The Urinary System:

● The kidneys filter waste products from the blood and convert the filtrate into urine.
● The ureters, urinary bladder and urethra are collectively known as urinary tract.
Functions:
. Removes waste from blood.
. Stores Urine: Urinary bladder is an expandable, muscular sac that can store as much as 1 liter
 .
of urine.
. Expulsion of urine: Urethra transports urine out of the urinary bladder. (Micturition).
. Regulation of blood Volume and thus the blood pressure.
. Regulation of erythrocyte production by production of erythropoietin which acts on stem cells
in the bone marrow to increase erythrocyte production.
. Regulation of ion levels: Help control ion balance such as sodium, potassium, calcium and
phosphate.
. Regulation of acid-base balance: alter blood levels of both hydrogen ions (H+) and bicarbonate
ions (HCO3-).

The table below summarizes the various structures of the urinary system:

Kidneys:
● Bean shaped, reddish brown.
● Posterior abdominal wall, lateral to vertebral column.
● Each kidney weighs about 100 grams and measures about 12 cm in length, 6.5 cm in width and
2.5 cm in thickness.

Gross and sectional Anatomy of the Kidney:

● Retroperitoneal.
● Left kidney is slightly (2 cm) superior to the right kidney.
● The superior pole of the left kidney is at level of T12 vertebrae and its inferior pole is at about
the level of the L3 vertebrae.
● Hilum: the medial concave border of the kidney where vessels, nerves and the ureter enter or
exit the kidney.
● Renal sinus: the hilum is continuous with an internal space called renal sinus that houses renal
arteries, renal veins, lymph vessels, nerves, the renal pelvis, renal calyces and variable amount
of fat.
● Each kidney is surrounded and supported by several tissue layers from innermost to outermost:
. Fibrous Capsule: adheres directly to the inner surface of the kidneys. Made of dense irregular
connective tissue. Maintains shape of the kidney, protects from trauma and help prevent
infectious pathogens from entering the kidney.
. Perinephric (perirenal) Fat: Made of adipose connective tissue. Offers cushioning and support.
. Renal Fascia: made of dense irregular connective tissue. Anchors the kidney to the posterior
abdominal wall and the peritoneum.
. Paranephric (pararenal) fat: made of adipose connective tissue.
 ● Each kidney has an outer renal cortex and inner renal medulla.
● Renal Column: These are extensions of cortex into the medulla.
● Renal pyramids (Medullary pyramids): Renal columns divide the medulla into 8-15 renal
pyramids.
● Corticomedullary junction: the wide base of the renal pyramid lies at the external edge of the
medulla where the cortex and medulla meet, this is called the corticomedullary junction.
● Renal papilla: the apex (tip) of the medullary pyramid that projects towards the renal sinus.

● Minor calyx: each renal papilla projects into a funnel shaped space called the minor calyx. (One
minor calyx per renal pyramid).
● Major calyx: several minor calyces merge to form a major calyx. Each kidney has 2-3 major
calyces.
● Renal Pelvis: The major calyces merge to form a large, funnel shaped renal pelvis that collects
urine and transports it to the ureters.
● Renal lobes: A renal lobe consists of a medullary pyramid and some cortical substance
surrounding it. Each kidney has 8-15 renal lobes.

Blood Supply to the Kidneys:

● 20-25% of the body's blood supply flows through the kidneys at any given moment.
● Blood is carried to the kidneys in the renal artery.
● Up to 5 segmental arteries branch from the renal artery within the renal sinus.
● While still within the renal sinus, the segmental arteries branch further to form the interlobar
arteries.
● Interlobar arteries travel through the renal column towards the corticomedullary junction where
they branch to form arcuate arteries which lie parallel to the base of the medullary pyramid at
the corticomedullary junction.
● Arcuate arteries give off branches called interlobular arteries that project into the cortex.
 ● The interlobular arteries extend small branches called afferent arteriole which enters the renal
corpuscle and forms a network of capillaries called the glomerulus.
● Once blood plasma is filtered, the remaining blood enters the efferent arteriole.
● The efferent arteriole branch into either:
a. Peritubular capillaries: intertwined with the convoluted tubules and reside in the cortex of the
kidneys.
b. Vasa recta: intertwined with the loop of Henle, and reside mainly in the medulla.
● Peritubular capillaries and vasa recta then drain the blood into a network of veins.
● The smallest vein is the interlobular vein.
● Interlobular veins merge to form arcuate veins that project parallel to the base of the
corticomedullary junction.
● Arcuate veins merge to form interlobar veins that travel through the renal column towards the
renal sinus.
● The interlobar veins join to form the renal vein in the renal sinus.
● The renal vein leaves the kidneys at the hilum and drains into the vena cava.
● Blood remains oxygenated until it reaches peritubular capillaries or vasa recta where gas
exchange occurs.
Nephrons:
● Functional filtration unit in the kidneys.
● A nephron has 2 main parts:
a. Renal corpuscle: consist of glomerulus and glomerular capsule.
b. Renal Tubule: consist of proximal convoluted tubule, loop of Henle and distal convoluted tubule.
 ● There are two main types of nephrons:
a. Cortical Nephrons (85%): they reside almost completely in the cortex and have short nephron loops
that barely penetrate the medulla.
b. Juxtamedullary Nephrons (15%): Their renal corpuscle lie close to the corticomedullary junction,
and their long nephron loop extend deep into the medulla.
Urine Formation:
Three main steps:
. Glomerular Filtration: water and small solutes move out of the glomerulus into the glomerular
capsule due to pressure difference across the filtration membrane. This separated fluid is called
the filtrate.
. Tubular reabsorption: substances in the renal tubules are returned back to the blood by
diffusion or active transport. Once the filtrate begins to be modified, it becomes the tubular
fluid. Necessary salts and water are reabsorbed.
. Tubular Secretion: active transport of the solutes of the blood into the tubular fluid.
Renal corpuscle:

