HBHD 13e Ch22

Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 22
The Urinary System

Copyright © 2015 Wolters Kluwer • All Rights Reserved
Overview

Key Terms
angiotensin glomerulus tubular reabsorption
antidiuretic hormone (ADH) hemodialysis urea
calculi kidne ureter
cystitis micturition urethra
dialysis nephron urinalysis
excretion osmolarity urinary bladder
glomerular filtrate pyelonephritis urine
glomerulonephritis renin

Systems Involved in Excretion
Learning Objectives
1.Describe the organs of the urinary
system, and give the functions of
each.
2. List four systems that eliminate
waste, and name the substances each
eliminates.

The Kidneys
Learning Objectives
3. List four activities of the
kidneys in maintaining homeostasis.
4. Describe the location and
internal organization of the kidneys.
5. Describe a nephron.
6.Trace the path of a drop of blood as
it flows through the kidney.
7.Name the four processes involved
in urine formation, and describe what
happens during each.

The Kidneys (cont.)
Learning Objectives
8.Explain the roles of juxtamedullary
nephrons and antidiuretic hormone
(ADH) in urine formation.
9.Describe the components and
functions of the juxtaglomerular (JG)
apparatus.

Elimination of Urine
Learning Objectives
10.Describe the process of
micturition.
11. List normal and abnormal
constituents of urine.

Disorders of the Urinary System
Learning Objectives
12. Discuss six types of urinary
system disorders.
13. List six signs of chronic renal
failure.
14. Explain the principle and purpose
of renal dialysis.

Case Study
Learning Objective
15. Referring to the case study,
describe how urethral blockage
can affect kidney function.

Word Anatomy
Learning Objective
16. Show how word parts are used to build words
related to the urinary system.

Systems Involved in Excretion
• Urinary (excretory system)
‒ Regulates volume, acid–base balance and electrolyte
composition of body fluids
‒ Main parts of the urinary system
• Kidneys
• Ureters
• Urinary bladder
• Urethra
• Other systems that function in excretion:
– Digestive
– Respiratory
– Integumentary

Figure 22-1 Urinary system.
Identify the structure that carries urine to and from the
bladder.
Systems Involved in Excretion (cont.)

Systems Involved in Excretion (cont.)
✓
Checkpoints
22-1 What are the organs of the urinary system?
22-2 What are three systems other than the urinary
system that eliminate waste?

The Kidneys (cont.)
Kidney Activities
•Excretion
– Urea
•Homeostasis of body fluids
•Blood pressure regulation
•Hormone production
– Erythropoietin (EPO)

The Kidneys (cont.)
Kidney Structure
•Lie against back muscles in the upper abdomen
•Right kidney lower than left to accommodate liver
•Enclosed in membranous renal capsule
•Adipose capsule of fat
•Fascia anchors the kidney to peritoneum and abdominal
wall
•Retroperitoneal space
•Renal blood vessels
– Renal artery
– Renal vein

The Kidneys (cont.)
Kidney Structure (cont.)
•Organization
– Hilum
– Renal cortex (outer portion)
– Renal medulla (inner portion)
• Renal pyramids
– Renal pelvis
• Calyces

The Kidneys (cont.)
•Nephron and its blood supply
– Nephron
• Glomerular (Bowman) capsule
• Renal tubule
– Proximal tubule
– Nephron loop
– Distal tubule

The Kidneys (cont.)
•Nephron and its blood supply (cont.)
‒ Blood supply
• Glomerulus
• Afferent arteriole
• Efferent arteriole
• Peritubular capillaries

Figure 22-2 Kidney structure and the renal blood supply.
What is the outer region of the kidney called? What is the
inner region of the kidney called?
The Kidneys (cont.)

Figure 22-3 A nephron and its blood supply.
The nephron is associated with two capillary beds. Which
capillary bed receives blood first?
The Kidneys (cont.)

Figure 22-4 Microscopic view of the kidney.
The Kidneys (cont.)

