I/RINARY SYSTEM

,,.FUNCTIONS
- formation of urine (elimination of metabolic waste products)
- regulation of fluid and electrolyte balance (reiyclinS of water and electrolytes)
- regulation of blood pressure (r'enin - angiotensin - aldosterone)
- synthesis and release of hormones (erythropoietin)
- erythropoietin - interstitialfibroblasts - controls erythropoiesis - red biood cellproduction)
Urinary system: kidneys, ureters, bladder, urethra
kidney
- surrounded by connective tissue capsule
- subdivided into an outer cortex and inner medulla
- medulla - renal pyramids {broad base of pyramid faces the renal cortex, apex (papilla), points internally).
- renal hilum - the renal artery enters the kidney, the renal vein and ureter leave
- the apex {papilla} of pyramid empties urine into a minor calyx;
- rninor calyces empty into major calyces
- major and minor calyces collect urine and empty it into the renal pelvis (continuation of the ureter)
- apexes of renal papillae - perforated by ducts of Bellini - area e ribrosa (sieve-like region of the apex of the renal pyramid)
Cortex of the kidney:
- renal corpuscles
- cortical labyrinth - convoluted tubules
- medullary rays - cortical continuations of straight tubules located in renal pyramids {medulla}
Kidney is a multilobar organ
Renal lob is composed of:
- renaf pyramld - parallel tubules of nephrons and collecting ducts
- renalcolumn - separates two neighboring pyramid
- cortical arch - a part of renal cortex overlying the base of pyramid
Uriniferau; tubule - composed of nephron and collecting tubule
- the functional unit of the kidney
Nephron: renal corpuscle, proximaltubule, loop of Henle, distal tubule
Two types of nephronsi ,
- Cortical nephrons- short loop of Henle
- Juxtamedullary nephrons * long loop of Henle
Narmal kidney contains about 1.3 million nephrons
The renal corpuscte - filters the fluid expressed from the bloodstream
Proximal tubula, locp of llenle and distal tubule - modify the filtrate to form the urine
renalccrpusele
- a tuft of capillaries - glomerulus - formed when a mass of gtcmerular capillaries grows into the blind ending of a nephron
iBowman's capsule)
- surrounded by Ecwrnan's capsule
Bouvman's capsule
- Visceral layer - modified epithelial cells - podocytes
- Parietallayer - simple squamous epithelium
Bowman'g rpaee {urilary space}
- between the visceral and parietal layers of Bowman's capsule
- into Bowman's space the filtrate enters after filtration
renal corpuscle
- Vascular pole - vessels {affere nt and efferent arteriole} enter and exit Bowman's capsule
' Urinary pole - between renal corpuscle and the proximal tubule, drains Bowman's space
6lomerulus is completely arterialbed !t
- i: supplied by afferent glomerular arteriole and drained by efferent glomerular arteriole
6lomerulus contains
- fenestrated capillaries
- mesangialcells {replace the connective tissue cells}
1. extraglomerular mesangial cells - located at the vascular pole
2" intraglomerular nresangial cells - pericyte-like cells - within the renal corpuscle
-
- provide physical support to the capillary
- phagocytosis
' regulate blood flow of the glomerular capillaries by their contractile activity
I
Clomerulus is a network ttuft) of capillaries - performs the first step of blood fittering
I
Filtration barrier - The blood plasma - filtered through the capillaries of the glomerulus into the Bowman's space
 1. glomerular capillary endothelial cells (numerous pores - fe nestraei
2. glomerular basal lamina (very thick),
3. podocytes (visceral layer of Bowman's capsule)
Basal lamina ofglomerularcapillary-betweenendothelial cellsand'risceral layerof Bowman'scapsule-podocytes:
- perlecan, agrin) - stop ihe passage of negativel
- Lamina rara interna and externa (laminin, fibronectin and proteoglycans
charged molecules
- Lamina densa (collagen type lVi- traps molecules largerthen 69kDa
Podocytes - cells of visceral layer of Bowman's capsule
- highly modified to perform a filtering function
- numerous, [ong processes and secondary processes - pedicels
- glycocalyx (sialoproteins: podocalyxin, podoendin)
Foot processes of podocytes
- interdigitate with one another forming filtration siits {slit pores) - are spanned by stit diaphragms {in contrast to pores in t
glomerular endothelium )
Filtration process
- fenestration {pores} - prevents filtration of cells
- lamina densa of basal lamina - traps large rnolecules (69kDa), lamina rara - negatively charged molecules
- pores of slit diaphragms of podocytes - permit to pass uncharged macromolecules smaller than 4 nm in diameter (mediun
size molecules)
lntraglomerular mesangial cells are not a part of the filtration barrier
- are specialized pericytes, participate indirectly in filtration by contracting and reducing the glomerular surface area
- phagocytosis of particles stopped through the basal lamina the old basal lamina (new is formed by endothelial cells and
podocytes)
Filtration process
- blood flows through the afferent arteriole and leaves through the efferent arteriole {the blood pressure in the efferent
arteriole is higher than in the afferent arteriole).
