The kidneys work like sanitation workers

who keep a city’s water supply drinkable

and dispose its waste. Usually the kidneys
are unappreciated until there is an
imbalance and “internal garbage” piles up.
Every day, the kidneys filter gallons of fluid
from the bloodstream. They then process
this filtrate, allowing wastes and excess
ions to leave the body in urine while
returning needed substances to the blood
in just the right proportions. It also bears
the major responsibility for eliminating
nitrogenous wastes, toxins, and drugs from
the body.

The kidneys have other regulatory functions as well: by producing the enzyme renin,
they help regulate blood pressure, and their hormone erythropoietin stimulates red
blood cell production in bone marrow. Kidney cells also convert vitamin D to its active
form.

The other organs of the urinary system include the paired ureters and the single urinary
bladder and urethra.

Kidneys

Location and Structure

These small, dark red organs

with a kidney-bean shape are
positioned against the dorsal
body wall in a retroperitoneal
position in the superior
lumbar region. The left kidney
is located at about the T12 to
L3 vertebrae, whereas the
right is lower due to slight
displacement by the liver.
Upper portions of the kidneys
are somewhat protected by
the eleventh and twelfth ribs.
Each kidney weighs about
125–175 g in males and 115–
155 g in females. They are about 12 cm in length, 6 cm wide and 3 cm thick. It is a
convex laterally and has a medial indentation called the renal hilum. Several structures,
including the ureters, the renal blood vessels and nerves, enter or exit the kidney at the
hilum. On top of each kidney lies the adrenal gland.

Each kidney is enclosed by a transparent fibrous capsule. A fatty mass, the perirenal fat
capsule surrounds each kidney and acts to cushion it against blows. The renal fascia,
the outermost capsule, anchors the kidney and helps hold it in place.

A frontal section through the kidney

reveals an outer region called the
renal cortex and an inner region
called the medulla. The renal
columns are connective tissue
extensions that radiate downward
from the cortex through the medulla
to separate the most characteristic
features of the medulla, the renal
pyramids and renal papillae. The
papillae are bundles of collecting
ducts that transport urine made by
nephrons to the calyces of the
kidney for excretion. Medial to the
hilum is a flat, basinlike cavity, the
renal pervis. The renal columns also
serve to divide the kidney into 6–8
lobes and provide a supportive framework for vessels that enter and exit the cortex. The
pyramids and renal columns taken together constitute the kidney lobes.

Blood Supply

Approximately one-quarter of the total blood supply of the body passes through the
kidneys each minute. The arterial supply of each kidney is the renal artery, as the renal
artery approaches the hilum, it divides into segmental arteries, each of which gives off
several branches called interlobar arteries, which travel through the renal columns to
reach the cortex. At the cortex-medulla junction, interlobar arteries give off the arcuate
arteries, which curve over the medullary pyramids. Small cortical radiate arteries then
branch off the arcuate arteries and run outward to supply the cortical tissue. Venous
blood draining from the kidney flows through veins that trace the pathway of the arterial
supply but in a reverse direction- cortical radiate veins to arcuate veins to interlobar
veins to the renal vein, which emerges from the kidney hilum.
Nephrons and Urine Formations

Nephrons

Each kidney contains over a million tiny structures called nephrons. Nephrons are the
structural and functional units of the kidneys and, as such, are responsible for forming
urine. Figure 15.3 shows the anatomy and relative positioning of nephrons in each
kidney.

Each nephron consists of two main structures a glomerulus, which is a knot of

capillaries, and a renal tubule. The closed end of the renal tubule is enlarged and cup-
shaped and completely surrounds the glomerulus. The portion of the renal tubule is
called the glomerular, or Bowman’s capsule. The inner (visceral) layer of the capsule is
made up of highly modified octopus-like cells called podocytes. Podocytes have long
branching processes called food processes that intertwine with one another and cling to
the glomerulus. Because openings, the so called filtration slits, exists between their
extensions, the podocytes form a porous, or “holey”, membrane around the glomerulus
(Figure15.3c and d).

The rest of the tubule is about 3 cm (approximately 1.25 inches) long. As it

extends from the glomerular capsule, it coils and twists before a hairpin loop and then
again becomes coiled and twisted before entering a collecting tubule called the
collecting duct. The different regions of the tubule have specific names (See Figure
15.3) In order from the glomerular capsule they are the proximal convoluted tubule
(PCT), the loop of Henle, and the distal convoluted tubule (DCT). The lumen surfaces
(surfaces exposed to the filtrate) of the tubule tubule cells in the proximal convoluted
tubules are covered with dense microvilli, which increases their surface area
tremendously. Microvilli also occur on the tubule cells in other parts of the tubule but in
much reduced numbers.

