾﻤﻜﻦ أن ﯾﺆدي إﻟﻰ ﻋﺪم ﻛﻔﺎﯾﺔ اﻟﻮﻗﺖ ﻹﻋﺎدة اﻻﻣﺘﺼﺎص‬GFR: 
 GFR: Can lead to insufficient time for proper .‫اﻟﻤﻨﺎﺳﺐ‬
reabsorption.
I increase
:‫• ﺗﺸﻤﻞ آﻟﯿﺎت اﻟﺘﺤﻜﻢ ﻓﻲ ﻣﻌﺪل اﻟﺘﺮﺷﯿﺢ اﻟﻜﺒﯿﺒﻲ ﻣﺎ ﯾﻠﻲ‬
Mechanisms Controlling the GFR include: (‫• اﻟﻨﻈﺎم اﻟﺪاﺧﻠﻲ )اﻟﺘﻨﻈﯿﻢ اﻟﺬاﺗﻲ اﻟﻜﻠﻮي‬
- Intrinsic system (Renal autoregulation) .(‫• اﻵﻟﯿﺎت اﻟﺨﺎرﺟﯿﺔ )اﻟﻀﻮاﺑﻂ اﻟﻌﺼﺒﯿﺔ واﻟﮭﺮﻣﻮﻧﯿﺔ‬
- Extrinsic (Neural controls & Hormonal)
mechanisms.

Filtration fraction ‫ﺟﺰء اﻟﺘﺮﺷﯿﺢ‬

 Is the fraction of renal plasma flow filtered across the ، ‫ ھﻮ ﺟﺰء ﻣﻦ ﺗﺪﻓﻖ اﻟﺒﻼزﻣﺎ اﻟﻜﻠﻮﯾﺔ اﻟﻤﺼﻔﺎة ﻋﺒﺮ اﻟﺸﻌﯿﺮات اﻟﺪﻣﻮﯾﺔ اﻟﻜﺒﯿﺒﯿﺔ‬
glomerular capillaries, i.e. the ratio of GFR to the renal .‫إﻟﻰ ﺗﺪﻓﻖ اﻟﺒﻼزﻣﺎ اﻟﻜﻠﻮﯾﺔ‬GFR ‫أي ﻧﺴﺒﺔ‬
plasma flow. ‫ ﻣﻌﺎد اﻣﺘﺼﺎﺻﮭﺎ و‬٪RPF (19 ‫ ﻣﻦ‬٪20 ‫ ﯾﺘﻢ ﺗﺮﺷﯿﺢ اﻟﻘﯿﻤﺔ اﻟﻄﺒﯿﻌﯿﺔ ﺣﻮاﻟﻲ‬
 Normal value about 20% of the RPF is filtered (19% .(‫ ﺗﻔﺮز‬٪1
reabsorbed & 1% excreted). ‫ اﻟﻤﺘﺒﻘﯿﺔ ﺗﺘﺮك اﻟﺸﻌﯿﺮات اﻟﺪﻣﻮﯾﺔ اﻟﻜﺒﯿﺒﯿﺔ ﻣﻦ اﻟﺸﺮاﯾﯿﻦ اﻟﺼﺎدرة‬٪ 80 ‫ ال‬
 The remaining 80% leaves the glomerular capillaries by .‫وأﺻﺒﺤﺖ اﻟﺪورة اﻟﺪﻣﻮﯾﺔ اﻟﺸﻌﺮﯾﺔ ﺣﻮل اﻷﻧﺒﻮب‬
I
the efferent arterioles and became the peritubular capillary
circulation. non filter
 cell
2. Tubular Reabsorption:arrests
blood
:‫ إﻋﺎدة اﻻﻣﺘﺼﺎص اﻷﻧﺒﻮﺑﻲ‬.2
The process of selectively moving ‫ ﻋﻤﻠﯿﺔ ﻧﻘﻞ اﻟﻤﻮاد ﺑﺸﻜﻞ اﻧﺘﻘﺎﺋﻲ ﻣﻦ اﻟﻤﺮﺷﺢ إﻟﻰ‬
substances from the filtrate back into .‫اﻟﺪم‬
the blood.
‫ ﻣﻦ ﺣﺠﻢ‬٪ 99 ‫ ﯾﺘﻢ إﻋﺎدة اﻣﺘﺼﺎص ﺣﻮاﻟﻲ‬
 About 99% of the filtrate volume is
.‫ ﯾﺼﺒﺢ اﻟﺒﻮل‬٪ 1 ‫اﻟﻤﺮﺷﺢ ؛‬
reabsorbed; 1% becomes urine.