- the high hydrostatic pressure of the blood forces srnallmolecules through the filter, from the blood, across the filtration
barrier, into Bowman's space - glomerular ultrafiltrate {water, glucose, amino acids, sodiurn chloride and urea - is similar to
blood plasma)
From Bowman's space glomerular filtrate flows to the proximal tubule at the urinary pole
Proximaltubule - two regions:
- proximal ccnvoluted tubule (pars convoluta) - in cortex
- pars recta {descending thick limb of Henle's loop}
- cuboidal epithelial cells possess microvilli - brush border
- numerous mitochondria within the infoldings of the basal plasma membrane (mitochondria give cells an acidophilic
appearance).
Function of proximal tubules - resorption of most material frorn the ultrafiltrate !
Cells of proximal tubule transpoft from the ultrafiltrate into the connective tissue strcma:
- Na+ and Cl- ions {NalK/ATPase pumps}
- Water (80%)
- Glucose, amino acids, proteins and vitamins
- The substances released by cells into the lumen of tubules: H+, ammonia, uric
acid, urea, creatinine, some drugs and toxir
Thin limbs of Henle's loop - Ieads from the proximal tubule to the distal convoluted tubule
- Descending thin limb
- Henle's loop
- Ascending thin limb
' squamous epithelial cells
- resembles capillary in cross section
Thin limbs of Henle's loop - function
thin descending limb - low permeability to ions, highly permeable to water (the concentration
of the urine increases -
reaches 1200m0srn - hypertonic)
- thin ascending limb - impermeable to water,
but is permeable to ions {ions leave the lumen - the concentration of urine
becomes more hypotonic - 100-150 m0sm/L)
thin limbs of Henle's loop ' establish of the countercurrent multiplier
system- creates a gradient of osmolarity in the renal
interstitium
the interst;tium increases in osmolarity - from 600 mosm/L in
ihe outer medulla to 1200 mosm/L in the inner medulla (the
concentration of sodium and chloride is the greatest in
the region of the bend of the loop).
Distal tubule
ascending thick limb of Henle,s loop (pars recta) q
- the macula densa
{cerls lining the wall of the ascending thick rimb } |
,Ttstat convolureo ruElule (pars convo,utal
Ascending thick limb of Henle's loop
enters from medulla to the cortex
- passes near its own renal corpusqle (between afferent and efferent arterioles)
- lined with low cuboidalepithelium
cells - impermeable to water or urea, but transport ions to the insterstitium - the concentration of salts decreases and the
concentration of urea remains high.
Macula densa
- an area of closely packed, tall and narrow specialized cells lining the wall of ascending thick iimb of Henle's loop - between
afferent and efferent arteriole.
nuclei of cells are near to each other - looks like a dense spot.
- is a part of juxtaglomerular apparatus
Juxtaglomerular apparatus - regulates the function of nephron, is composed of:
1. extraglomerular mesangial cells - outside the glomerulus, near the vascular pole and macula densa {role is unclear).
2. macula densa - sensitive to the concentration of sodium chloride
3. juxtaglomerular cells - specialized smooth muscle cells mainly in the walls (tunica media) of the afferent arterioles -
synthesize and secrete - renin {enzyme}
Function of nephron is regulated by Juxtaglomerular apparatus
Macula densa cells detect the salt content and the volume of fluid within the tubule.
- if the salt content or the volume of fluid is incorrect, the macula densa cells:
1. regulate the release of renin by juxtaglomerular cells,
2. regulate the contraction of afferent and efferent arteriole of the glomerulus.
- renin converts angiotensinogen {bloodstream} into angiotensin I
- in capillaries of lungs imainly) angiotensin-converting enzyme
{ACE} converts angiotensin I to angiotensin ll
(vasoconstrictor, stimulates production of aldosterone)
Angiotensyn 2 - {octapeptide} - function
'- contraction of smooth rnuscles of the arterioles
- production of aldosterone - from the adrenal cortex
Aldosterone
- causes vasoconstriction, which, in turn, increases blood pressure
- enhances the reabsorption of sodium and chloride ions by the cells of distal convoluted tubules of
the nephron
- stimulates ADH {Vasopressin) release {hypothalarnus - posterior pituitary gland} - increases water reabsorption
Distal convoluted tubule {pars convoluta}
- lumen wide-open, cells narrow with blunt microvilri and pare cytoplasm.