Most nephrons are called cortical nephrons because they are located almost
entirely within the cortex. In a few cases, the nephrons are called juxtamedullary
nephrons because they are situated close cortex medulla junction, and their loops of
Henle dip deep into the medulla (See Figure 15.3a). The collecting ducts, each of which
receives urine from many nephrons, run downward through the medulla pyramids,
giving pyramids striped appearance. They deliver the final urine product into the calyces
and renal pelvis.

Each and every nephron is associated with two capillary beds---the glomerulus
(mentioned earlier) and the peritubular capillary bed. The glomerulus is both fed and
drained b arterioles. The afferent arteriole which arises from a cortical radiate artery is
the “feeder vessel”, and the efferent arteriole receives blood that has passed through
the glomerulus. The glomerulus, a specialized for filtration, is unlike any other capillary
bed in the entire body. Because it is both fed and drained by arterioles, which are high
resistance vessels, and because the afferent arteriole has a larger diameter than the
efferent, blood pressure in theglomerular is much higher than in other capillary beds.
The extremely high pressure forces fluid and solutes (smaller than proteins) out of the
blood into the glomerular capsule. Most of the filtrates (99 percent) is eventually
reclaimed by the renal tubule cells and returned to the blood in the peritubular capillary
beds.

The second capillary bed, the peritubular capillaries, arises from the efferent
arteriole that drains the glomerulus. Unlike the high-pressure glomerulus, these
capillaries are low-pressure, porous vessels that are adapted for absorption instead of
filtration. They cling closely to the whole length of the renal tubule, where they are in an
ideal position to receive solutes and water from the tubule cells as these substances are
reabsorbed from the filtrate percolating through the tubule. The peritubular capillaries
drain into interlobular veins leaving the cortex.

Urine Formation

Urine formation is a result of three processes---glomerular filtration, tubular

reabsorption, and tubular secretion.

Glomerular filtration: water and solutes smaller than proteins are forced through the
capillary walls and pores of the glomerular capsule in to the renal tubule.

Tubular reabsorption: water, glucose, amino acids, and needed ions are transported out
of the filtrate into the tubule cells and then enter the capillary blood.

Tubular secretion: H+ K+, creatinine, and drugs are removed from the peritubular blood
and secreted by the tubule cells into the filtrate.

Glomerular Filtration As just described, the glomerulus acts as filter. Glomerular filtration
is a nonselective, passive process in which fluid passes from the blood into the
glomerular capsule, the fluid is called filtrate and it is essentially blood into the
glomerular capsule part of the renal tubule. Once in the capsule, the fluid is called
filtrate and it is essentially blood plasma without proteins. Both proteins and blood cells
are normally too large to pass through the filtration membrane, and when either of these
appear in the urine, it is pretty fair bet that there is some problem with the glomerular
filters. As long as the systemic blood pressure is normal, filtrate will be formed. If arterial
blood pressure drops too low, glomerular pressure becomes inadequate to force
substances out of the blood into the tubules, and filtrate formation stops.

Tubular Reabsorption Besides wastes and excess ions that must be removed from the
blood, the filtrate contains many useful substances (including water, glucose, amino
acids, and ions), which must be reclaimed from the filtrate and returned to the blood.
Tubular Reabsorption begins as soon as the filtrate the proximal convoluted tubule
(Figure 15.5). The tubule cells are “transporters”, taking up needed substances from the
filtrate and then passing them out their posterior aspect into the extracellular space,
from which they are absorbed into peritubular capillary blood. Some reabsorption is
done passively (for example, water passes by osmosis), but reabsorption of most
substances depends on active transport processes, which use membrane carriers and
are very selective. There is an abundance of carriers for substances that need to be
retained, and few or no carriers for substances of no use to the body. Needed
substances (for example, glucose and amino acids) are usually entirely removed from
the filtrate. Nitrogenous waste products are poorly reabsorbed, if at all. These include
urea formed by the liver as an end product of protein breakdown when amino acids are
used to produce energy; uric acid released when nucleic acids are metabolized; and
creatinine associated with creatine metabolism in muscle tissue. Because tubule cells
have few membrane carriers to reabsorbed these substances, they tend to remain in
the filtrate and are found in high concentrations in urine excreted from the body. Various
ions are reabsorbed or allowed to go out in the urine, according to what is needed at a
particular time to maintain the proper pH and electrolyte composition of the blood. Most
reabsorption occurs in the proximal convoluted tubules, but the distal convoluted tubule
and the collecting duct are active.