 About 65% of the filtrate volume is
‫ ﻣﻦ ﺣﺠﻢ‬٪65 ‫ ﯾﺘﻢ إﻋﺎدة اﻣﺘﺼﺎص ﺣﻮاﻟﻲ‬
reabsorbed in the proximal .‫اﻟﺮاﺷﺢ ﻓﻲ اﻟﻨﺒﯿﺒﺎت اﻟﻤﻠﺘﻮﯾﺔ اﻟﻘﺮﯾﺒﺔ‬
convoluted tubule. ‫ ﻓﻲ اﻟﻄﺮف اﻟﮭﺎﺑﻂ‬٪ 15 ‫ ﯾﺘﻢ إﻋﺎدة اﻣﺘﺼﺎص‬
 15% is reabsorbed in the Henle. ‫ﻣﻦ ﺣﻠﻘﺔ‬
descending limb of the loop2 of ‫ ﻓﻲ اﻟﻨﺒﯿﺒﺎت اﻟﻤﻠﺘﻮﯾﺔ‬٪ 19 ‫ ﯾﺘﻢ إﻋﺎدة اﻣﺘﺼﺎص‬
Henle. .‫اﻟﺒﻌﯿﺪة وﻗﻨﺎة اﻟﺘﺠﻤﯿﻊ‬
 19% is reabsorbed in the distal
convoluted tubule and collecting
duct.

2. Tubular Reabsorption: :‫ إﻋﺎدة اﻻﻣﺘﺼﺎص اﻷﻧﺒﻮﺑﻲ‬.2

A. In proximal convulated tubules: :‫ ﻓﻲ اﻷﻧﺎﺑﯿﺐ اﻟﻤﺘﺸﻨﺠﺔ اﻟﻘﺮﯾﺒﺔ‬.‫ أ‬
 A large portion of the water, sodium ‫ ﯾﺘﻢ إﻋﺎدة اﻣﺘﺼﺎص ﺟﺰء ﻛﺒﯿﺮ ﻣﻦ اﻟﻤﺎء‬
chloride, bicarbonate, potassium, ‫وﻛﻠﻮرﯾﺪ اﻟﺼﻮدﯾﻮم واﻟﺒﯿﻜﺮﺑﻮﻧﺎت واﻟﺒﻮﺗﺎﺳﯿﻮم‬
calcium, amino acids, glucose and ‫واﻟﻜﺎﻟﺴﯿﻮم واﻷﺣﻤﺎض اﻷﻣﯿﻨﯿﺔ واﻟﺠﻠﻮﻛﻮز‬
other substances needed by the body ‫واﻟﻤﻮاد اﻷﺧﺮى اﻟﺘﻲ ﯾﺤﺘﺎﺟﮭﺎ اﻟﺠﺴﻢ وﺗﻌﻮد‬
are reabsorbed and pass back into .‫إﻟﻰ ﻣﺠﺮى اﻟﺪم‬
the bloodstream. :‫ ﺣﻠﻘﺔ ﺗﻨﺎزﻟﯿﺔ‬.‫ ب‬
I
B. Descending loop: ‫ ﯾﺘﺤﺮك اﻟﻤﺎء ﻟﻤﺤﺎوﻟﺔ ﺗﺤﻘﯿﻖ‬، ‫ ﻧﻔﺎذﯾﺔ إﻟﻰ اﻟﻤﺎء‬
 Permeable to water, water moves to ‫اﻟﺘﻌﺎدل‬
try to equalize :‫ اﻟﺤﻠﻘﺔ اﻟﺘﺼﺎﻋﺪﯾﺔ‬-‫ ج‬
C.Ascending loop: .‫ إﻋﺎدة اﻣﺘﺼﺎص ﻧﺸﻂ ﻟﻜﻠﻮرﯾﺪ اﻟﺼﻮدﯾﻮم‬
 Active reabsorption of sodium
chloride.
