a.

Anatomy and Physiology

The urinary system is the
bodys

water

treatment

plan. Its main task is to

collect waste products and
excrete them as urine. The
structures

of

the

renal

system include the two

Figure 1

kidneys, ureters, bladder,

and the urethra. The ureters, urinary bladder, and urethra form the urinary tract,
which drain urine from the kidneys, store it, and then release it during urination.
The kidneys lie on the posterior abdominal wall, behind the peritoneum
or in a retroperitoneal position with the right kidney just below the liver and the
left kidney below the spleen. An adrenal gland is positioned at the top of each
kidney and is distinctly separate organ functionally. The ureters extend from the
kidneys to the urinary bladder within the pelvic cavity. The urinary bladder serves
as storage of urine until it is eliminated through the urethra (Seeley, et al, 2005).

Kidneys
The kidneys are a pair of dark red,
bean-shaped organs, each about the size of
a tightly clenched fist. They are surrounded

Figure 2

by connective tissue known as the renal capsule. A thick layer of adipose tissue
surrounded the renal capsule which holds them in place and protects them from
mechanical shock (Marieb, 2006).
The major functions of the urinary system are performed by the kidneys.
They play a vital role in controlling the composition and volume of body fluids
through excretion, blood volume control, ion concentration regulation, pH
regulation, red blood cell concentration, and vitamin D synthesis (Seeley, et al,
2005).

Internal Structure of the Kidneys

Inside each kidney are three distinct regions:
renal cortex, renal medulla, and renal
pyramids. Renal cortex has a lighter color and
the outermost layer while the darker reddishbrown area deep to the cortex is the
renal medulla. In the medulla are the triangular
Figure 3

regions with striped appearance, the medullary pyramids.

Renal columns, the extension of cortex-like tissue, separated the pyramids. The
flat, basin-like cavity medial to the hilus is the renal pelvis which stretches along
the ureter. The calyces which are the extensions of the pelvis form cup-shaped
areas that enclose the tips of the pyramids. The calyces are the ones which drain
urine from the tips of the pyramids into the renal pelvis. After which, urine flows

from the pelvis into the ureter and transports it to the bladder for temporary
storage (Marieb, 2006).

Blood Supply of the Kidneys

The kidneys have a very rich blood supply since
they continuously cleanse the blood and adjust
its composition. Approximately one-quarter of the total
blood of the body passes through the kidneys each
minute (Marieb, 2006). The arterial supply of each
kidney comes from the renal arteries, left and right, Figure 4
which branch out directly from the abdominal aorta. Each renal artery branches
into segmental arteries as they approach the hilus and into lobar arteries once
inside the pelvis. The lobar arteries are

further divided into interlobar arteries

which travel the renal columns between the renal pyramids to reach the cortex.
The interlobar arteries then supply blood to the arcuate arteries which curve over
the medullary pyramids to supply several interlobular arteries that feed into the
afferent arterioles that supply the glomeruli.
Venous blood from the kidneys flows through veins that trace the pathway
of the arterial supply but in a reverse direction: from interlobular veins to arcuate
veins to interlobar veins to the renal vein which come out from the kidney hilus.
Unlike the arterial supply, there are no lobar or segmental veins (Marieb, 2006).

Nephrons

The functional units of the kidneys which

are responsible for forming
urine

are the nephrons. Each kidney

contains

approximately

1.3

million of nephrons (Seeley, et al,

2005). The glomerulus, which is
a knot of capillaries, and a
renal tubule are the two main structures of
Figure 5

a nephron. The closed and enlarged

end of the renal tubule which completely surrounds the glomerulus is called the
glomerular or Bowmans capsule. The inner or the visceral layer of the capsule is
made up of highly modified octopus-like cells called podocytes (Marieb, 2006).
Podocytes have foot processes that intertwine with one another and filtration slits
which exists between their extensions which make it porous or a holey
membrane around the glomerulus (Marieb, 2006).
The rest of the tubule which consists of the proximal convoluted tubule
(PCT), the loop of Henle or the nephrotic loop, and the distal convoluted tubule
(DCT) is about 3 cm long (Marieb, 2006). The collecting ducts that receive urine
from many nephrons run downward through the medullary pyramids, giving them
their striped appearance. These ducts deliver the final urine product into the
calyces and renal pelvis.
In each and every nephron are two capillaries beds: the glomerulus and
the peritubular capillary bed. The glomerulus is both supplied and drained by the

afferent and efferent arterioles. Afferent arteriole is the feeder vessel which arises
from the interlobular artery while efferent arteriole receives blood that has passed
through the glomerulus. Specialized for filtration, blood pressure in the
glomerular capillaries is much higher than any other capillary beds which allow
fluid and solutes out of the blood into the glomerular capsule. However, 99% of
these filtrates are eventually reclaimed by the renal tubule cells and returned to
the blood by the peritubular capillary beds (Seeley, et al, 2005).
The peritubular capillaries, the second capillary bed, come out from the
efferent arteriole and drain the glomerulus. Unlike the glomerulus, peritubular
capillaries are low-pressure, porous vessels that are adapted for absorption
instead of filtration. These capillaries drain into interlobular veins leaving the
cortex (Seeley, et al, 2005).

Urine Formation
There

are

three

processes

involve in urine formation: filtration,

tubular

reabsorption,

and

tubular

secretion. Filtration, a nonselective and

passive process, is the passage of solvent and dissolved
substances through a membrane or filter (Seeley, et al,
2005). The glomerulus acts as the filter. Water and solutes
smaller than proteins are forced through

Figure 6

the capillary walls and pores of the glomerular capsule into the renal tubule.

Bood proteins and blood cells are normally too large to pass through the filtration
membrane. Filtrate will be formed as long as the systemic blood pressure is
normal.
As soon as the filtrate enters the proximal convoluted tubule, tubular
reabsorption starts. Useful substances in the filtrate such as water, glucose,
amino acids, and needed ions are transported out of the filtrate into the tubule
cells and then enter the capillary blood. Some reabsorption is done passively but
the reabsoprtion of most substances requires active transport processes which
use membrane carriers and are very selective. A lot of carriers are present for
substances then needed to be retained and few or no carriers for those
substances that are of no use to the body like nitrogenous waste products such
as urea, uric acid, and creatinine. Most reabsorption happens in the proximal
concoluted tubules but the distal convoluted tubule and the collecting duct are
also active.
Tubular secretion is reabsorption in reverse. Some substances such as
hydrogen, potassium ions, creatinine, and drugs are removed from the
peritubular blood and secreted by the tubule cells into the filtrate.