Tubular Secretion Tubular Secretion is essentially tubular reabsorption in reverse.

Some substances, like hydrogen and potassium ions and creatinine, also move from the
blood of the peritubular capillaries through the tubule cells or from the tubule cells
themselves into the filtrate to be eliminated in urine. The process seems to be important
for getting rid of substances not already in the filtrate, such as certain drugs, excess
potassium, or as an additional means for controlling blood pH (See Figure 15.5).

Characteristics of Urine

In 24 hours the marvelously complex kidneys filter some 150 to 180 liters of blood
plasma through their glomeruli into the tubules, which process the filtrate by taking
substances out of it (reabsorption) and adding substances into it (secretion). In the
same 24 hours, only about 1.0 to 1.8 liters of urine are produced. Obviously, urine and
filtrate are quite different. Filtrate contains everything that blood plasma does (except
protein), but by the time it reaches the collecting ducts, the filtrate has lost most of its
water and just about all of its nutrients and necessary ions. What remains, urine,
contains nitrogenous wastes and unneeded substances.

Freshly voided urine is generally clear and pale to deep yellow. The normal yellow color
is due to urochrome, a pigment that results from the body’s destruction of hemoglobin.
The more solutes are in the urine, the deeper yellow its color; on the other hand, dilute
urine is a pale straw color. At times, urine may be a color other than yellow. This might
be a result of eating certain foods (beets) or the presence of bile or blood in the urine.

When formed, urine is sterile, and its odor is slightly aromatic. If it is allowed to stand, it
takes on an ammonia odor caused by the action of bacteria on the urine solutes. Some
drugs, vegetable and various diseases alter the usual odor of urine.

Urine pH is usually slightly acidic (usually 6) but changes in body metabolism and
certain foods may cause it to be much more acidic or basic. Because urine is water plus
solutes, urine weighs more, or is more dense, than distilled water. The term used to
compare how much heavier urine is than distilled water is specific gravity. Whereas the
specific gravity of pure water is 1.0, the urine’s specific gravity ranges from 1.001 to
1.035. Urine is generally dilute when a person drinks excessive fluids, uses diuretics, or
has chronic renal failure, a condition in which the kidney loses its ability to concentrate
urine. Conditions that produce urine with a high specific gravity include inadequate fluid
intake, fever, and a kidney inflammation called pyelonephritis.

Solutes normally found in urine include sodium and potassium ions, urea, uric acid,
creatinine, ammonia, bicarbonate ions, and various other ions, depending on blood
composition. Substances not normally found in urine are glucose, blood proteins, red
blood cells, hemoglobin, white blood cells (pus) and bile. Names and possible causes of
conditions in which abnormal urinary constituents and volumes might be present are
given in the table below.

Ureters, Urinary Bladder, and Urethra

Ureters

These are two slender tubes each25 to 30 cm long and 6 mm in diameter. Each ureter
runs behind the peritoneum from the renal hilum to the posterior aspect of the bladder,
which it enters at a slight angle. The superior end of each ureter is continuous with the
pelvis of the kidney and its mucosal lining is continuous with that lining the renal pelvis
and the bladder below.

Essentially, the ureters are passageways that carry urine from the kidney to the bladder.
Smooth muscle layers in their walls contract to proper urine into the bladder by
peristalsis. Once urine has entered the bladder, it is prevented from flowing back into
the ureters by small valvelike folds of bladder mucosa that flap over the ureter openings.

Urinary Bladder

It is a smooth, collapsible, muscular sac that stores urine temporarily. It is located

retroperitoneally in the pelvis just posterior to the pubic symphysis. If the interior of the
bladder is scanned, three openings are seen- the two ureter openings (ureteral orifices)
and the single opening of the urethra, which drains the bladder. The smooth triangular
region of the bladder base outlined by these three openings is called the trigone. The
trigone is important clinically because infections tend to persist in this region. In males,
the prostate gland surrounds the neck of the bladder where it empties into the urethra.