 3. Tubular Secretion: :‫ إﻓﺮاز أﻧﺒﻮﺑﻲ‬.3
The process of selectively moving substances from the .‫ ﻋﻤﻠﯿﺔ ﻧﻘﻞ اﻟﻤﻮاد ﺑﺸﻜﻞ اﻧﺘﻘﺎﺋﻲ ﻣﻦ اﻟﺪم إﻟﻰ اﻟﻤﺮﺷﺢ‬
blood into the filtrate. :‫ ﻋﻤﻠﯿﺔ اﻹﻓﺮاز اﻷﻧﺒﻮﺑﻲ‬
The tubular secretion process: ‫ ﯾﺰﯾﻞ اﻟﻨﻔﺎﯾﺎت اﻷﺟﻨﺒﯿﺔ ﻏﯿﺮ اﻟﻀﺮورﯾﺔ اﻟﺘﻲ ﻻ ﯾﺘﻢ ﺗﺮﺷﯿﺤﮭﺎ‬
 Removes unneeded foreign waste substances that .‫ﺑﻮاﺳﻄﺔ اﻟﻜﺒﯿﺒﺔ ﺑﻤﺎ ﻓﻲ ذﻟﻚ اﻷدوﯾﺔ واﻟﺴﻤﻮم اﻟﻤﺨﺘﻠﻔﺔ‬
are not filtered by the glomerulus including ‫ ﯾﻌﺰز إﻓﺮاز أﯾﻮﻧﺎت اﻟﮭﯿﺪروﺟﯿﻦ واﻷﯾﻮﻧﺎت اﻷﺧﺮى ﻟﻠﻤﺴﺎﻋﺪة ﻓﻲ‬
various medications and toxins. .‫ﺗﻨﻈﯿﻢ ﺗﻮازن اﻟﺤﻤﺾ واﻟﻘﺎﻋﺪة واﻟﻜﮭﺎرل‬
 Promotes secretion of hydrogen ions and other ‫ ﻛﻤﺎ ﯾﺘﻢ إﻓﺮاز أﯾﻮﻧﺎت ﻣﺨﺘﻠﻔﺔ )أﯾﻮﻧﺎت اﻷﻣﻮﻧﯿﻮم واﻟﺼﻮدﯾﻮم‬
ions to help regulate acid – base and electrolytes (..,‫واﻟﺒﻮﺗﺎﺳﯿﻮم واﻟﺒﯿﻜﺮﺑﻮﻧﺎت وﺣﻤﺾ اﻟﯿﻮرﯾﻚ‬
balance. .‫ ﯾﺤﺪث اﻹﻓﺮاز اﻷﻧﺒﻮﺑﻲ ﺑﺸﻜﻞ رﺋﯿﺴﻲ ﺑﺴﺒﺐ اﻟﻨﻘﻞ اﻟﻨﺸﻂ‬
 Various ions are also secreted (ammonium ions,
sodium, potassium, bicarbonate, uric acid,..)
 Tubular secretion is caused mainly by active
transport.TWreationatietraffy
 DIFFERENCE BETWEEN FILTRATE AND URINE NORMAL COMPOSITION OF URINE
‫اﻟﻔﺮق ﺑﯿﻦ اﻟﺘﺮﺷﯿﺢ واﻟﺒﻮل‬
 The final composition of urine is the result of filtration,
 Filtrate contains everything found in blood plasma
absorption and secretion by the nephrons.
except proteins.
 The kidneys produce, on average, 1.5 liters of urine each
 Urine contains unneeded substances such as excess salts
day. important
and metabolic wastes. The kidneys process about 180 L
 Chemical composition: (normal constituents of urine)
of blood-derived fluid daily. Of this amount, less than
1% (1.5 L) typically leaves the body as urine; the rest  95% water.
returns to the circulation.  5% solutes (urea, sodium chloride (NaCl), potassium,
creatinine, uric acid).
.‫ ﯾﺤﺘﻮي اﻟﻤﺮﺷﺢ ﻋﻠﻰ ﻛﻞ ﺷﻲء ﻣﻮﺟﻮد ﻓﻲ ﺑﻼزﻣﺎ اﻟﺪم ﺑﺎﺳﺘﺜﻨﺎء اﻟﺒﺮوﺗﯿﻨﺎت‬
 Volume:
‫ ﯾﺤﺘﻮي اﻟﺒﻮل ﻋﻠﻰ ﻣﻮاد ﻏﯿﺮ ﺿﺮورﯾﺔ ﻣﺜﻞ اﻷﻣﻼح اﻟﺰاﺋﺪة واﻟﻨﻔﺎﯾﺎت‬
 Normal volume: Passage of 1 to 2 L/day (Average 1.5).
