urinary system

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urinary System : 

1 urinary System SMS 1113 Dr. Mohanad R. Alwan

Types of Nephron : 

2 Types of Nephron (1) Cortical (sub-capsular) nephrons are the most common type of nephron.  Their renal corpuscles are found in the outer cortex and their short loops are formed by distal straight tubules in the outer medulla. (2) Juxtamedullary nephrons account for approximately 20% of all nephrons; their corpuscles are  found adjacent to the medulla.  They are long looped nephrons whose loop is formed by thin limbs.  These nephrons are responsible for producing the urine-concentrating mechanism of the kidney.  (3) Intermediate nephrons have their renal corpuscles in the mid-region of the cortex and their loops are intermediate in length.

Glomerulus : 

3 Glomerulus Structure of a Nephron: 2 main structures Glomerulus – a knot of capillaries Renal tubule (about 2 inches long). The endothelium of the glomerular capillaries is fenestrated

Glomerular capsule : 

4 Glomerular capsule a double-walled epithelial cup capillaries External parietal layer: (simple sequamous epithelium) Visceral layer (Podocysts)

Visceral layer of Bowman’s capsule : 

5 Visceral layer of Bowman’s capsule The podocytes possess processes called pedicles that wrap around the capillaries and interdigitate to form filtration slits approximately 25nm wide.  The mesangial cells serve a phagocytic function and keep the basement membrane clear of debris.  All 3 components combine to retains cells and macromolecules (proteins > 70 kd) but permit the passage of water and small solutes (salts, glucose, amino acids, nitrogenous wastes) into the urinary space as filtrate.

Filtrate membrane : 

6 Filtrate membrane Consist of 3 layers Capillary endothelium Basement membrane (intervening basement membrane) Foot processes of podocytes of glomerular capsule.

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Urinary Filtration Membrane : 

8 Urinary Filtration Membrane Endothelial cell 70-90 nm fenestra restrict proteins > 70kd Basal lamina heparan sulfate is negatively charged produced by endothelial cells & podocytes phagocytosed by mesangial cells Podocytes pedicels 20-40 nm apart diaphragm 6 nm thick with 3-5 nm slits podocalyxin in glycocalyx is negatively charged

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Renal tubule – site of selective re-absorption / secretion of solutes : 

10 Renal tubule – site of selective re-absorption / secretion of solutes The renal tubule serves to recover water and other desirable solutes (sugar, ions, small proteins) from the filtrate.  The proximal convoluted tubule receives filtrate from the urinary space and is the site of the selective re-absorption of most solutes including all the glucose and amino acids and most of the water and salts.

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Renal tubule : 

12 Renal tubule Proteins are absorbed by pinocytosis, broken down by lysosomal degradation and released as amino acids to the peritubular capillary network.  This is also the site of pH balancing and elimination (active transport) of creatine.

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Histology of tubules : 

14 Histology of tubules Structurally the proximal convoluted tubule is formed by a simple cuboidal to low columnar epithelium.  The apical surface is covered with microvilli creating a light microscopic brush border that increases the surface area for ion absorption.  The cells are tightly bound to one another to seal off the intercellular spaces from the lumen using junctional processes apically and interdigitating plicae (folds) laterally.  Basally, interdigitating processes contain numerous mitochondria which create light microscopic basal striations that are associated with ion transport.

Histology… : 

15 Histology… Proximal convoluted tubules are the most abundant tubule in the cortex.  They have a eosinophilic cytoplasm with a basal nucleus.  The brush border is rarely preserved and the indistinct cells margins are due to basal and lateral border interdigitations. The proximal straight tubules are located within or near the medulla, depending upon the type of nephron.  They are formed by lower cuboidal epithelium and their microvilli and basal and lateral interdigitations are less well developed.  Histologically they are similar to proximal convoluted tubules

Histology…. : 

16 Histology…. Descending thin tubules are located within the medulla and are formed by low cuboidal to squamous epithelium. The microvilli are poorly developed as are the basal and lateral interdigitations creating a very leak cell that serves as the site of passive transport of ions (inward) and water (outward) between the lumen and interstitium. The ascending thin tubules are also located within the medulla and are similar in appearance to descending thin tubules.  However, these tubes are impermeable to water and permit passive transport of NaCl into the interstitium.

