LI 1 : ANATOMY, HISTOLOGY, AND PHYSIOLOGY OF URINARY SYSTEM

A. ANATOMY

1. Kidney
 A pair of bean – shaped organs located retroperitoneally , responsible for
blood filtering and urine formation.
 Parts of kidney :
Renal capsule – a layer of fibrous connective tissue covering the kidneys.
Renal cortex – outer region of the kidneys where most enthrones is located .
Renal medulla – inner region of the kidneys where some enthrones is located ,
also where urine is collected to be excreted outward .
Renal calyx – duct – like sections of renal medulla for collecting urine from
nephrons and direct urine into renal pelvis.
  Each kidney consists of about 1 million basic functional units called nephrons
where blood filtering and urine formation occur .
 Each nephron is composed of 10 parts :
afferent arteriole → glomerulus →bowman's capsule → efferent arteriole →
proximal convoluted tubule (PCT) → descending limb of loop of henle →
loop of henle ascending limb of loop of henle → distal convoluted
tubule(DCT) → collectin duct (not part of the nephron).
 Molecules in the blood that will be transformed to become part of urine travel
through the above structures , while molecules that will be retained and
reabsorbed back to the blood will come out of the bowman's capsule , and go
into efferent arteriole and the peritubular capillaries .

2. Ureter
Abdominal and pelvic parts
• Pelvic part: lateral wall of pelvis - superior of pubic tubercle
• The three bottle necks –constrictions:
 Start (ureteropelvic junction)
 entering the pelvis (brim), consider the artery
 entering the bladder
Vascularization: renal, internal ovaric/spermatic, inferior vecical arteries,
(aorta)
 Lymph flow
Abdominal: lateral aortic (lumbal), common iliac node
Pelvic: bladder (internal illiac nodes)
 Innervation
Renal, aortic, superior hypogastric, inferior hypogastric plexuses
Visceral afferent: T11-L2 , Referred pain
 Visceral efferent: autonomic nervous system

3. Urinary Bladder
 Pelvic viscera (was in the abdomen)Pelvic – abdomen (up to umbilicus)
 Three sided pyramid (empty)
Apex: àmedian umbilical fold
Base: inverted triangle, faces posteroinferiorly
Inferolateral surface
Superior surface
 Trigona: internal urethral orifice – opening of ureters
 Male Female

4. Urethra
 Last part of urinary tract
 Consider the gender:
B. HISTOLOGY
1. Kidney
 Parenchyma organized into cortex and medulla
 Within parenchyma occur nephrones, collecting ducts, blood vessels,
lymphatics and nerves
 Parenchyma organized into lobes and lobules
 Lobes are located btw adjacent renal columns with peripheral limits within
medulla being the interlobar arteries
 A renal lobule is defined as a portion of the kidney containing those
nephrons that are drained by a common collecting duct.
 At the cortex, the collecting duct lies at the axis of lobule, being
surrounded by corticolabyrinth or network comprising of renal corpuscles,
PCT and DCT
 Lobules are centered on "medullary rays“, which are bundles of straight
tubules (collecting ducts and loops of Henle)
 Within the cortex, peripheral limits of a lobule are the interlobular blood
vessels while in medulla, limits of lobules are not defined
 NEFRON :
Tubules in which urine is formed (functional unit of the kidney
Form the most abundant tissue of renal parenchyma
Consist of 5 parts;
i. Renal corposule,
 Produces glomerular ultrafiltrate
 Is a spherical structure comprising of
a. cluster of blood vessels= glomerulus
b. double walled envelope= glomerular or Bowman’s capsule
 Efferent arterioles enter while the afferent arterioles leave the
glomerulus at vascular pole while ultrafiltrate leave corpuscle
at renal pole
 Capillaries forming glomerulus are fenestrated and their
endothelium rests on a thick basal lamina
 Bowman’s capsule comprise of inner visceral and outer parietal
layers and Bowmans space in btw the layers
 Parietal layer is formed by simple squamous cells while
visceral is formed by podocytes, whose foot processes
(pedicels) contact glomerular blood capillaries
  The connective tissue stroma of the glomerulus is constituted
by mesangial cells, which support the glomerular capillaries

ii. Proximal convoluted tubule

 Reabsorption of water, nutrients and solids (obligatory)
 Lined by simple cuboidal epithithelium resting on a thin b.
Lamina
 Tubule cells have microvilli on their luminal surfaces (typical
brush border)
 Tubule cells appear striated due to numerous basal infoldings &
plenty of mitochondria

iii. Medullary loop (loop of Henle)