● It is composed of two structures:

a. Glomerulus: A thick tangle of capillaries.
b. Glomerular capsule: an epithelial capsule surrounding the glomerulus.
– glomerular capsule has two layers:
(1) A visceral layer that directly overlies the glomerulus and is made of special cells called podocytes.
(2) A parietal layer formed of simple Squamous epithelium.
– between the two layers is the capsular space where solutes and water within the blood enter
after getting filtered through the glomerulus.
● The renal corpuscle has two opposing poles:
a. Vascular pole: where the afferent and efferent arterioles are found.
b. Tubular pole: where the PCT joins the renal corpuscle.
● Filtration membrane of the renal corpuscle:
– porous, 0.1 micrometer wide, negatively charged formed by the glomerulus and visceral layer of
the glomerular capsule.
– For a substance to become a part of the filtrate, it has to pass through the three layers of the
filtration membrane from innermost to outermost:
. Endothelium of glomerulus: the glomerular capillaries are fenestrated and allow passage of
plasma and its dissolved substances while preventing the passage of large substances and
formed element (RBC, WBC and platelets).
. Basement Membrane of glomerulus: The porous basement membrane allows the passage of
smaller structures and prevents the passage of large plasma proteins.
 . Visceral layer of glomerular Capsule (podocytes): podocytes are octopus shaped cells with long
foot like processes called pedicels that wrap around the glomerular capillaries. The pedicels of
these podocytes are separated by thin spaces called filtration slits that are covered by a
membrane. Pedicels of one podocyte interlock with those of the other podocyte and prevent
the passage of small proteins.

Proximal convoluted Tubule (PCT):

● Lined by simple cuboidal epithelium with tall microvilli.
● Lumen appears fuzzy due to the brush border formed by microvilli.
● Cytoplasm stains brightly due to abundance of mitochondria.
● It reabsorbs: all nutrients (glucose and amino acids), most vitamins, any plasma proteins, and
60-65% water (by osmosis) which enter the peritubular capillaries and are returned to the
general circulation.
● It secrets: some hydrogen ions.
Nephron Loop (Loop of Henle):
● Each nephron loop has two limbs: descending limb (goes from the cortex towards and into the
medulla) and ascending limb (goes from the medulla towards the cortex).
● Both ascending and descending limbs have two segments:
– a thick segment lined of simple cuboidal epithelium.
– a thin segment lined with simple squamous epithelium.
● Its primary function is the reabsorption of water and solutes.
– sodium and chloride are the main ions reabsorbed in the ascending limb.
– it also secretes some hydrogen ions into the tubular fluid.
● Substances reabsorbed here are returned to blood via vasa recta.

Distal convoluted Tubule:

● Originates at the end of the ascending limb and contacts the afferent arteriole at the vascular
pole (look at the image to understand this).
● Lined by simple cuboidal epithelium with short, sparse microvilli and does not appear fuzzy.
● Cytoplasm stains more lightly as compared to the PCT as they have fewer mitochondria.
● Primary function:
– secretion of hydrogen and potassium ions.
– reabsorption of water and sodium ions under the influence of ADH and aldosterone.
– ADH and aldosterone cause more water and sodium reabsorption in the DCT.
Collecting tubules and collecting ducts:
● Tubular fluid leaving the DCT travels through a series of small collecting tubules that empty into
collecting ducts.
● Collecting tubules are lined by simple cuboidal epithelium but very tall columnar epithelial cells
are found in the ducts near the renal papilla.
● The collecting ducts are the last structures that are able to modify the tubular fluid and do so
under the influence of either ADH or aldosterone.
● Several collecting ducts open at the tip of the renal papilla.
● Urine leaves the renal papillae and enters the minor calyces which then transport the urine to
 ●
the major calyces that open into the renal pelvis.
● As the renal pelvis and calyces are in contact with the urine, they are lined with transitional
epithelium.
● Once the tubular fluid leaves the collecting duct and enters the papillary duct, it becomes urine
and cannot be modified any further.

