URINARY SYSTEM

 It is one of the excretory system of the body.

 It consists of two Kidneys which secrete urine to uterus which convey urine from kidney to bladder,
one bladder where urine collect the term and is temporarily stored 13 through which the urine is
discharged.

Kidney
 It lies on the posterior abdominal Wall one on each side of vertebral column.
 They extend from the level of thoracic vertebrae till lumbar vertebrae.
 The right kidney is slightly lower than the left.
 They are Bean shaped organ for about 11 cm long 6 cm wide 3 cm thick.

Gross Anatomy of kidney:

 Three areas of tissue which can be distinguished in a longitudinal section of kidney is viewed by naked
eyes.
 Fibrous capsule surrounding the Kidneys. A cortex a reddish brown layer of tissue.
 The medulla innermost layer that consists of conical shaped renal pyramid.
 The hilum that is in the medial border of kidney where the renal blood lymph vessel urator and nerves
enter.
  Renal pelvis is a funnel shaped structure which act as hollow object for urine that is formed by kidney.
 It has a number of distilled branches called calix each in each kidney which surrounds the apex of renal
pyramid.
 The urine is formed in the Kidney and passes through the pappila at the apex of pyramid into minor
calyx later into major calyx before passing into ureter.
 The walls of pelvis contains smooth muscle and lined with transitional epithelium.
 The basis of the smooth muscle origin aching in pacemaker cells in the walls of calyces form urine
then through the pelvis and ureter then through bladder.
 It is an intrinsic pathway of smooth muscle and is not under the Nerve cells.
Functions of Kidney:
 Its main its main function is to maintain water equilibrium, pH equilibrium, osmotic equilibrium, Ionic
Equilibrium.
 It aids to keep the optimum concentration of certain important substances.
 Poisonous and foreign substances from the body which includes drugs and toxins.
 It's synthesize new substance ammonia and inorganic phosphate.
 Ammonia also helps in maintaining acid base equilibrium. Formation and Recreation of urine.
 Production and saturation of erythropoietin.
 Production and maintaining enzyme and controlling of BP.
 Helps in kidney excretion secrete synthesis and equilibrium to keep the constituency of blood by
process of filtration, secretion, reabsorption and excretion.

Nephron:
 It is a structural and functional unit of kidney.
 There are about 1million nephron in each kidney. Normally not all are functioning.
 It consists of Bowman’s capsule, glomerulus, proximal convoluted tubule, loop of henle, distal
convoluted tubule and collecting duct.
Structure of nephron:
 It is the structural and functional unit of kidney.
 1,000,000 nephron in one kidney.
 Normally all are not active.
 Each nephron consists of Bowman’s capsule, glomerulus and proximal convoluted tubule, loop of
Henley, distal convoluted tubule and collecting tubule.
Bowman’s capsule:
 It is proximal, blind, dilated end which covers up like a cap on the glomerular tuft so that the
glomerular blood is filtered into the nephron.
Glomerulus:
 It is a tuft of capillaries with an afferent capillary coming in from the circulation and an efferent
capillary going out into the circulation.
Glomeruli:
 Act as a positive ultra-filters.
 The deep protein plasma is filtered through a glomerulus into the nephron.
Renal tubule:
 The tubular part of the nephron and its about 0.3 centimetre in length.
 There are about 2 millions in both kidney.
 it has the following parts:
1. narrow neck
2. proximal convoluted tubule
3. loop of Henley
4. secondary or distal convoluted tubule
5. Collecting tubule
6. Duct of Bellini
1. Narrow neck: It is constricted and lined by cubicle cells.
2. Proximal convoluted tubule: Lined by cubicle cells and are active and secrete enzymes like
carbonic anhydrase which help in maintenance of acid base balance.
3. Loop of Henley: U shaped tube and has descending limb and ascending limb, it is constricted part
of nephron and is physiologically important because it reabsorbs a number of important substances
that are filtered by glomerulus back into the blood.
 4. Distal convoluted tubule: lined by cuboidal cells, the absorption of sodium is under control of
aldosterone which takes place in this part of nephron.
5. Collecting tubule: lined by cuboidal cells, convoluted tubule of many nephrons combined into one
straight tube.
6. Duct of Bellini: arises from the final combination of many straight tubules and finally drained into
the apex of pyramid of kidney.
Physiology of urine formation:
Mainly three processes are involved in the urine formation filtration, tubular reabsorption, tubular
secretion.
 Glomerular filtration:
It is a filtration of body fluid and solutes from the blood out of glomerular capillaries into bowman's
capsule.
All substances from the blood of filtered out except retains blood cells.
Filtration takes place in associated by the difference between the blood pressure in glomerulus and
pressure of the filtration glomerular capsule because of the diameter of afferent at areas it is less than that of
different efferent arterials of the capillary.
 Tubular reabsorption:
About 180 liters of deprotenised Plasma is filtered out through the normal life in 24 hours but only
1.2 - 1.5-liter urine finally secreted daily the rest of the fluid with many important constituents are reabsorbed
back to the blood.
o Glucose:
It is reabsorbed completely from the proximal convoluted tubule along with glucose Galactose,
Fructose are also observed.
o Water:
More than 85% of water is reabsorbed from the distal convoluted tubule henle's loop and proximal
convoluted tubule this reabsorption is controlled by the antidiuretic hormone of posterior gland.
ADH or vasopressin regulate extracellular water by adjusting the amount of water absorbed in the
blood by distal convoluted tubule and collecting duct when this fails reabsorption does not take place and
abundant amount of urine followers and this is called diabetes insipidus.
o Salt:
Sodium chloride is reabsorbed in the proximal and distal convoluted tubule.
Potassium is completely absorbed from the proximal convoluted.
o Bicarbonate:
It is reabsorbed by tubules.
Phosphate is reabsorbed by proximal convoluted tubule and Aldosterone is an hormone which regulate
the extracellular fluid volume by adjusting the amount of sodium reabsorbed.
 Tubular secretion:
 Substances which are not found in the filtrate are also found in urine so therefore they directly excreted
from the blood by tributes themselves through enzyme mechanism drugs like phenol penicillin are directly
excreted by tubular cells from the blood.
o Acid base balance:
Extracellular fluid ranged from 7.35 to 7.45. Mentoring of it is essential and depends on three major
mechanism. Buffer system, respiration, kidney excretion.
o Micturition:
Urinary bladder actors Reservoir for urine effort and automatic fibres in bladder wall sense to stretch.
In infants this initiate is in spinal reflex.