 Functions as a counter-current multiplier system to determines
osmolarity of urine; blood flow in the loop is counter to that in
medullary vasa recta.
 Extends from corticomedullary junction to medulla
 Consists of an descending limb, a thin segment and a ascending
limb
  The thin part is lined by simple squamous epithelium resting on
a thin BL; the sq cells sq. cells bulge into the lumen of tubule

iv. Distal convoluted tubule

 Reabsorbs most of substances contained in ultrafiltrate
especially glucosa and amino acids (mainly facultative)
 Reabsorption regulated by ADH and aldosterone
 Continues from the m. loop and extends to collecting tubule
within cortex
 Lined by low simple cuboidal epithelium resting on a thin BL
 The cells lack microvilli but are striated, with basal infoldings
and but less mitochondria
 Its epithelial cells stain less osmophilic compared to those of
PCT
  JUXTAGLOMERULAR APPARATUS :

- Formed where the DCT contacts the afferent arteriole of

parent r. Corpuscle
- Constituted by 3 cell types;
 macular densa cells of DCT (t. cells that become
columnar & closely packed)
 Juxtaglomerular cells of afferent arteriole (smooth
muscle cells of tunica media that become spherical and
contain renin granules)
 Extraglomerular mesangial cells (similar to those
within glomerulus and surrounded by thick BL)
- Produce renin which converts angiotensinogen to
angiotensin, (a vasoconstricter which raises bld pressure
thus flow of ultrafiltrate)

v. Collecting duct
 Drain urine from nephron to renal pelvis
 Lie on medullary ray within cortex
 Progressively increase in diameter towards medullar
 In inner medullar, CD from different renal lobes unite to form
large papillary ducts, which open into renal pelvis
 Drain urine from nephron to r. pelvis
 Progressively increase in diameter towards medullar
 In inner medullar, unite with other CDs to form large papillary
ducts, which open into renal pelvis
 CD are lined by epithelium that has 2 cell types
 1. collecting duct cells – cuboidal in cortical part, columnar in
medullary
2. intercalated /dark cells- resemble those of DCT but bulge
into lumen of the CD
 Both cell types rest on a thin BM and lack basal infoldings
 Permeability of CD to water and ions is regulated by ADH

2. Ureter
 Conducts urine from kidney to bladder
 Has 3 tissue layers
 Tunica mucosa; lined by 5-6 cell layer of transitional epith that rests on
lamina propria of loose c. tissue having bld vessels, lymphatics and
with tubular mucus glands in the equidae
 Tunica. muscularis; has inner and outer longitudinal and middle layer
of smooth muscles
 Tunica serosa/ adventitia
3. Urinary Bladder
 Its wall has 4 tissue layers;
 Tunica mucosa; lined by up to 14 cell layers of transitional epith that
rests on lamina propria of loose c. Tissue
 Tunica submucosa; highly vascular and rich in elastic fibers
 Tunica muscularis; has inner and outer longitudinal and middle layer of
smooth muscles (dextruser muscles)
 Tunica serosa/ adventitia; The longi muscles form sphincters at
ureterovesicular junction to prevent backflow of urine and at neck of
bladder to regulate urine emptying
4. Urethra
 Its wall has 4 tissue layers :
 Tunica mucosa; epith transitional but changes to stratified squamous at
external urethral orifice
 Tunica submucosa; has cavernous tissue spaces that are typical of
erectile tissue
  Tunica muscularis; has inner and outer longi and middle layer of
smooth muscles as in bladder but towards external urethral orifice, it
acquires an external layer of skeletal muscle called striated urethralis
muscle
 Tunica serosa/ adventitia

