The Urinary

System

Structure, Function,
and Pathology

Teresa Morales
Learning Objectives
After completing this lesson, you should be able to:
28.2 Identify the purpose of the urinary system.
28.3 List the structures associated with the urinary system.
28.4 Describe how the urinary system changes during the life
span of a child to an older adult.
28.5 Describe the three processes involved with the formation of
urine.
28.6 Identify physical characteristics of urine.
28.7 Identify common pathology associated with the urinary
system.
Overview of the Urinary System
◦ Urinary system consists of organs that produce and excrete
urine from the body
◦ Vital to maintaining homeostasis because it removes waste
products from bloodstream
◦ Some organs of urinary system share structures of reproductive
system
◦ Urinary system also called genitourinary system
Video: Urinary System in 7 minutes
Organs of the Urinary System
◦ Kidneys
◦ Bean-shaped organs
◦ Located at back of abdominal cavity, against muscles of the
back, on either side of spinal column
◦ Three capsules surround each kidney
▪ True capsule
▪ Adipose capsule (perirenal fat)
▪ Renal fascia
Organs of the Urinary System
◦ External Structure of the Kidney
◦ Hilum
▪ Located on concave border of each kidney
▪ Entrance for renal artery and vein, nerves, and
lymphatic vessels
▪ Opening for ureter, which connects with renal pelvis in
the kidney
◦ Renal pelvis: saclike collecting area for urine
Organs of the Urinary System
◦ Internal Structure of the Kidney
◦ Renal cortex
▪ Soft and dense
▪ Outermost layer of internal structure of kidney
◦ Renal medulla
▪ Deep within cortex
▪ Contains cone-like structures called renal pyramids
▪ Pyramids formed of tubes to transport urine
Organs of the Urinary System
◦ Nephrons
◦ Functional units of kidney
◦ About a million in each kidney
◦ Help body maintain fluid balance by regulating amount of
fluid and electrolytes reabsorbed into blood and amount
excreted
◦ Each nephron contains a renal corpuscle and a tubule
◦ Renal corpuscle consists of glomerulus and Bowman’s
capsule
Organs of the Urinary System
◦ Nephrons
◦ As blood flows into glomerulus, nephron removes waste
materials discarded via tubule
◦ Tubule extends from Bowman’s capsule
◦ Consists of proximal convoluted portion, loop of Henle, and
distal convoluted portion, which opens into collecting tubule
◦ Connecting tubule transports discarded waste products (urine)
to renal pelvis and then emptied into the ureters
Organs of the Urinary System
◦ Ureters
◦ Two muscular tubes that carry urine from kidneys down to
bladder
◦ Composed of three layers
▪ Inner mucous membrane
▪ Middle coat of smooth muscle
▪ Outer fibrous tissue
◦ Each ureter approximately 8 to 12 inches long
Organs of the Urinary System
◦ Urinary Bladder
◦ Muscular sac in pelvic cavity
◦ Serves as reservoir for urine
◦ When bladder is empty, it feels firm because walls are thick
◦ As bladder fills, it stretches and walls become thinner
◦ Bladder holds approximately 16 ounces of urine
◦ Wall of bladder made up of four layers
▪ Innermost layer of epithelium
▪ Lamina propria
▪ Muscular propria
▪ Perivesicle fat
Organs of the Urinary System
◦ Urethra
◦ Tube of muscle and membrane extending from bladder to
urinary meatus, external opening of urinary system
◦ Male urethra approximately 20 centimeter (7 inches) long
and transports both urine and semen
▪ Three sections
▪ Prostatic
▪ Membranous
▪ Penile
Organs of the Urinary System
◦ Urethra
◦ In females, urethra approximately 3 c m (1.2 inches) long
enti eter

◦ External opening situated between clitoris and opening of the

vagina
◦ In females, urethra transports only urine
Urine
◦ Formation of urine three processes:
◦ Filtration
◦ Reabsorption
◦ Secretion
◦ Consists of 95 percent water and 5 percent solid substances
◦ Adult feels need to void (urinate) when bladder contains 300 to
350 mL of urine
◦ Medical term for urination is micturition
Urine
◦ Physical Characteristics of Urine
◦ 1,000 to 1,500 mL of urine voided daily
◦ Normal urine
▪ Clear (not cloudy)
▪ Straw colored
▪ Mildly aromatic odor
▪ Specific gravity of 1.003 to 1.030
▪ Slightly acidic pH of about 6
The Urinary System and the Life Span
◦ The Child
◦ Kidneys begin forming urine about the tenth week of
gestation. Fetus secretes small amounts of urine round third
month
◦ Children wearing diapers are susceptible to urinary tract
infections
◦ Bedwetting, nocturnal enuresis, can occur from potty-training
through age 5 or 10 years
The Urinary System and the Life Span
◦ Older Adults
◦ Urinary function declines as blood vessels degenerate with
aging
◦ Dehydration can happen more quickly because of a decreased
ability to conserve water and sodium
◦ A loss of muscle tone in the ureters, bladder, and urethra play
a part in incontinence (the inability to voluntarily retain
urine)
◦ Bladder capacity is reduced by as much as 50 percent,
causing more frequent trips to the bathroom
◦ Urinary tract infections (UTIs) are much more common in
the older adult population; infection can progress quickly and
rapidly, leading to further complications that are sometimes
fatal
 Table 28-3: Disorders Related to Urination
Disorder Description

