The urinary system, also known as the renal system or urinary tract, consists of the kidneys, ureters, bladder, and the urethra. The purpose of the urinary system is to eliminate waste from the body, regulate blood volume and blood pressure, control levels of electrolytes and metabolites, and regulate blood pH. The urinary tract is the body's drainage system for the eventual removal of urine.[

1. Overview of Genitourinary
Tract Part 1
Judy D’Angelo RN MSN ANP LNC CDP CADDCT
Wilson Shepard Education Associates
http://wilsonshepard.com
585-360-4192
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Approval Code #20-732588

2. Disclaimer
 Disclaimer: Information on this program is intended for
educational purposes only.
 It is not intended to provide legal and/or medical advice
or to be a comprehensive compendium of evidence based
practice.
 For specific implementation information, please contact
an appropriate professional, organization, legal source,
or facility policy.
 The author and planning committee members have
declared no conflict of interest.
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3. Continuing Education Credit
 Wilson Shepard Education Associates is an approved
provider of continuing nursing education by The
Alabama State Nurses Association, an accredited
approver of continuing nursing education by the
American Nurses Credentialing Center’s Commission on
Accreditation.
CE Provider Number is 5-166
Florida Board of Nursing, DC Board of Nursing, &
Georgia Board of Nursing
CE Provider #:50-17938
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4. For credit
 For continuing education credit, please visit our sister
site
 http://www.wshep.com/gu-course-evaluation-page.html
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5. Homeostasis
 Maintaining a dynamic, steady state of internal balance.
 Any change or damage at the cellular level can affect the
entire body.
 When homeostasis is disrupted by an external stressor,
 Injury
 Decrease in nutrients
 Illness can occur.
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6. Renal System
 The Renal System
 Excrete foreign or excessive materials and
wastes
 These basic functions affect other body
systems and the patient’s overall health
 Renal and urologic disorders can affect fluid
and electrolyte balance and other important
body functions.
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7.  Physical assessment
 Inspection: scars, lesions,
bruises, asymmetry
 Jugular venous distension
(JVD), ascites –
 distension, skin tightness
and glistening, striae –
 Color of urine, odors,
oliguria/ anuria hematuria
 Urethral discharge or
ulcerations
 Auscultation: abdominal
bruits abnormal
 Bruit and thrill of AV
fistula’s/ shunts normal; if
absent, may have a clotted
access
 Percussion: pain should not
be elicited
 Palpation: kidneys not
palpable unless enlarged
 Tumors, masses, unequal
sizes –
 Tenderness/pain may
indicate
inflammation/infection
Renal Assessment
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8. What is renal autoregulation?
Exists to ensure adequate perfusion to the kidneys
Kidneys produce and secrete enzyme renin in response to decreased
extracellular fluid volume (low BP) –
Renin forms angiotensin I, which is converted to
Angiotensin II, which increases low BP levels by:
 Increasing peripheral vasoconstriction
 Stimulating aldosterone secretion
 Aldosterone secretion promotes resorption of sodium and water
to correct the fluid deficit and inadequate renal blood flow
When BP falls, the kidneys response is afferent arteriolar dilation and
efferent arteriolar vasoconstriction
Autonomic nervous system (sympathetic response)
Renal Anatomy & Physiology
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9. Renal Assessment
 Health history: family history, medical disorders
 Medications, diet, lifestyle
 Diseases that may predispose to renal problems
 Diabetes mellitus (DM) –
 Systemic lupus erythematosus (SLE) –
 Sickle cell anemia –
 Good pasture's syndrome –
 is a rare autoimmune disease in which antibodies attack the
basement membrane in lungs and kidneys, leading to bleeding
from the lungs and kidney failure.
 Acute glomerulonephritis –
 Acute pyelonephritis –
 Kidney/bladder tumors –
 Recipient of contrast medium
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10. Urine Formation
 The kidneys collect and eliminate wastes from the body
in a 3 step process;
1. In glomerular filtration
2. During tubular reabsorption
3. In tubular secretion
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16.  Ureters: two 16 to 18-inch muscular
tubes that contract rhythmically to
transport urine from kidney to
bladder
 Bladder: muscular walled sac that
holds urine (300-500 mL) expelled
by ureters
 Urethra: narrow tube from bladder
to outside of the body that excretes
urine –
 Surrounded by prostate gland in
men
Renal Anatomy & Physiology
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17. Renal Anatomy & Physiology
 Renal system: kidneys, ureters, bladder and urethra
 Kidneys: one each side of lower back –
 Renal artery: blood to kidney
 Cortex: outer layer of kidney
 Medulla: inner portion, renal pyramids and tubules
 Renal pyramids: output to renal pelvis for excretion
 Renal calyx: channels urine from pyramids to pelvis
 Renal pelvis: after blood containing wastes is processed in
kidney, formed urine channeled to renal pelvis
 Renal vein: 99% filtered blood back to general circulation,
remaining 1% waste products
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18. Renal System
 The kidneys filter the entire plasma volume (approx. 3 L)
every 22 minutes.
 Essential to maintaining the normal extracellular fluid
environment that bathes the cells of the body.
 Kidneys perform the following primary functions
 Regulation of plasma ionic composition
 Regulation of plasma osmolality
 Regulation of plasma hydrogen ion concentration pH
 Removal of metabolic waste products and foreign
substances from the plasma.
 The kidneys ultimately control the volume and
composition of ALL body fluids
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20. Nephron:
Functional/structural unit of kidney –
Selective resorption and secretion of ions and mechanical filtration of
fluids, wastes, electrolytes, acids and bases –
1 million in each kidney –
Bowman’s capsule: structure contains glomerulus –
Glomerulus: twisted capillaries that filter protein-free fluid
Proximal convoluted tubule: resorption of glucose, amino acids,
metabolites, electrolytes back to circulation –
Loop of Henle: U-shaped nephron tubule in medulla connects proximal
and distal tubules, concentrates filtrate. –
Distal convoluted tubule: receives filtrate that enters collecting tubule,
which releases urine
Renal Anatomy & Physiology
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21. Renal System
The kidneys perform several secondary functions as well.
Kidneys are endocrine organs
 They secrete the hormone erythrocyte production by the
bone marrow
 The enzyme renin – which is necessary for production
angiotensin II, a hormone important in regulating salt and
water balance for tong-term control of BP
 Kidneys are also necessary for the activation of Vit. D3, &
calcitriol – important factor in regulating blood calcium
and phosphate levels.
Kidneys can function during periods of fasting to maintain
steady supply of plasma glucose by carrying out
gluconeogenesis. 21