.‫ ﻟﺘﺮا ﻣﻦ اﻟﺴﻮاﺋﻞ اﻟﻤﺸﺘﻘﺔ ﻣﻦ اﻟﺪم ﯾﻮﻣﯿﺎ‬180 ‫ ﺗﻌﺎﻟﺞ اﻟﻜﻠﻰ ﺣﻮاﻟﻲ‬.‫اﻷﯾﻀﯿﺔ‬
 Polyuria: Passage of more than 2L/day of urine.
‫ اﻟﺒﺎﻗﻲ‬.‫ ﻟﺘﺮ( ﻋﺎدة ﻣﺎ ﯾﺘﺮك اﻟﺠﺴﻢ ﻛﺒﻮل‬1.5) ٪ 1 ‫ أﻗﻞ ﻣﻦ‬، ‫ﻣﻦ ھﺬه اﻟﻜﻤﯿﺔ‬ home
.‫ﯾﻌﻮد إﻟﻰ اﻟﺪورة اﻟﺪﻣﻮﯾﺔ‬ Jabrand
 Oliguria: Passage of less than 500 mL/day of urine.
 Anuria: Passage of less than 100 mL/day of urine.
G absenses

‫اﻟﺘﻜﻮﯾﻦ اﻟﻄﺒﯿﻌﻲ ﻟﻠﺒﻮل‬

‫ اﻟﺘﻜﻮﯾﻦ اﻟﻨﮭﺎﺋﻲ ﻟﻠﺒﻮل ھﻮ ﻧﺘﯿﺠﺔ اﻟﺘﺮﺷﯿﺢ واﻻﻣﺘﺼﺎص واﻹﻓﺮاز ﺑﻮاﺳﻄﺔ‬
.‫اﻟﻨﯿﻔﺮون‬
.‫ ﻟﺘﺮ ﻣﻦ اﻟﺒﻮل ﻛﻞ ﯾﻮم‬1.5 ، ‫ ﻓﻲ اﻟﻤﺘﻮﺳﻂ‬، ‫ ﺗﻨﺘﺞ اﻟﻜﻠﻰ‬
(‫ )اﻟﻤﻜﻮﻧﺎت اﻟﻄﺒﯿﻌﯿﺔ ﻟﻠﺒﻮل‬:‫ اﻟﺘﺮﻛﯿﺐ اﻟﻜﯿﻤﯿﺎﺋﻲ‬ I finding
.‫ ﻣﺎء‬٪95 
، (‫ ﻛﻠﻮرﯾﺪ اﻟﺼﻮدﯾﻮم )ﻛﻠﻮرﯾﺪ اﻟﺼﻮدﯾﻮم‬، ‫ اﻟﻤﻮاد اﻟﻤﺬاﺑﺔ )اﻟﯿﻮرﯾﺎ‬٪ 5 
.(‫ ﺣﻤﺾ اﻟﯿﻮرﯾﻚ‬، ‫ اﻟﻜﺮﯾﺎﺗﯿﻨﯿﻦ‬، ‫اﻟﺒﻮﺗﺎﺳﯿﻮم‬
:‫ ﺣﺠﻢ‬
.(1.5 ‫ ﯾﻮم )ﻣﺘﻮﺳﻂ‬/ ‫ ﻟﺘﺮ‬2 ‫ إﻟﻰ‬1 ‫ ﻣﺮور‬:‫ اﻟﺤﺠﻢ اﻟﻄﺒﯿﻌﻲ‬
.‫ ﯾﻮم ﻣﻦ اﻟﺒﻮل‬/ ‫ ﻟﺘﺮ‬2 ‫ ﻣﺮور أﻛﺜﺮ ﻣﻦ‬:‫ ﺑﻮال‬
.‫ ﯾﻮم ﻣﻦ اﻟﺒﻮل‬/ ‫ ﻣﻞ‬500 ‫ ﻣﺮور أﻗﻞ ﻣﻦ‬:‫ ﻗﻠﺔ اﻟﺒﻮل‬ IN D
.‫ ﯾﻮم ﻣﻦ اﻟﺒﻮل‬/ ‫ ﻣﻞ‬100 ‫ ﻣﺮور أﻗﻞ ﻣﻦ‬:‫ اﻧﻘﻄﺎع اﻟﺒﻮل‬ WE
 Micturition‫اﻟﺘﺒﻮل‬ Micturition Reflex
 Micturition: The act of emptying the urinary bladder. When the volume of urine in the bladder reaches about
 Higher brain centers control the micturition reflex. Stretching of the
250 ml, stretch receptors in the bladder walls are
urinary bladder stimulates sensory neurons that carry impulses to the
brain and inform the brain of the need to urinate. stimulated and excite sensory parasympathetic fibers
 For micturition to occur: which relay information to the sacral area of the spine.