Urethra Male

Urethra Female
C. PHYSIOLOGY OF THE URINARIA SYSTEM

1. Kidney

Each human kidney consists of about one million nephrons, each of which has the
task of forming urine. The kidneys cannot form new nephrons, therefore, in trauma, kidney
disease, or normal kidney aging there will be a gradual decrease in the number of nephrons.
After age 40, the number of nephrons usually decreases every 10 years. This reduced function
should not be life-threatening because of the body's adaptive process to decrease kidney
function (Sherwood, 2001). Each nephron has 2 main components namely glomerulus and
tubules. The glomerulus (glomerular capillary) is passed through by a number of filtered
fluids from the blood while the tubules are long channels that convert the filtered fluid into
urine and flow into the kidney. The glomerulus is composed of branched and anastomosed
glomerular capillary tissue that has a high hydrostatic pressure (approximately 60mmHg),
compared to other capillary tissues. Glomerular capillaries are coated with epithelial cells and
the entire glomerulus is enclosed by Bowman's capsule. The filtered liquid from the
glomerular capillary enters Bowman's capsule and then enters the proximal tubule, which is
located in the renal cortex. From the proximal tubule then proceed with ansa Henle (Loop of
Henle). In the Henle ansa there are descendent and ascending parts. At the end of the thick
ascending branch there is a macula densa. Makula densa also has the empty ability to regulate
nephron functions. After that, from the distal tubule, the urine to the rectus tubules and
tubules of modular cholules until urine flows through the tip of the renal papilla and then
joins to form the renal pelvic structure (Berawi, 2009). There are 3 basic processes that play a
role in the formation of urine, namely glomerular filtration of tubular reabsorption, and
tubular secretion. Filtration begins when blood flows through the glomerulus resulting in
protein-free plasma filtration through the glomerular capillary to Bowman's capsule. This
process is known as glomerular filtration which is the first step in the formation of urine.
Every day an average of 180 liters of glomerular filtrate is formed. Assuming that the average
plasma volume in adults is 2.75 liters, this means that all plasma volumes are filtered about
sixty-five times by the kidneys every day. If everything is filtered into urine, the total plasma
volume will run out in urine within half an hour. However, it does not occur because of the
presence of kidney tubules that can reabsorb substances that can still be used by the body.
The transfer of substances from the inside of the tubule into the peritubular capillary plasma
is referred to as tubular reabsorption. Reabsorbed substances do not come out of the body
through the urine, but are transported by the peritubular capillaries to the venous system and
then the loop to be re-circulated. Of the 180 liters of plasma filtered daily, 178.5 liters are
reabsorbed, with the remaining 1.5 liters continuing to flow through the renal pelvis and out
as urine. In general, substances that are still needed by the body will be reabsorbed while
those that are not needed will remain with urine to be removed from the body. The third
process is tubular secretion which refers to the selective transfer of substances from the
peritubular capillary blood to the lumen of the tubules. Tubular secretion is the second route
for substances in the blood to enter the kidney tubules. The first method is by glomerular
filtration where only 20% of the plasma flows through Bowman's capsule, the rest continues
to flow through the efferent arterioles into the peritubular capillaries. Some substances,
perhaps discriminatively transferred from the plasma to the tubular lumen through the
mechanism of tubular secretion. Through the 3 basic processes of the kidney, urine is
collected which is ready to be excreted (Sherwood, 2001). The kidneys play an important role
in bodily function, not only by filtering the blood and removing residual products, but also by
balancing the levels of electrolytes in the body, controlling blood pressure, and stimulating
the production of red blood cells. The kidneys have the ability to monitor the amount of body
fluids, the concentration of electrolytes such as sodium and potassium, and the acid-base
balance of the body. The kidneys filter waste products from the body's metabolism, such as
urea from protein metabolism and uric acid from DNA descriptions. Two blood residual
products that can be measured are Blood Urea Nitrogen (BUN) and creatinine (Cr). When
blood flows to the kidneys, the sensors in the kidney decide how much water is released as
urine, along with what concentration of electrolytes. For example, if someone is dehydrated
from exercise or from an illness, the kidneys will hold as much water and urine as possible to
become very concentrated. When the water is sufficient in the body, urine is much thinner,
and urine becomes clear. This system is controlled by renin, a hormone produced in the
kidneys which is part of the body's fluid regulation system and blood pressure (Ganong,
2009).

Kidney function in general :

• Excretion of metabolic waste products and foreign chemicals

• Regulation of water and electrolyte balances

• Regulation of body fluid osmolality and electrolyte concentrations

• Regulation of arterial pressure

• Regulation of acid-base balance

• Secretion, metabolism, and excretion of hormones

• Gluconeogenesis

The process of urine formation.

Stage of urine formation

a. Filtration process, in the glomerulus.

