URINARY SYSTEM

Urinary system is one of the excretory system of human body. The system which excretes waste materials
& different body metabolites through production of urine is called urinary system. Urinary system also
plays important role in maintaining water & electrolyte balance according the body needs.

 Two kidneys: Produce Urine

 Two ureters: Transfer urine from
kidneys to Urinary bladder
 One Urinary bladder: Store urine
temporarily
 One urethra: Discharges urine
from the body

Fig: Parts of Urinary system

KIDNEY
The kidney lie on the posterior abdominal wall. Adult kidneys are bean shaped organs, about 5 inch long,
3 inch wide, 1 inch thick and weigh 150 gm. On the medial border of the kidneys, where renal blood
vessels enter and ureter come out is called hilum.

Gross structure of the kidneys

A longitudinal section of the reveals three distinct area (from outside to inward):

 A fibrous capsule, surrounding the

kidney.
 The cortex, a reddish brown layer of
tissue immediately below the capsule
and outside the pyramids.
 The medulla, the innermost layer.
Medulla consists of 8 – 18 pale, conical
shaped renal pyramids.

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Microscopic structure of the kidneys
 Functional unit of kidney is called Nephron.
 Each kidney is composed of about 1 million nephrons and a smaller number of collecting
tubules.
 Collecting tubules transport urine through the pyramids to the renal pelvis.

Nephron
Nephron is the structural & functional unit of the kidney. Urine is produced in this nephron through a
number of process. Each nephron consists of two parts:
1. Renal corpuscle
 Glomerulus: it is a capillary network which filter the blood to excrete the waste
materials.
 Bowman’s capsule:
2. Renal tubule: in the order that fluid passes through, the renal tubule consists of:
 Proximal convoluted tubule
 Loop of Henle
o Descending limb of loop of Henle
o Ascending limb of loop of Henle
 Thin Ascending limb of loop of Henle
 Thick Ascending limb of loop of Henle
 Distal Convoluted tubule
 Collecting duct

Fig: Structure of Nephron

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 URINARY SYSTEM
Renal Tubule
Distal convoluted tubules of several nephrons empty into a single collecting duct. Several collecting
ducts drain into a papillary duct. Each papillary duct drain into minor calyx. Thus, in each kidney, about 1
million nephrons drain into several hundred papillary ducts.

FUNCTIONS OF KIDNEY
 Urine formation
 Electrolyte balance: most importantly – Na+, K+, Ca2+, Cl- and HPO42-
 Excretion of waste & foreign substances
 Regulation of blood pressure: kidneys secret the enzyme renin, which increases blood pressure.
 Hormone production: Erythropoietin.

Waste products excreted by the kidneys

Urea, Creatinine, Uric Acid, Ammonia, Bilirubin, Drugs etc.

PHYSIOLOGY OF URINE FORMATION

Three process are involved in urine formation:

1. Glomerular filtration: Glomerular filtration takes place through the semi-permeable membrane
of the glomerulus and Bowman’s capsule. From the capillary network of the glomerulus water
and a large number of small molecules are filtered out into the Bowman’s capsule.

Substances that are filtered out from blood: Water, minerals, amino acid, Keto acid, Glucose,
hormone, creatinine, urea, toxin, some drugs etc.

Substances that are not filtered out: RBC, WBC, Platelet, Plasma protein, some drugs.

Fig: Physiology of Urine Formation

1. Glomerular filtration: filtration of blood into Nephron
2. Tubular reabsorption: selective reabsorption of some molecules from filtrate into blood.
3. Tubular secretion: secretion of some waste materials into Nephron that are nor filtered through
Nephron

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 URINARY SYSTEM
Glomerular Filtration Rate (GFR)
The volume of filtrate formed by both kidneys in each minute is called GFR. In a healthy adult GFR is
about 125 ml/minute & 180 liters/day. Out of 125 ml, around 124 ml is reabsorbed in blood and only 1
ml go for urine. So, amount of urine produced every day is around (24 X 60 X 1) = 1440 ml ≡ 1.5 liter.
That’s why every healthy adult person should take minimum 1.5 liters water equivalents to 8 glass (200
ml/glass).

2. Tubular Reabsorption: the term absorption means “entry of new substances into the body” as
occur in gastrointestinal tract.
Reabsorption means “the return of substances into blood stream’’.
As filtered fluid flows through the renal tubule and collecting duct, tubular cells reabsorb about
99% of the filtered water and many useful solutes and return to blood.
 Some constituents of glomerular filtrate are completely reabsorbed. E.g.: Glucose, Amino
acid
 Some constituents are not absorbed:
I. Nitrogenous waste products like urea, uric acid
II. Substances that are not normal blood constituents are not reabsorbed.
 Electrolytes, e.g.: Na+, K+, Ca+, Cl-, PO42- are reabsorbed in regulated fashion.

3. Tubular Secretion: Some substances like penicillin and aspirin, may not be filtered through
glomerulus because of the short time it remains in the glomerular capillary. Such substances are
cleared by secretion into the convoluted tubules.
Substances that are secreted in the convoluted tubule are Penicillin, Aspirin, H +, K+, NH4+,
Creatinine etc.

After completion of these three processes (Glomerular filtration, Tubular Reabsorption, Tubular
Secretion) the end product produced is called urine.

URINE
Solutes in the fluid that drains in the renal pelvis remain in the urine and are excreted.
Physical properties of urine:
 Color: clear/straw due to presence of urobilinogen.
 pH: around 6 (normal range is 4.5 – 8).
 Amount: a healthy adult passes 1000 to 1500 ml per day. Amount vary according to fluid
intake and physiological conditions.