Histology…. : 

17 Histology…. Distal straight tubules are located within both the medulla and cortex .  Histologically these appear as a simple cuboidal epithelium with sparse microvilli and lacking lateral interdigitations.  The nucleus is apical and basal interdigitations with abundant mitochondria are present.  These tubes are impermeable to water and are the site of ion transport from the lumen to the interstitium that establishes the ion gradient of medullary interstitium.

Histology…. : 

18 Histology…. Distal convoluted tubules are located within the cortex.  They are approximately 1/3rd as long as their proximal counterparts.  They contact the renal corpuscle forming a macula densa which is part of the juxtaglomerular apparatus (see below).  Histologically they are similar to the distal straight tubules and also function in ion exchange.

Collecting tubules…. : 

19 Collecting tubules…. The collecting system starts in the cortex as a continuation of the distal convoluted tubules and descend through the medulla.   As the ducts coalesce and increase in size, the cells of the tubes change from somewhat squamous to cuboidal to columnar and similarly become increasing stratified.  They terminate at the tip of the renal pyramid as the papillary ducts .

Collecting tubules…. : 

20 Collecting tubules…. Histologically they appear as tubes with distinguishable cells margins, central nuclei and poorly staining cytoplasm.  At the EM level many posses a single cilium and sparse microvilli.  The collecting system functions to concentrate urine through ADH-regulated and ADH-independent water channels

PCT : 

21 PCT the walls formed by cuboidal epithelial cells Their Luminal surfaces have dense microvilli.

Renal (Uriniferous) Tubule : 

22 Renal (Uriniferous) Tubule Proximal convoluted tubule (PCT) longest, most coiled, simple cuboidal with brush border Nephron loop - U shaped; descending + ascending limbs thick segment (simple cuboidal) initial part of descending limb and part or all of ascending limb, active transport of salts thin segment (simple squamous) very water permeable Distal convoluted tubule (DCT) cuboidal, minimal microvilli

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23 Kidney Cortex – PCT (P) & DCT (D) P P D D

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24 Long section of Collect tubules (CT) and PCT (P) CT CT P

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Proximal Convoluted Tubules (PCT) : 

26 Proximal Convoluted Tubules (PCT) Reabsorbs 65% of GF to peritubular capillaries Great length, prominent microvilli and abundant mitochondria for active transport Reabsorbs greater variety of chemicals than other parts of nephron transcellular route - through epithelial cells of PCT paracellular route - between epithelial cells of PCT Transport maximum: when transport proteins of plasma membrane are saturated; glucose > 220 mg/dL remains in urine (glycosuria)

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Loop of Henle : 

28 Loop of Henle Descending limb Proximal part: similar cells of the PCT Thin segment: simple sequamous epithelium Ascending limb Cuboidal epithelium or low columnar? thick segment

Thin loop of Henle : 

29 Thin loop of Henle

Thick loop of Henle : 

30 Thick loop of Henle

DCT : 

31 DCT The wall: cuboidal epithelium (like PCT) Thinner Lack micrivilli

Collecting ducts : 

32 Collecting ducts Have 2 types of cells Intercalated cells: cuboidal cells with extensive microvilli Maintain the acid –base balance (blood pH) Principal cells: short microvilli maintain water-sodium (Na+) balance Have receptors to antidiuretic hormone & aldosterone

DCT and Collecting Duct : 

33 DCT and Collecting Duct Effect of aldosterone ? BP causes angiotensin II formation angiotensin II stimulates adrenal cortex adrenal cortex secretes aldosterone aldosterone promotes Na+ reabsorption Na+ reabsorption promotes water reabsorption water reabsorption ? urine volume BP drops less rapidly

DCT and Collecting Duct 2 : 

34 DCT and Collecting Duct 2 Effect of atrial natriuretic factor (ANF) ? BP stimulates right atrium atrium secretes ANF ANF promotes Na+ and water excretion BP drops Effect of ADH dehydration stimulates hypothalamus hypothalamus stimulates posterior pituitary posterior pituitary releases ADH ADH ? water reabsorption urine volume ?