The bladder wall contains 3 layers of smooth muscle, collectively called the detrusor
muscle, and its mucosa is a special type of epithelium, transitional epithelium. Both of
these structural features make the bladder uniquely suited for its function of urine
storage. When the bladder is empty, it Is collapsed, 5 to 7.5 cm long at most, and its
walls are thick and thrown into folds. As urine accumulates, the bladder expands and
rises superiorly in the abdominal cavity. Its muscular wall stretches, and the transitional
epithelial layer thins, increasing its volume and allowing the bladder to store more urine
without substantially increasing its internal pressure. A moderately full bladder is about
12.5 cm long and holds about 500 ml of urine, but it is capable of holding more than
twice that amount. When the bladder is really distended, or stretched by urine, It
becomes firm and pear-shaped and may be felt just above the pubic symphysis. Urine
is formed continuously by the kidneys, but it is usually stored in the bladder until its
release is convenient.

Urethra

It is a thin-walled tube that carries urine by peristalsis from the bladder to the outside of
the body. At the bladder-urethra junction, a thickening of the smooth muscle forms the
internal urethral sphincter, an involuntary sphincter that keeps the urethra closed when
urine is not being passed. A second sphincter, the external urethral sphincter, is
fashioned by skeletal muscle as the urethra passes through the pelvic floor. This
sphincter is voluntarily controlled.

The length and relative function of the urethra differ in the two sexes. In women, it is
about 3 to 4 cm long and its external orifice, or opening, lies anteriorly to the vaginal
opening. Its function is to conduct urine to the body exterior.

In men, the urethra is approximately 20 cm long and has three named regions: the
prostatic, membranous, and spongy urethrae. The urethra opens at the tip of the penis
after traveling down its length. The urethra of the male has a double function. It carries
urine out of the body, and it provides the passageway through which sperm is ejected
from the body. Thus, in males, the urethra is part of both the urinary and reproductive
systems.

Micturition

Micturition of voiding is the act of emptying the bladder. Two sphincters, or valves,
control the flow of urine from the bladder. Ordinarily, the bladder continues to collect
urine until about 200 ml have accumulated. At about this point, stretching of the bladder
wall activates stretch receptors. Impulses transmitted to the sacral region of the spinal
cord and then back to the bladder via the pelvic splanchnic nerves cause the bladder to
go into reflex contractions. As the contractions become stronger, stored urine is forced
past the internal urethral sphincter into the upper part of the urethra.it is then that a
person feels the urge to void. Because the lower external sphincter is skeletal muscle
and is voluntarily controlled, we can choose to keep it closed and postpone bladder
emptying temporarily. However, if it is convenient, the external sphincter can be relaxed
so that urine is flushed from the body. When one chooses not to void, the reflex
contractions of the bladder will stop within a minute or so, and urine will continue to
accumulate in the bladder. After 200 to 300 ml more have been collected, the micturition
reflex occurs again. Eventually, micturition occurs whether one wills it or not.

Fluid, Electrolyte, and Acid-Base Balance

Blood composition depends on three major factors: diet, cellular metabolism, and urine
output. In general, the kidneys have four major roles to play, which help keep the blood
composition relatively constant. These are (1) excretion of nitrogen-containing wastes,
maintaining (2) water and (3) electrolyte balance of the blood, and (4) ensuring proper
blood pH.

Maintaining Water and Electrolyte Balance of Blood

Body Fluids and Fluid Compartments

If you are a healthy young adult, water probably accounts for half or more of your body
weight- 50 % in women and about 60 % in mean. These differences reflect the fact that
women have relatively less muscle and a larger amount of body fat. Babies, with little fat
and low bone mass, are about 75 % water, but total body water content declines
through life and accounts for only about 45 % of body weight in old age.

Water occupies three main locations within the body, referred to as fluid compartments.
About two-thirds of body fluid, the so-called intracellular fluid (ICF), is contained within
the living cells. The remainder, called extracellular fluid (ECF), includes all body fluids
located outside the cells. Although ECF most importantly includes blood plasma and
interstitial fluid, it also accounts for cerebrospinal and serous fluids, the humor of the
eye, lymph, and others.

Plasma circulates throughout the body and links the external and internal environments.
Exchanges occur almost continuously in the lungs, gastrointestinal tract, and kidneys.
Although these alter plasma composition and volume, adjustments in the other two fluid
compartments follow quickly so that balance is restored.