Composition of urine:
Water 96 %
Urea 2%
Uric acid
Ammonia
Sodium
Potassium
2%
Chloride
Phosphate
Sulphate
oxalate

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URETER
Two hollow tubes through which urine is passed average capacity of bladder is around 600 ml. it
from kidneys to the urinary bladder. In adult, has three orifices:
each ureter is 25 to 35 cm long with a diameter
 Upper two for ureter
of about 3 mm. continuous above with funnel
shaped renal pelvis and opens below into the  Lower one orifice is for urethra
urinary bladder.

Functions of ureter: propels urine from the

kidneys into the bladder by peristaltic
contraction.

URINARY BLADDER
It is hollow muscular organ which reserves the
urine producing in kidney temporarily. The

Micturition
Expulsion of urine from the urinary bladder is called micturition. It is also known as urination or voiding.

When:
 Bladder content 150 ml: first urge to void
 Bladder content 400 ml: marked sense of fullness
 Bladder content 800 ml: intolerable pain

URETHRA
Urethra is a small tube extending from the urinary bladder to the exterior at the external urethral
orifice. Length of urethra is about: Male-20 cm, Female-4 cm.

DISEASES OF URINARY SYSTEM

Diseases of kidney

 Glomerulonephritis: it is inflammatory condition of the glomerulus (the filter paper of

nephron).
 Nephrotic syndrome: glomeruli are damaged, permeability of glomerular membrane is
increased and protein is lost through urine (proteins are not normally filtered through
glomerulus).
 Pyelonephritis: it is the infection of kidney tissues, renal pelvis and calices.
 Renal failure: Failure of the excretory function of the kidneys leading to retention of
nitrogenous waste products of metabolism in the body. Renal failure is two types:
o Acute renal failure:
 Sudden and usually reversible
 Plasma creatinine >200 µmol/L
o Chronic renal failure: irreversible deterioration of renal function which classically
develops over a period of years.

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 Renal calculi: A kidney stone, also known as a renal calculus or nephrolith, is a solid piece of
material which is formed in the kidneys from minerals in urine. Kidney stones typically leave
the body in the urine stream, and a small stone may pass without causing symptoms.
 Congenital abnormalities of kidney: Congenital means “By Birth”. If any problem is occurred
in kidneys at the time of fetus, then the baby comes out from mother with some
abnormality in kidney function which is called congenital abnormality of kidneys.
 Tumors of kidney: if the cells of kidneys grow abnormally and make tumor like structure,
then it is called tumors of kidneys. Kidney cancer -- also called renal cancer -- is a disease in
which kidney cells become malignant (cancerous) and grow out of control, forming a tumor.
Almost all kidney cancers first appear in the lining of tiny tubes (tubules) in the kidney. This
type of kidney cancer is called renal cell carcinoma.

Diseases of Ureter, Bladder and Urethra

 Urinary tract infection (UTI): Infection of any part of the urinary tract (ureter, urinary bladder,
and urethra) is called urinary Tract Infection (UTI).
o Infection of ureter: Ureteritis
o Infection of Urinary bladder: Cystitis
o Infection of urethra: urethritis

These three are collectively known as Urinary Tract Infection (UTI). UTI implies multiplication of
organisms in the urinary tract which is usually associated with the presence of more than 100000
organisms/ml in a midstream sample of urine.

UTI is more common in women. About one third of woman have UTI at some time in their life. In male,
UTI is uncommon except below 1 and over 60 years of age. In a minority of cases, untreated UTI may
cause renal damage and chronic renal failure.

Types of UTI
 Uncomplicated:
o Normal urinary tract, no damage occur
o Caused by single strain of organism
o Easy to treat by using an antibiotic
 Complicated
o It is associated with anatomical & physiological abnormality of urinary tract
o Caused by mixed strain of organisms
o Very complicated to treat due to diagnosis problem.

Organism causing UTI

Escherichia coli and other coliforms 75%

Proteus mirabilis 12%
Staphylococcus saprophyticus
10% (more common in young women)
Or Staphylococcus epidermidis
In hospital
 Klebsiella aerogenes 4%
 Enterococcus faecalis 6%

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 URINARY SYSTEM
Why UTI is more common in woman?
Reasons are:
 The urethra of women is very short (F: 4 cm, M: 20 cm), so that bacteria can easily go upward to
reach in urinary tract and causes UTI.
 The vaginal orifice is always exposed to open air, so that bacteria can easily enter and reach
urinary tract to cause UTI.
 The anal canal & urinary tract are very close in woman, so that bacteria can easily translocate
into urinary tract to cause UTI.

Urinary tract obstruction

o Obstruction of ureter: caused by o Obstruction of urethra: caused

 Stones by
 Stricture  Stricture
 Spasm  Tumor
 Tumor  Stone
o Obstruction of bladder: Caused  Benign prostatic
by hyperplasia
 Stone
 Tumor

Urinary incontinence
Urinary incontinence is the involuntary leakage of urine; in simple terms, to wee when you don't intend
to. It is the inability to hold urine in the bladder because voluntary control over the urinary sphincter is
either lost or weakened.

BENIGN PROSTATIC HYPERPLASIA

The prostate gland lies below the bladder

surrounding the first part of urethra. Prostate
glands present only to male and it secrets a
thin milky fluid that make up about 30% of
semen. This fluid is called seminal fluid.
Prostatic hyperplasia or enlargement is
common in men over 50 years of age. Cause
is not clear but it is thought that due to
decline in the androgen level and due to an
imbalance in androgen-estrogen balance in
old age, cells of the prostate gland increase in
number.

Consequences of BPH: enlarged prostate may constrict the urethra leading to disruption of urination.
Patient experiences hesitancy, poor stream, intermittent stream, terminal dribbling, increased
frequency, UTI, retention of urine.

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