Absorption of filtered blood is part of blood fluid except protein. The filtered liquid is
collected by a bowmen loop consisting of glucose, water, sodium, chloride, sulfate,
bicarbonate, etc., passed to the kidney tubule. The filtered liquid is called glomerular
filtrate.
 b. Reabsorption process
In this process reabsorption occurs mostly from glucose, sodium, phosphate chloride
and some bicarbonate ions. The process occurs passively (obligator reabsorption) in
the proximal tubule. Whereas in the distal tubule, sodium and bicarbonate ions re-
occur when the body needs it. Absorption occurs actively (facultative reabsorption)
and the rest is channeled to the renal papilla.
c. Secretion process
The remainder of the reabsorption that occurs in the distal tubule is channeled into the
renal papilla and then forwarded (Rodrigues, 2008).

2. Ureter

Consists of 2 pipelines each connected from the kidney to vesika urinaria. The length
is ± 25-34 cm, with a cross section of 0.5 cm. The ureter is partly located in the abdominal
cavity and partly located in the pelvic cavity. The lining of the ureteral wall causes peristalsis
which pushes urine into the bladder.

The lining of the ureteric wall consists of: University of North Sumatra

a. Outer wall of connective tissue (fibrous tissue)

b. Middle layer of smooth muscle layer

c. The inner layer of the mucosal layer

3. Urinary Bladder

Urinary bladder works as a urine container. This organ is shaped like a pear (jug). It is
located behind the pubic symphysis in the pelvic cavity. Vesika urinaria can expand and
deflate like a rubber balloon.

4. Urethra

Is a narrow channel that originates in vesika urinaria which functions to channel urine
out. In males approximately 13,7-16,2 cm in length, consisting of:

a. Pars prostatic urethra

b. Membranous pars

c. Urethra pars spongiosa.

 The urethra in women is about 3.7-6.2 cm long. The urethral sphincter is located
above the vagina (between the clitoris and vagina) and the urethra is here only as an excretion
channel (Panahi, 2010)

Urine.

Physical properties of urine, consisting of:

a. The amount of excretion in 24 hours ± 1,500 cc depends on fluid intake and other factors.

b. The color is light yellow and if left unchecked it will become cloudy.

c. Yellow color depends on concentration, diet, medicines and so on.

d. Odor, typical odor of urine if left for long will smell ammonia.

e. Specific gravity 1,015-1,020.

f. Acidic reactions, if over time become alkaline, also depend on the diet

(Vegetables cause alkaline reactions and protein reacts to acid reactions).

The composition of urine, consists of:

a. Urine consists of approximately 95% water.

b. Nitrogen residual substances from protein metabolism, urea acid, ammonia and creatinine.

c. Sodium electrolyte, calcium, NH3, bicarbonate, phosphate and sulfate.

d. Pigments (bilirubin and urobilin).

e. Toxin.

f. Hormones (Velho, 2013).

Micnutrition

Micturition is the process of emptying the bladder after filling with urine. The micturition
involves 2 main stages, namely:

a. The bladder is filled progressively until the stress on the wall rises beyond the threshold
value, this condition will trigger the 2nd stage.
b. The presence of nerve reflexes (called the mycturial reflex) which will empty the bladder.
The micturition nerve center is in the brain and spinal cord (spine). Most of the evacuation is
out of control but control can be learned "practice". The sympathetic nervous system: the
impulse inhibits vesika urinaria and internal spinal motions, so the detrusor muscle relaxes
and the internal sphincter constricts. The parasympathetic nervous system: the impulse causes
the detrusor muscles to contract, whereas the relaxation spincher occurs with a micturition
(Roehrborn, 2009).

Characteristics of normal urine.

a. On average, one day is 1-2 liters, but varies according to the amount of liquid that enters.

b. The color is clear without any deposits.

c. It smells sharp.

d. The reaction is slightly acidic to litmus with an average pH of 6 (Velho, 2013).

Source :

http://www.austincc.edu/sziser/Biol%202404/2404LecNotes/2404LNExV/o.Urinary%20Syst
em.pdf

http://www.phschool.com/atschool/florida/pdfbooks/sci_Marieb/pdf/Marieb_ch25.pdf

http://www.lamission.edu/lifesciences/lecturenote/AliPhysio1/Urinary.pdf

Slides Lecture of Urinary organs (kidney, ureter, bladder, urethra) by Anatomy Lecturer
Team from Faculty of Medicine Airlangga University

Slides of Urinary System by DR. B.M. KAVOI

Lecture of Renal Physiology from dr. Irfiansyah dan dr. Paulus

http://repository.usu.ac.id/bitstream/handle/123456789/39905/Chapter%20II.pdf?sequence=4
Slides of Histologi Sitem Urinalis by dr. Joni & Tania from Faculty of Medicine Airlangga
University