Role of kidney in acid base balance

In healthy person the pH of extracellular fluid range from 7.35 to 7.45 maintenance of this essential for
survival.
3 major mechanisms:
1. buffer system
2. respiration
3. kidney excretion
Buffer system:
Most buffer systems of the body are weak acids and weak base it includes:
 Carbonic acid - bicarbonate system.
 Phosphate system
 The hemoglobin oxygen system
 Protein system

1. Carbonic acid – bicarbonate system:

 Based on carbonic acid and sodium bicarbonate.
 Hcl+NaHCO3 = NaCl + H2O3
 NaOH + H2CO3 = NaHCO3 + H2O
 Body needs more bicarbonate salt than carbonic acid.
2. Phosphate buffer system:
 It has 2 components namely sodium dihydrogen phosphate and sodium mono hydrogen
phosphate.
 NaOH + NaH2PO4 = H2O + Na2HPO4.
 Hcl + Na2HPO4 = NaCl + Na2HPO4
Important mechanism in kidney:
 Sodium dihydrogen phosphate is formed when excess of hydrogen ion in kidney combined
with sodium dihydrogen phosphate.
 The sodium released from this reaction forms sodium bicarbonate and passed into blood.
 The hydrogen ion that replaces sodium become part of sodium dihydrogen phosphate and is
passed into urine.
 This reaction tends to reduce acidity of the blood.
3. the oxyhemoglobin buffer system:
 Active system for buffering carbonic acid in blood.
4. protein buffer system:
 It is the most abundant buffer in body cells and plasma.
 The amino acid contain carboxyl group and at least one amino group.
 The carboxyl group act as an acid and amine group act as a base.
 They can react with excess hydroxide and hydrogen ions.
 Kidney play an important role in maintaining pH by excretion of hydrogen ions and
Reabsorption of bicarbonate ion.
Formation of ammonia
 It is another important mechanism that helps in acid base balance.
 Ammonia react with hydrogen ion and form ammonium ion.
 It’s created in urine in combination with chlorine ion as ammonium chloride NH4Cl.
Micturition reflexes:
 When 300 to 400 ml of urine accumulated in the urinary bladder, afferent autonomic nerve fibres in
the bladder wall sensitise to stretch and are stimulated.
 In the infants this initiates a spinal reflex occur and micturition occur.
 Micturition occur when autonomic efferent fibres convey impulses to bladder causing contraction of
detrusor muscle and relaxation of internal urethral sphincter.
 Nervous system fully developed micturition reflex is stimulated but sensory impulses pass upward to
the brain and the awareness of desire to pass urine.
 Role of RAS
 Renin is secreted by juxtaglomerular apparatus in kidney.
 It is a peptide with 340 amino acids.
 Along with angiotensin Renin forms renin angiotensin system.
 Angiotensinogen is converted into angiotensin one and one is converted to angiotensin 2 by activity
of angiotensin converting enzyme [ACE] which is secreted by the lungs.
 Angiotensin 2 has short life about one to 2 minutes.
 It is rapidly degraded by angiotensin 3 by angiotensinase and 3 rapidly converted into 4
Angiotensin 2 regulates GFR into ways:
 Constrict the efferent arterioles which cause decrease in the filtration.
 It increases sodium reabsorption from renal tubule and more on PCT.

DISORDERS OF URINARY SYSTEM

1. Renal calculi or kidney stones:
 These are stones formed in kidney and bladder when urinary constituencies in solution are
precipitated.
 Solutes involved are oxalates phosphate.
 They consists of more than one substance deposit in layers.
 It is more common in males, they originate in Renal papilla and pass into renal pelvis where
they may increase in size hence, obstructing the flow of urine.
2. Glomerulonephritis:
 It is inflammatory condition of glomerulus.
 There are several types:
In many cases in immune complex damage the glamour like these are formed when antigen
and antibody combine either and kidney or in the body when immune complexes are large and deposit
in walls of the like which cause inflammation response.
There are two type:
 Diffuse glomerulonephritis and
 Membranous glomerulonephritis.
3. Cystitis:
 Inflammation of urinary bladder caused by infection and usually accompanied by frequent
painful urination.
 More common in females.
o Risk factors:

Most cases have infectious cause bacteria enters from external genitourinary structure.
o Treatment:

Three days course of antibiotics example: nitrofurantoin, ciprofloxacin, ofloxacin.

4. Urinary incontinence:
 It is an involuntary leakage of urine.
 Control over urinary spinster is either lost or weakened.
 Most common among women than men.
o Symptoms:

Unintentional release of urine common in women who give birth or have gone through
Menopause.

o Risk factors:

Obesity, diabetes, smoking, old age.