The Kidneys (cont.)
✓
Checkpoints
22-3 Where is the retroperitoneal space?
22-4 What vessel supplies blood to the kidney, and what
vessel drains blood from the kidney?
22-5 What is the name of the funnel-shaped collecting
area that forms the upper end of the ureter?
22-6 What is the functional unit of the kidney called?
22-7 What name is given to the coil of capillaries in the
glomerular capsule?

The Kidneys (cont.)
Formation of Urine
•Glomerular filtration
– Glomerular filtrate
•Tubular reabsorption
– Diffusion
– Osmosis
– Active transport
•Tubular secretion

Figure 22-5 Glomerular filtration: The first step in urine
formation.
The Kidneys (cont.)

The Kidneys (cont.)
Formation of Urine (cont.)
•Concentration of urine
– The proximal tubule reabsorbs about 65% of filtered
water by osmosis.
– Juxtamedullary nephrons
– Medullary osmotic gradient
– Antidiuretic hormone (ADH)

Figure 22-6 Urine concentration.
The Kidneys (cont.)

The Kidneys (cont.)
Summary of Urine Formation
1.Glomerular filtration
2.Tubular reabsorption
3.Tubular secretion
4.Concentration of urine

Figure 22-7 Summary of urine formation in a nephron.
What vessels absorb materials that leave the nephron?
The Kidneys (cont.)

The Kidneys (cont.)
The Juxtaglomerular (JG) Apparatus
•Specialized region of the kidney is involved in blood
pressure regulation.
– Distal tubule
– Afferent arteriole
•Triggered by low sodium content in the glomerular
filtrate.
‒ Secretes enzyme renin
•Angiotensin II

Figure 22-8 The juxtaglomerular (JG) apparatus.
The Kidneys (cont.)

The Kidneys (cont.)
✓
Checkpoints
22-8 What process drives materials out of the glomerulus
and into the glomerular capsule?
22-9 What is the name of the process that returns
materials from the nephron back to the circulation?
22-10 What component of the filtrate is moved by tubular
secretion to balance pH?
22-11 What hormone controls water reabsorption from the
collecting duct of the nephron?
22-12 What substance is produced by the JG apparatus,
and under what conditions is it produced?

The Ureters
•Long, slender, muscular tubes
•Extend from the kidney to urinary bladder
•Entirely extraperitoneal
•Move urine by gravity and peristalsis
Elimination of UrineElimination of Urine (cont.)

The Urinary Bladder
•Located posterior to the pubic symphysis
•Temporary reservoir for urine
•Bladder wall has many layers:
– Lined with mucous membrane
– Rugae
– Connective tissue
– Involuntary muscle tissue
– Parietal peritoneum
•Trigone

Figure 22-9 The male urinary bladder.
What gland does the urethra pass through in the male?
The Kidneys (cont.)

The Urethra
•Carries urine from the bladder to the outside
•Differs in males and females:
– Male
• Approximately 20 cm in length
• Serves dual purpose as part of both the
reproductive and urinary systems
– Female
• Approximately 4 cm in length
• Entirely separate from the reproductive system

Urination
•Process of expelling urine from bladder (micturition)
•Involuntary control
– Internal urethral sphincter
•Voluntary control
– External urethral sphincter

The Urine
•95% water, 5% dissolved solids and gases
•pH averages 6.0
•Specific gravity measures amount of dissolved
substances
– Normal range 1.002 (very dilute) to 1.040 (very
concentrated)

The Urine (cont.)
•Normal constituents of urine
– Nitrogenous waste products
• Urea
• Uric acid
• Creatinine
– Electrolytes
• Sodium and chloride ions
• Sulfates
• Phosphates
– Pigments (e.g., urochrome, bile pigments, food
pigments)
Elimination of Urine (cont.)