Anuria No urine formed by the kidneys and a complete lack of urine excretion

Dysuria Painful or difficult urination

Enuresis Involuntary discharge of urine after the age by which bladder control
should have been established; usually occurs by age 5 years; called
bedwetting at night

Hematuria A condition of blood in the urine; usually a symptom of a disease process

Nocturia Excessive urination during the night; may or may not be abnormal

Pyuria Presence of pus in the urine

Common Disorders Associated with the
Urinary System (1 of 38)
◦ Cystitis
◦ Inflammation of the bladder
◦ Etiology
▪ Occurs when bacteria infect lower urinary tract, causing
irritation and inflammation
▪ Usually secondary to another infection, such
as epididymitis, prostatitis, gonorrhea, syphilis, or
kidney stones
◦ Particularly sexually active women between ages of 20 and 50
▪ Because sexual activity can introduce bacteria into the
urethra
Common Disorders Associated with the
Urinary System
◦ Cystitis Symptoms:
▪ Urgency (need to void immediately)
▪ Frequency (need to void often)
▪ Itching
▪ Painful urination
▪ Dark, cloudy, blood tinged urine
▪ May have foul odor
▪ Chills and fever
◦ Treatment:
▪ Antibiotics
▪ Medications to relieve sense of burning pain or urgency
▪ Increasing fluid intake
Common Disorders Associated with the
Urinary System
◦ Glomerulonephritis
(pronounced: gluh-mare-you-low-neh-FRY-tis)
◦ Also called glomerular disease
◦ Inflammation of kidneys that primarily affects the glomeruli
hindering the kidneys’ ability to properly filter waste and
fluids from the blood
◦ Can be acute, chronic, part of systemic disease or a disease
by itself
◦ Treatment varies based on underlying cause
▪ Medications to lower blood pressure
▪ Corticosteroids
▪ Limit sodium, fluid, protein intake
Common Disorders Associated with the
Urinary System
◦ Glomerulonephritis Etiology:
▪ Infections
▪ Autoimmune diseases
▪ Inflammation of blood vessels (vasculitis)
▪ Conditions that scar glomeruli
▪ Develops after bout of acute glomerulonephritis
Common Disorders Associated with the
Urinary System
◦ Glomerulonephritis Symptoms:
◦ Abnormal urinalysis
◦ Urine dark amber color or blood in urine
◦ Foam in toilet water caused by protein in urine
◦ High blood pressure
◦ Fatigue
◦ Joint and muscle aches
◦ Edema
◦ Abdominal pain
◦ Diarrhea
Common Disorders Associated with the
Urinary System
◦ Incontinence
◦ Involuntary and unpredictable flow of urine
◦ Etiology can be due to health conditions, medications,
anatomical defects, urinary tract infections, blockage, or
alcohol use
◦ Common in women who have had children
◦ Treated with medications that relax bladder wall and
reduce overactive contractions, surgery, and/or Kegel
exercises (to strengthen pelvic floor) depending on type of
incontinence
Common Disorders Associated with the
Urinary System
◦ Kidney Stones
◦ Also called renal calculi
◦ Are formed when urine contains too much of a certain
substance
◦ They pass into ureter, they slow or block urine flow
▪ Because stones have a rough surface, they irritate and
scratch the ureters, causing bleeding and intense
physical pain
◦ Many pass out of body without intervention by a physician
◦ Others may require lithotripsy
▪ Passing intense sound waves through body to break
down physical structure of stone
Common Disorders Associated with the
Urinary System
◦ Kidney Stones Etiology
▪ Formed when urine contains too much of a certain
substance(calcium, uric acid, phosphate, oxalate)
▪ Most stones formed by combination of calcium and
oxalate
▪ Formed while still in kidney, but when they pass into
ureter, they slow or block urine flow
◦ Kidney Stones Symptoms:
◦ Intense lower back (flank) pain
◦ Possible nausea and vomiting
◦ Decreased urine output
◦ Hematuria usually present
Common Disorders Associated with the
Urinary System
◦ Polycystic Kidney Disease (PKD)
◦ Multiple (poly) clusters of cysts develop primarily within and
on surface of kidneys
◦ Associated with other disorders including aortic and brain
aneurysms and diverticulosis
◦ Disorder in which multiple (poly) clusters of cysts develop
primarily within and on surface of kidneys
◦ Affects more than 12 million people worldwide
◦ Liver and pancreas of digestive system may develop multiple
cysts
Common Disorders Associated with the
Urinary System
◦ Polycystic Kidney Disease (PKD)
◦ Etiology
▪ Considered inherited disease
▪ Developing high blood pressure is the greatest risk for
people with PKD
▪ Kidney failure common with PKD
◦ Treatment
▪ Symptom control
▪ Minimizing complications of high blood pressure, pain,
bladder and kidney infections, blood in urine, kidney
failure
Common Disorders Associated with the
Urinary System
◦ PKD Signs and Symptoms
▪ High blood pressure
▪ Back or side pain related to enlarged kidneys
▪ Abdominal pain particularly over liver
▪ Joint pain
▪ Drowsiness
▪ Increase in size of abdomen
▪ Blood in urine
▪ Kidney failure
▪ Kidney infections
▪ Headache
Common Disorders Associated with the
Urinary System
◦ Renal Failure
◦ Kidney ceases to function properly
◦ Inhibits filtration of blood
◦ Results in increased buildup of toxins and waste products
◦ May be acute or chronic
Common Disorders Associated with the
Urinary System
◦ Acute Renal Injury
◦ Change in filtering function of kidneys, impairing kidneys’
ability to maintain normal body function
◦ Can occur in matter of hours or over course of a couple of
days
◦ Acute Renal Injury Etiology
▪ Caused by blockage, toxins, sudden loss or decrease of
blood flow to kidneys
▪ Serious health conditions including liver disease, high
blood pressure, heart disease, other kidney diseases,
diabetes
Common Disorders Associated with the
Urinary System
◦ Acute Renal Injury Signs and symptoms
◦ No immediate signs
◦ Urine output decreased
◦ Irregular heart rate
◦ Ascites
◦ Swelling in extremities
◦ Treatment:
 Dialysis which uses a filter other than the kidneys
to remove toxins and maintain water balance
Dialysis