1. The detrusor must contract, This information is integrated in the spine and relayed to
2. The internal urethral sphincter must open. two different sets of neurons at the same time:
3. The external urethral sphincter must open. 1. Stimulation of the Parasympathetic motor neurons
.‫ ﻓﻌﻞ إﻓﺮاغ اﻟﻤﺜﺎﻧﺔ اﻟﺒﻮﻟﯿﺔ‬:‫ اﻟﺘﺒﻮل‬
 Contraction of the detrusor muscles in the bladder
‫ ﯾﺤﻔﺰ ﺗﻤﺪد اﻟﻤﺜﺎﻧﺔ اﻟﺒﻮﻟﯿﺔ اﻟﺨﻼﯾﺎ اﻟﻌﺼﺒﯿﺔ اﻟﺤﺴﯿﺔ‬.‫ ﺗﺘﺤﻜﻢ ﻣﺮاﻛﺰ اﻟﺪﻣﺎغ اﻟﻌﻠﯿﺎ ﻓﻲ ﻣﻨﻌﻜﺲ اﻟﺘﺒﻮل‬
.‫اﻟﺘﻲ ﺗﺤﻤﻞ اﻟﻨﺒﻀﺎت إﻟﻰ اﻟﺪﻣﺎغ وﺗﺒﻠﻎ اﻟﺪﻣﺎغ ﺑﺎﻟﺤﺎﺟﺔ إﻟﻰ اﻟﺘﺒﻮل‬  Opening of the internal urethral sphincter.
:‫ ﻟﺤﺪوث اﻟﺘﺒﻮل‬ 2. Stimulation of Somatic motor neurons:
، ‫ ﯾﺠﺐ أن ﺗﻨﻜﻤﺶ اﻟﻨﺎﻓﺼﺔ‬
 Opening of the external sphincter allowing urine to
.‫ ﯾﺠﺐ ﻓﺘﺢ اﻟﻌﻀﻠﺔ اﻟﻌﺎﺻﺮة اﻟﺪاﺧﻠﯿﺔ ﻟﻺﺣﻠﯿﻞ‬
.‫ ﯾﺠﺐ ﻓﺘﺢ اﻟﻌﻀﻠﺔ اﻟﻌﺎﺻﺮة اﻟﺨﺎرﺟﯿﺔ ﻟﻺﺣﻠﯿﻞ‬
flow out, assisted by gravity.

‫ﻣﻨﻌﻜﺲ اﻟﺘﺒﻮل‬
‫ ﯾﺘﻢ ﺗﺤﻔﯿﺰ‬، ‫ ﻣﻞ‬250 ‫ ﻋﻨﺪﻣﺎ ﯾﺼﻞ ﺣﺠﻢ اﻟﺒﻮل ﻓﻲ اﻟﻤﺜﺎﻧﺔ إﻟﻰ ﺣﻮاﻟﻲ‬
‫ﻣﺴﺘﻘﺒﻼت اﻟﺘﻤﺪد ﻓﻲ ﺟﺪران اﻟﻤﺜﺎﻧﺔ وإﺛﺎرة اﻷﻟﯿﺎف اﻟﺤﺴﯿﺔ اﻟﺴﻤﺒﺘﺎوي اﻟﺘﻲ‬
‫ ﯾﺘﻢ دﻣﺞ ھﺬه‬.‫ﺗﻨﻘﻞ اﻟﻤﻌﻠﻮﻣﺎت إﻟﻰ اﻟﻤﻨﻄﻘﺔ اﻟﻤﻘﺪﺳﺔ ﻣﻦ اﻟﻌﻤﻮد اﻟﻔﻘﺮي‬
‫اﻟﻤﻌﻠﻮﻣﺎت ﻓﻲ اﻟﻌﻤﻮد اﻟﻔﻘﺮي وﻧﻘﻠﮭﺎ إﻟﻰ ﻣﺠﻤﻮﻋﺘﯿﻦ ﻣﺨﺘﻠﻔﺘﯿﻦ ﻣﻦ اﻟﺨﻼﯾﺎ‬
:‫اﻟﻌﺼﺒﯿﺔ ﻓﻲ ﻧﻔﺲ اﻟﻮﻗﺖ‬
‫ ﺗﺤﻔﯿﺰ اﻟﺨﻼﯾﺎ اﻟﻌﺼﺒﯿﺔ اﻟﺤﺮﻛﯿﺔ اﻟﺴﻤﺒﺘﺎوي‬
‫ ﺗﻘﻠﺺ ﻋﻀﻼت اﻟﻨﺎﻓﺼﺔ ﻓﻲ اﻟﻤﺜﺎﻧﺔ‬
.‫ ﻓﺘﺢ اﻟﻌﻀﻠﺔ اﻟﻌﺎﺻﺮة اﻟﺪاﺧﻠﯿﺔ ﻟﻺﺣﻠﯿﻞ‬