The Urine (cont.)
•Abnormal constituents of urine
‒ Glucose
‒ Albumin
‒ Blood
‒ Ketones
‒ White blood cells
‒ Casts

Elimination of Urine (cont.)
✓
Checkpoints
22-13 What is the name of the tube that carries urine from
the kidney to the bladder?
22-14 What openings form the bladder’s trigone?
22-15 What is the name of the tube that carries urine from
the bladder to the outside?
22-16 What are some normal constituents of urine?
Abnormal constituents?

Disorders of the Urinary System (cont.)
Obstructions and Structural Disorders
•Hydronephrosis
•Kidney stones (renal calculi)
– Staghorn calculi
– Renal colic
– Lithotripsy (extracorporeal shock wave lithotripsy)
•Structural abnormalities
– Renal hypoplasia
– Renal dysplasia
– Ureteral stricture
– Ureterocele
– Hypospadias

Figure 22-10 Kidney stones.
What does the word extracorporeal mean?

Figure 22-11 Hypospadias.

Inflammatory Disorders
•Urinary tract infection (UTI)
•Urethritis
•Cystitis
– Interstitial cystitis
•Pyelonephritis
•Glomerulonephritis

Neoplasms
•Bladder tumors
– Symptoms
• Hematuria
• Frequent urination
– Causes
• Toxins
• Heavy cigarette smoking
• Presence of urinary stones
– Treatment
• Tumor removal
• Localized chemotherapy
• Cystectomy
• Ileal conduit

Figure 22-12 Cystoscopy.

Figure 22-13 Ureterocele.

Figure 22-15 Ileal conduit.

Polycystic Kidney Disease
•Genetic disorder
•Usually asymptomatic in children
•Destruction of nephrons as disease progresses resulting in
chronic renal failure
•Treatment:
– Renal dialysis
– Kidney transplantation

Renal Failure
•Renal insufficiency
•Acute renal failure
– Causes for acute renal failure
• Medical or surgical emergencies
• Toxins that damage the renal tubules
– Symptoms
• Sudden serious decrease in kidney function
• Electrolyte imbalance
• Acid–base imbalance

Renal Failure (cont.)
•Chronic renal failure
– Causes for chronic renal failure
• Gradual loss of nephrons
– Symptoms
• Dehydration
• Edema
• Electrolyte imbalance
• Hypertension
• Anemia
• Uremia

Renal Failure (cont.)
•Renal dialysis and kidney transplantation
– Dialysis
• Hemodialysis
• Peritoneal dialysis
– Kidney transplantation
• Final option for treatment of kidney failure

Figure 22-14 Dialysis.

Urinary Incontinence
•Causes
– Neurologic disorder
– Trauma to the spinal cord
– Weakness of the pelvic muscles
– Impaired bladder function
– Medications
•Types of urinary incontinence
– Stress incontinence
– Urge incontinence (overactive bladder)
– Overflow incontinence
– Enuresis

✓
Checkpoints
22-17 What is the scientific name for stones as may
occur in the urinary tract?
22-18 What is the term for inflammation of the bladder?
22-19 What is the term for an excess of nitrogenous waste
products in the blood?
22-20 What process can be used to eliminate waste
products from the blood in cases of renal failure?

The Effects of Aging on the Urinary
System
• Loss of the kidney’s ability to concentrate urine
• Decrease in number and size of nephrons
• Increase in blood urea nitrogen (BUN)
• Urinary infections
• Prostate enlargement
• Decreased bladder capacity
• Incontinence

Case Study (cont.)
Urinary Obstruction
•Symptoms of benign prostatic hypertrophy
− Urinary urgency and frequency
− Hesitation in starting stream
− Decreased urine volume
− Diminished force of stream
− Incomplete emptying of bladder

Case Study (cont.)
Urinary Obstruction (cont.)
•Diagnosis
− Digital exam
− Cystoscopy
− Intravenous pyelogram results:
• Hydroureter (from back pressure of urine)
• Hydronephrosis (from back pressure of urine)
•Treatment
− Transurethral prostatectomy

Word Anatomy (cont.)

HBHD 13e Ch22

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HBHD 13e Ch22