◦ Two types: hemodialysis and peritoneal

▪ Hemodialysis is ongoing dialysis (3 to 5 times a week)
that cleans blood, usually in a dialysis center. The
hemodialysis access is in arm.
▪ Peritoneal dialysis is ongoing dialysis (daily)
that collects waste from the blood by washing the empty
space in the abdomen (peritoneal cavity). It can be done
from home.
Common Disorders Associated with the
Urinary System
◦ Chronic Renal Failure
◦ Gradual and progressive loss of kidney function that
transpires over months to years
◦ Final stages referred to as end-stage renal disease (ESRD)
◦ Etiology
▪ Diabetes and hypertension are two most common
causes of chronic renal failure in United States
Common Disorders Associated with the
Urinary System
◦ Chronic Renal Failure Signs and Symptoms:
◦ Fatigue
◦ Headaches
◦ Itchy and dry skin; changes in skin color
◦ Nausea
◦ Weight loss
◦ Bone and nervous system changes
◦ Bone pain
◦ Excessive thirst
◦ Frequent hiccups
◦ Low levels of sexual desire and impotence
Common Disorders Associated with the
Urinary System
◦ Chronic Renal Failure Treatment
▪ Identify, treat, reverse what is causing kidneys to fail
▪ Prevent excess fluid volume while kidneys heal and
resume normal function
▪ If normal function cannot be regained, dialysis may be
necessary
▪ Hemodialysis and peritoneal dialysis
◦ Kidney Transplant
▪ Dialysis would continue until patient is able to receive
a new kidney or for remainder of patient’s life
▪ Kidney transplant recipients must take antirejection
drugs for the rest of their lives to live with the
transplanted kidney
 Table 28-2: Disorders of the Urinary
System (1 of 2)
Disorder Description

Benign Prostatic Enlargement of the prostate gland caused by tissue growth, which can
Hyperplasia cause urinary flow disruption

Bladder Neck Blockage of the bladder outlet, which inhibits it from opening completely
Obstruction during urination

Cystocele A condition that occurs when the vaginal wall weakens, allowing the
bladder to droop down into the vaginal space

Cystolithiasis The formation of stones in the urinary bladder, similar in formation to

kidney stones

Hypospadias A congenital birth defect characterized by the opening of the male urethra
on the underside of the penis

Lupus Nephritis An inflammation of the kidneys caused by systemic lupus erythematosus

Pyelitis Inflammation of the renal pelvis often caused by a bacterial infection

Table 28-2: Disorders of the Urinary System (2
of 2)

Disorder Description

Renal Artery A narrowing of one or both of the renal arteries that carry blood to the
Stenosis kidney; most often it is caused by atherosclerosis

Renal Colic Pain caused by a kidney stone; can be excruciating pain and generally
requires medical treatment

Urinary Retention Inability to start a stream of urine or completely empty the bladder of urine
caused by trauma or injury, underlying medical conditions, surgery, and
certain medication

Vesicoureteral Common in infants and young children, VUR is characterized by urine

Reflux (VUR) that backflows from the ureters back into the kidneys, causing urinary tract
infections
Questions