- distal tubules are much shorter than proximal - kidney cortex presents many more cross sections
of proximal then distal
convoluted tubules,
Distal convoluted tubule - function
- region is impermeable to water and urea.
- numerous Na/K/ATPase complexes pumps Na+ ions into the interstitium (Cl-
ions are passively resorbed)
- almost all remaining Na+ ions resorbed
- {aldosterone),
- creatinine, and drugs - are removed from blood into the distal
convoluted tubule or collecting duct
collecting tubules - collerting tubules are not a part of nephrons !
- convey the ultrafiltrate from the nephron to the minor calyces
- distal convoluted tubules of several nephrons join to one collecting tubule
- in collecting tubule ultrafiltrate is modifled
- cortical collecting tubule
- n:eduilary collecting tubule
- papillary collecting tubule (duct of Bellini) formed by the confluence
of several medullary tubules, lined by principalcells
Collecting tubule - function
- Principal cells - possess numerous aquaporin -2,
3 and 4 channels, sensitive to ADH
. Intercalated cells *

lype A with H+ATPase transport ions to lhe lumen,

type B with H+ATPase resorb H+ and secrete HCO3-
collecting tubule - uses an osmotic gradient of the medulla to the
concentration of the urire
filtrate entering collecting tubule is hypotonic (L00mOsm)
under the influence of ADH ceils of collecting tubule - permeable
to vrrater
as filtrate rlescends through the renal medulla in the
collecting tubule, is subjected to the osmotic pressure gradient
water learyes the lumina of collecting tubule
urine becomes concentrated and hypertonic
ln the absence of antidiuretic hormone
{ADH} collecting tubules are completely impermeable to water
 , Mechanism of action of antidiuretic hormone (vasopressin)
- ADH binds to the V2 reeeptors on the basolateral surface of cells of collecting ducts
- Aquaporin-2 (AaP-2) channels are inserted into the plasma membrane
- water from the lumen of the collecting duct enters the ceil
- water leaves the cell via aquaporin-3 and aquaporin- channels
{are always present in cell membranei
Kidney - blood supply
- renal arteries
- segmental arteries
- interlobar arteries
- arcuate arteries {run through the boundary of the cortex and the medulla).
- interlobular arteries
- afferent arterioles - supply the glomeruli
- veins follow the same pattern
efferent glomerular arterioles of juxtamegullary nephrons {only} branch off, enter the medulla, and surround the loop of Her:
- form vasa recta - maintain the osmotic gradient in the rnedulla
vasa recta are necessary for countercurrent exchanger system
Countercurrent excha nger 5ystem
- the blood flows down the arterial limb - loses water and gains sarts
- as it returns via the venous limb - loses salts and gains water
iosmotic gradient in the medulla remains undisturbed)
- osmolarity of the blood in vessels is equilibrated with osmolarity of the interstitium
- salt and water are resorbed {returned back to the body}
Excretory passages
Urine moves from the ducts of Bellini (area cribrosa) to the
- - minor calyces
- major calyces
- the renal pelvis
- a,pexes of pyrarnids, minor calyces, major calyces and renal pelvis - lined by the transitional epithelium.
- in lamina propria - a rnuscular coat - smooth muscle cells - propels the urine.
The ureters - tubes that deliver urine from the kidneys to the urinary UtiUOer.
The wall of the ureter:
- a mucosa {transitional epithelium and lamina propria}
- the rnuscularis - in proximal 2/3 - inner longitudinal and outer circular layer, in the lower
third - outer longitudinal layer
added - contractions of smooth muscle cells propel urine to the urinary bladder.
Urinary bladder - collects urine excreted by the kidneys
- mucosa {transitionalepithelium and lamina propria}
- smooth muscle - inner longitudinal, middle circular
{sphincter around the internal orifice of urethra}, outer lcngitudinal
Female urethra
- transitional epitheliurn {near the bladder)
- stratified squamous nonkeratinized epithelium with patches of pseudostratified
columnar epithelium {the remainder part}
- larnina propria folded - with glands of Littre and muscular
- layer
Male urethra
- prostatic urethra - in prostate gland - transitional epithelium
- membranous urethra - stratified columnar epithelium with patches
of pseudostratified colurnnar epithelium
- spongy urtthra -
in corpus spongiosum of the penis - stratifled columnar epithelium with patches
of pseudostratified -
columnar epithelium * navicular fossa - stratified squarnous nonkeratinized epithelium
- lamina propria with glands of Littre