Juxtaglomerular Apparatus:
● The components of the juxtaglomerular apparatus includes:
a. Granular Cells (juxtaglomerular epithelioid cells): these are modified smooth muscle cells located
near the entrance of the renal corpuscle.
b. Macula Densa: A group of modified epithelial cells in the DCT that monitor ion concentrations in the
tubular fluid. These are located on the tubule side next to the afferent arteriole are narrower and taller
than other DCT cells.
c. Extraglomerular Mesangial cells: Located between the granular cells and the arterioles. These can
contract and phagocytize filtered particles.
● Functions:
– Regulate blood pressure and GFR (amount of filtrate produced by kidneys during a period of
time).
– If GFR or blood pressure is reduced, the granular cells secrete rennin.
– this activates the rennin- angiotensin pathway that results in the production of aldosterone.
– This causes an increase in both sodium ion concentration in blood as well as the blood volume.

Substances absorbed in different regions of the nephron and concentration gradient:

Urinary Tract:

Ureters:
● Fibromuscular tubes conduct urine from kidneys to the urinary bladder.
● 25 cm in length.
● Retroperitoneal.
● Originates at the renal pelvis and leaves the kidneys at the hilum.
● Extend inferiorly and enter the base of the urinary bladder at its posterolateral walls.
● From innermost to outermost it has 3 tunics: mucosa, muscularis and adventitia.
a. Mucosa: - formed from transitional epithelium which makes it distensible (stretchy) and
impermeable to urine.
– external to the epithelium is the lamina propria composed of a fairly thick dense irregular
connective tissue.
– urine moves through the ureters by peristalsis.
b. Muscularis: - made of inner longitudinal and outer circular layer (opposite to that of the GI tract).
– presence of urine in the renal pelvis causes the muscular layer to produce a peristaltic wave.
c. Adventitia: formed of areolar connective tissue.
● The ureters are compressed as the bladder distends decreasing the likelihood of urine reflux.
● Blood supply to the ureters:
– the superior aspects of the ureter are supplied by the renal arteries whereas the inferior
aspects are supplied by aorta, common iliac and/or internal iliac arteries.
– venous drainage is through the companion veins.

Urinary Bladder:
● Expandable, muscular container that serves as a reservoir for urine.
● In females: located anteroinferior to the uterus and directly anterior to the vagina.
● In males: located anterior to the rectum and superior to the prostate gland.
● Retroperitoneal.
● When empty, it has an upside-down pyramidal shape, filling with urine distends it superiorly
until it assumes an oval shape.
● Median umbilical ligament: it is fibrous and cordlike and extends towards the umbilicus from its
origin on the anterosuperior border of the urinary bladder.it is a remnant of the embryological
structure called urachus.
● Ureteral opening: ureters enter the posterolateral wall of the urinary bladder through these
openings.
● The constricted neck of the bladder is located inferiorly and connected to the urethra.
● Trigone: A posteroinferior triangular area of the bladder wall formed by imaginary lines
connecting the two ureteral opening and the urethral opening.
– the trigone formed from the distal part of the ureters is embryologically different than the rest
of the urinary bladder which is formed from a structure called cloaca.
● There are four layers in the wall of the bladder:
a. Mucosa: formed by transitional epithelium, has folds called rugae and is supported by highly
vascularized lamina propria.
– the mucosa in trigone region is smooth, thick and lacking rugae.
b. Submucosa: Formed by dense irregular connective tissue.
c. Muscularis: consist of three layers of muscle called the detrusor muscle.
– At the neck of the urinary bladder, an involuntary internal urethral sphincter is found.
d. Adventitia: Outer layer of areolar connective tissue.
● Blood supply: internal iliac artery and vein.
Urethra:
● Fibromuscular tube originating at the neck of the urinary bladder.
● The luminal lining is a protective mucous membrane housing clusters of mucin producing cells
called urethral glands.
● Bundles of smooth muscle fibers surround the mucosa and help propel urine outside.
● Two urethral sphincters:
a. Internal urethral sphincter: involuntary, superior, surround the neck of the bladder, it is a circular
thickening of the detrusor muscle and is controlled by the autonomic nervous system.
b. External urethral sphincter: voluntary, inferior, circularly arranged skeletal muscles and controlled
by somatic nervous system.