22. Hormones and Kidneys
Two hormones help regulate tubular reabsorption and
secretion
1. Anti-diuretic hormone (ADH)
2.Aldosterone
Other hormonal functions of the kidneys include
1.Secretion of the hormone erythropoietin
2.Regulation of calcium and phosphorus balance
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23. Renal system functions:
Detoxifies blood and
eliminates wastes
Maintains fluid and
electrolyte balance –
 Sodium-potassium
balance
 Calcium-phosphate
balance
 Maintains acid-base
balance
 Secrete hydrogen ions
 Resorb sodium and
bicarbonate ions –
 Acidify phosphate salts
 Produce ammonia
 Regulates blood pressure
 Red blood cell (RBC)
production
Renal Anatomy & Physiology
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24.  Costovertebral angle: 12th rib and vertebrae –
 Palpation eliciting pain indicates renal inflammation
 Hypocalcemia assessment
 Chvostek’s sign: tap facial nerve in front of earlobe and
below zygomatic arch
 Mouth corner twitching or facial twitching indicates low
calcium levels
 Trousseau’s sign: occlude brachial artery by inflating BP
cuff above diastolic pressure
 Leave inflated 3 minutes; will illicit spasm of fingers –
 Tetany, laryngospasm, ECG abnormalities
Renal Assessment
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25.  Kidneys are endocrine glands – produce hormones
 What is a hormone? –
 Protein produced in one organ, released into the blood with
effects at distant organs and tissues
 What are the major renal/renal related hormones?
 Antidiuretic hormone (ADH): from the pituitary
 Important in water balance
 Aldosterone: from adrenal cortex
 Important in sodium, potassium and water balance
 Erythropoietin: stimulates RBC production
 Loss of renal function results in chronic anemia
 Vitamin D: important in calcium homeostasis
 Insufficient calcium levels due to decrease in active Vitamin D
Renal Anatomy & Physiology
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