Collecting Duct Concentrates Urine : 

35 Collecting Duct Concentrates Urine Osmolarity 4x as high deep in medulla Medullary portion of CD is permeable to water but not to NaCl

Cortical Collecting Tubule : 

36 Cortical Collecting Tubule

Medullary Collecting Tubule : 

37 Medullary Collecting Tubule

Control of Water Loss : 

38 Control of Water Loss Producing hypotonic urine NaCl reabsorbed by cortical CD water remains in urine Producing hypertonic urine GFR drops tubular reabsorption ? less NaCl remains in CD ADH ? CD’s water permeability more water is reabsorbed urine is more concentrated

Countercurrent Multiplier : 

39 Countercurrent Multiplier Recaptures NaCl and returns it to renal medulla Descending limb reabsorbs water but not salt concentrates tubular fluid Ascending limb reabsorbs Na+, K+, and Cl- maintains high osmolarity of renal medulla impermeable to water tubular fluid becomes hypotonic Recycling of urea: collecting duct-medulla urea accounts for 40% of high osmolarity of medulla

Countercurrent Multiplier of Nephron Loop Diagram : 

40 Countercurrent Multiplier of Nephron Loop Diagram

Countercurrent Exchange System : 

41 Countercurrent Exchange System Formed by vasa recta provide blood supply to medulla do not remove NaCl from medulla Descending capillaries water diffuses out of blood NaCl diffuses into blood Ascending capillaries water diffuses into blood NaCl diffuses out of blood

Maintenance of Osmolarity in Renal Medulla : 

42 Maintenance of Osmolarity in Renal Medulla

Summary of Tubular Reabsorption and Secretion : 

43 Summary of Tubular Reabsorption and Secretion

Interstitium….. : 

44 Interstitium….. The interstitium is the connective tissue matrix of the kidney. [Yes. it is the stroma of the kidney, but remember not all stromas are connective tissue.]  It is sparse in the cortex and most abundant the deep medulla.  The extracellular matrix consists of collagen fibers and glycosamionglycans (GAGs) and the cells are fibroblasts and macrophages.

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Ureters : 

53 Ureters Ureters:The ureters are muscular tubes connecting the renal pelvis to the urinary bladder. 25 cm long Enters on the floor of bladder

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56 Ureter

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57 Ureter – folded mucus membrane Transitional Epithelium

Urinary Bladder : 

58 Urinary Bladder Urinary Bladder Muscular sac on floor of pelvic cavity. Located in pelvic cavity, posterior to pubic symphysis Average bladder volume is 500 ml Max capacity is 700-800 ml

Urinary Bladder : 

59 Urinary Bladder Consists from: 3 layers parietal peritoneum, superiorly; fibrous adventitia rest muscularis: detrusor muscle, 3 layers of smooth muscle mucosa: transitional epithelium trigone: openings of ureters and urethra, triangular rugae: relaxed bladder wrinkled, highly distensible The outer layer may contain Pacinian corpuscles

Urinary Bladder and Urethra - Female : 

60 Urinary Bladder and Urethra - Female

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61 Bladder

Urinary Bladder : 

62 Urinary Bladder

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Urethra : 

65 Urethra Urethra Conveys urine out of body Female urethra – 3 - 4 cm Opens into external urethral oriface Lies between vaginal oriface and clitoris Male urethra – 18 cm 3 regions Prostatic urethra – 2.5 cm Membranous urethra – 0.5 cm Penile urethra – 15 cm

Urethra : 

66 Urethra

Blood supply… : 

67 Blood supply… Arterial:  renal artery > inter-lobar arteries > arcuate arteries > inter-lobular arteries > afferent arterioles > renal corpuscle (capillaries!) > efferent arteriole > peritubular capillary network (for cortical nephrons) --or-- > vasa recta (for juxtamedullary nephrons). Venous::  Peritubular capillary network > interlobular veins > arcuate veins > interlobar veins > renal vein. The vasa recta (L. straight vessels) are comprised of arteriolae rectae and venulae rectae and their associated capillaries.

Blood Supply Diagram : 

68 Blood Supply Diagram

Nerve Supply : 

69 Nerve Supply The smooth muscle of the glomerular arterioles receives sympathetic innervation.   Vasoconstriction of afferent arteriole decreases filtration rate (lowers pressure) whereas vasoconstriction of the efferent arterioles increases filtration rate.  Neither innervation is neither for normal function.

Urine flow : 

70 Urine flow urinary space of Bowman's capsule ---? > convoluted proximal tubule ---? > descending, thick, straight, proximal tubule ---? > descending, thin, straight, proximal tubule --? > ascending, thin, straight proximal tubule ---? > ascending, thick, straight, distal tubule ----? > convoluted, distal tubule ---? > collecting tubule ----? > collecting ducts ----? > papillary ducts of Bellini -----? > minor calyx ------? > major calyx ----? > renal pelvis -----? > ureter -----? > bladder -----? > urethra -----? > outside

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71 Thank you