:‫ ﺗﺤﻔﯿﺰ اﻟﺨﻼﯾﺎ اﻟﻌﺼﺒﯿﺔ اﻟﺤﺮﻛﯿﺔ اﻟﺠﺴﺪﯾﺔ‬
‫ ﺑﻤﺴﺎﻋﺪة‬، ‫ ﻓﺘﺢ اﻟﻌﻀﻠﺔ اﻟﻌﺎﺻﺮة اﻟﺨﺎرﺟﯿﺔ ﻣﻤﺎ ﯾﺴﻤﺢ ﻟﻠﺒﻮل ﺑﺎﻟﺘﺪﻓﻖ‬
.‫اﻟﺠﺎذﺑﯿﺔ‬
 ASSESSING KIDNEY FUNCTION‫ﺗﻘﯿﯿﻢ وظﺎﺋﻒ اﻟﻜﻠﻰ‬
 Blood tests: Plasma concentration of waste products (BUN, References‫ﻣﺮاﺟﻊ‬
creatinine, uric acid, .....)
 Urine tests: Urine specific gravity, Albumin excretion (presence of
the albumin in urine, microalbuminuria) 1. Marieb E. & Hoehn K. ( 2023). Human
 Imaging methods (MRI, ultrasound,....... etc)
 Biopsy
Anatomy & Physiology, 12th Global Edition-
 Clearance methods (24-hr creatinine clearance) Pearson Education Limited.
 Urine specific gravity: weight (density) compared to an equal
amount of distilled water.
، ‫ ﺣﻤﺾ اﻟﯿﻮرﯾﻚ‬، ‫ اﻟﻜﺮﯾﺎﺗﯿﻨﯿﻦ‬،BUN ) ‫ ﺗﺮﻛﯿﺰ اﻟﺒﻼزﻣﺎ ﻣﻦ اﻟﻨﻔﺎﯾﺎت‬:‫ اﺧﺘﺒﺎرات اﻟﺪم‬ 2. VanPutte C., Regan J., & Russo A. (2021).
(..... Seeley’s Essentials of Anatomy & Physiology,
‫ ﺑﯿﻠﺔ‬، ‫ إﻓﺮاز اﻷﻟﺒﻮﻣﯿﻦ )وﺟﻮد اﻷﻟﺒﻮﻣﯿﻦ ﻓﻲ اﻟﺒﻮل‬، ‫ اﻟﺜﻘﻞ اﻟﻨﻮﻋﻲ ﻟﻠﺒﻮل‬:‫ اﺧﺘﺒﺎرات اﻟﺒﻮل‬ 11th Edition- McGraw Hill Education.
(‫اﻟﺰﻻل اﻟﺪﻗﯿﻘﺔ‬
(‫ اﻟﺦ‬.......,‫ اﻟﻤﻮﺟﺎت ﻓﻮق اﻟﺼﻮﺗﯿﺔ‬، ‫ طﺮق اﻟﺘﺼﻮﯾﺮ )اﻟﺘﺼﻮﯾﺮ ﺑﺎﻟﺮﻧﯿﻦ اﻟﻤﻐﻨﺎطﯿﺴﻲ‬
‫ ﺧﺰﻋﮫ‬
(‫ ﺳﺎﻋﺔ‬24 ‫ طﺮق اﻟﺘﺨﻠﯿﺺ )ﺗﺼﻔﯿﺔ اﻟﻜﺮﯾﺎﺗﯿﻨﯿﻦ ﻋﻠﻰ ﻣﺪار‬
.‫ اﻟﻮزن )اﻟﻜﺜﺎﻓﺔ( ﻣﻘﺎرﻧﺔ ﺑﻜﻤﯿﺔ ﻣﺘﺴﺎوﯾﺔ ﻣﻦ اﻟﻤﺎء اﻟﻤﻘﻄﺮ‬:‫ اﻟﺜﻘﻞ اﻟﻨﻮﻋﻲ ﻟﻠﺒﻮل‬