● Female Urethra:
– Has a single function: transport urine out.
– Lumen is lined with a stratified squamous epithelium.
– 3 to 5 cm long
– opens to the outside at the external urethral orifice located in the female perineum.

● Male Urethra:
– Two functions: urinary and reproductive. Serves as a passageway for both urine and semen.
– 18 to 20 cm long.
– Partitioned into 3 segments:
a. Prostatic Urethra:
– 3 to 4 cm long.
– immediately inferior to the bladder, extends through the prostate gland where many prostatic
ducts enter it.
– most dilatable as it is lined by transitional epithelium and has underlying dense irregular
connective tissue.
– two smooth muscle layers: internal longitudinal and external circular.
b. Membranous urethra:
– shortest and least dilatable as it is made of stratified or pseudostratified columnar epithelium.
– Extends from the inferior surface of the prostate gland.
– surrounded by skeletal muscle fibers that form the external urethral sphincter.
c. Spongy urethra:
– longest part (15 cm).
– encased in erectile tissue of the penis called corpus spongiosum and extends to the external
urethral sphincter.
– proximal part is lined by pseudostratified columnar while distal part is lined by stratified
squamous.
Micturition / urination:
– expulsion of urine from the bladder.
– initiated by the micturition reflex.
– as the bladder fills with urine (200-300ml), it distends which activates the baroreceptors in the
walls of the bladder and sends a signal to the pons, which controls the autonomic innervation
involved in micturition.
– pelvic splanchnic nerves (parasympathetic nerves) from spinal cord segments S2 -S4 stimulate
detrusor muscles to contract and the internal urethral sphincter to relax.
– sympathetic axons from T 11 to L2 (sympathetic nerves) inhibit contraction of detrusor muscle
and stimulate the contraction (closing) of the internal urethral sphincter.

Development of the urinary system:

 ● Most of the urinary and reproductive system is formed from the intermediate mesoderm.

Kidney and Ureter development:

● The intermediate mesoderm forms the urogenital ridge.
● The urogenital ridge gives rise to three sets of excretory organs which become increasingly
more advanced:
. Pronephros: - appear in the cervical region
– vestigial: no function in humans.
– Appear in the early fourth week and quickly degenerate by the end of the same week.
. Mesonephro: - appear in the thoracic and lumbar region.
– composed of multiple saclike segments.
– mesonephric duct drains urine from each mesonephro to the developing urinary bladder.
– persist until the 10th week.
. Metanephrons: - appear early in the fifth week.
– each metanephros forms a functional adult kidney and takes over urine production by week 10.
– the components of the metanephros form one of the two structures:
a. Ureteric bud: forms as a separate outgrowth from the caudal end mesonephric duct and gives rise
to the collecting ducts, calyces, renal pelvis and ureters.
b. Metanephric mesoderm: develops from the intermediate mesoderm in the sacral region of the
embryo and gives rise to the nephron components of the kidneys: the glomerular capsule, PCT,
nephron loop and the DCT.
● As the ureteric bud grows and merges with the metanephric mesoderm, the ureteric bud
undergoes a branching pattern:
– the first set of branches form the major calyces by week 6.
– the second set forms the minor calyces by week 7.
– the branching continues till tiny collecting ducts are formed and by the end of week 32, over 1
million collecting tubules have formed.
● As the calyces and collecting ducts are formed, it signals the metanephric mesoderm to grow
and develop into nephron components.
– by week 10, metanephros is able to both produce and expel urine.
● During week 6 to 9, the developing kidneys migrate from their position in the pelvic cavity to a
more superior position in the lumbar region.
● By week 9, the kidneys complete migration to the lumbar region and acquire their permanent
renal arteries branching from the descending abdominal aorta.
●
Urinary bladder and urethra development:
● They develop from the distal part of hindgut called the cloaca.
● The cloaca forms the epithelium of the urinary bladder, urethra, the rectum and anal canal.
● The cloaca is separated from the outside of the body by the cloacal membrane.
● By week 4 and 7, a mass of mesodermal tissue called the urorectal septum grows through the
cloaca and divides it into the urogenital sinus and the anorectal canal.
● The uriogenital sinus (formed from endoderm) and some surrounding mesoderm forms the
urinary bladder and urethra.
● The urorectal septum grows towards and attaches to the cloacal membrane dividing it into
anterior urogenital membrane and posterior anal membrane.
● Both of these membranes rupture by week 8, allowing both the urethra and the anal canal to
communicate with the outside world.