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ANATOMY AND
PHYSIOLOGY
THE URINARY SYSTEM
BIO 343
 OUTLINE
1) OVERVIEW AND FUNCTIONS OF THE URINARY SYSTEM
2) ANATOMY OF THE KIDNEY
3) URINE FORMATION I: GLOMERULAR FILTRATION
4) URINE FORMATION II: TUBULAR REABSORPTION AND SECRETION
5) URINE FORMATION III: WATER CONSERVATION
6) COMPOSITION AND PROPERTIES OF URINE
7) CLINICAL APPLICATION

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 OVERVIEW AND FUNCTIONS OF THE URINARY SYSTEM
© McGraw-Hill Education

 The urinary system consists of

six principal organs:
• 2 kidneys
• 2 ureters
• 1 urinary bladder
• 1 urethra

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 FUNCTIONS OF THE KIDNEYS
 Although the primary function of the kidneys is excretion, they play more roles
than are commonly realized:
• They filter the blood and excrete the toxic metabolic wastes
• They regulate blood volume, pressure, and osmolarity by regulating water
output
• They regulate the electrolyte and acid-base balance of the body fluids
• They secrete the hormone erythropoietin, which stimulates the production of
red blood cells and thus supports the oxygen-carrying capacity of the blood

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 FUNCTIONS OF THE KIDNEYS
 Other functions of the kidneys:
• They help regulate calcium homeostasis and bone
metabolism by participating in the synthesis of
calcitriol
• They clear hormones and drugs from the blood and
thereby limit their action
PIXOLOGICSTUDIO/SCIENCE PHOTO LIBRARY / Getty Images

• In conditions of extreme starvation, they help support

blood glucose level by synthesizing glucose from
amino acids

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 METABOLIC WASTES
 A waste is any substance that is useless to the body or present in excess of the
body’s needs
 In particular, a metabolic waste is a waste substance produced by the body
• The food residue in feces, for example, is a waste but not a metabolic waste, since it wasn’t
produced by the body and never entered the body’s tissues
 Among the most toxic of our metabolic wastes are small nitrogen-containing
compounds called nitrogenous wastes
• About 50% of the nitrogenous waste is urea, a by-product of protein catabolism
• Other nitrogenous wastes in the urine include ammonia, uric acid and creatinine
 The level of nitrogenous waste in the blood is typically expressed as blood urea
nitrogen (BUN)
• The normal concentration of blood urea is 10 to 20 mg/dL
• Elevated BUN is called azotemia and may indicate renal insufficiency
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 EXCRETION
 Excretion is the process of separating wastes from the body fluids and
eliminating them from the body
• It is carried out by four organ systems: the respiratory, integumentary,
digestive and urinary system

 The urinary system particularly excretes a broad variety of metabolic

wastes, toxins, drugs, hormones, salts, hydrogen ions, and water

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 OUTLINE
1) OVERVIEW AND FUNCTIONS OF THE URINARY SYSTEM
2) ANATOMY OF THE KIDNEY
3) URINE FORMATION I: GLOMERULAR FILTRATION
4) URINE FORMATION II: TUBULAR REABSORPTION AND SECRETION
5) URINE FORMATION III: WATER CONSERVATION
6) COMPOSITION AND PROPERTIES OF URINE
7) CLINICAL APPLICATION

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GROSS ANATOMY OF THE KIDNEY

© McGraw-Hill Education

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 GROSS ANATOMY OF THE KIDNEY
 The kidney is a C-shaped structure divided into two zones: an outer renal cortex
and an inner renal medulla
• It encircles a medial cavity called the renal sinus
 Extensions of the cortex called renal columns project toward the sinus and divide
the medulla into 6 to 10 renal pyramids
 One pyramid and the overlying cortex constitute one lobe of the kidney
 Each renal pyramid is nestled in a cup called a minor calyx which collects its urine
 Two or three minor calyces converge to form a major calyx, and two or three
major calyces converge to form the funnel-like renal pelvis
 The ureter is a tubular continuation of the renal pelvis that drains the urine down
to the urinary bladder

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 RENAL CIRCULATION
 The kidneys receive about 1.1 liters of blood per
minute, equivalent to 21% of the cardiac output
 Each kidney is supplied by a renal artery arising
from the aorta, which then divides into a few
segmental arteries, each of which further divides
into a few interlobar arteries
 As the interlobar arteries penetrate each renal
column and travel between the pyramids, they
branch into arcuate arteries that give rise to
cortical radiate arteries which pass upward into the
cortex
 Filtered blood leaves the kidneys through the
cortical radiate veins, arcuate veins, interlobar
veins, and the renal veins (there are no segmental
veins) © McGraw-Hill Education

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 CAPILLARIES OF RENAL CIRCULATION
 As a cortical radiate artery ascends
through the cortex, a series of afferent
arterioles arise from it
 Each afferent arteriole supplies one
functional unit of the kidney (a nephron)
 The afferent arteriole leads to a ball of
capillaries called a glomerulus
 Blood leaves the glomerulus by way of an
efferent arteriole that leads to a plexus of
peritubular capillaries, which carry blood
out of the kidneys through the venous
circulation © McGraw-Hill Education

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 THE NEPHRON
 Nephrons are the structural and functional units of the kidneys
• Each kidney has approximately 1.2 million nephrons
 Each nephron is composed of two principal parts
• A renal corpuscle, which filters the blood plasma
• A long coiled renal tubule, which converts the filtrate to urine

 Not all nephrons are identical:

• Those close to the medulla are called juxtamedullary
nephrons (have very long nephron loops)
• The remaining nephrons, farther from the medulla, are called
cortical nephrons (have relatively short nephron loops)

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 THE RENAL CORPUSCLE
 The renal corpuscle consists of the Vascular pole Urinary pole

glomerulus and a two-layered glomerular

capsule that encloses it.
• Parietal (outer) layer made of simple squamous
epithelium
• Visceral (inner) layer consists of elaborate cells called
podocytes that wrap around the capillaries of the
glomerulus
• Visceral and parietal layers are separated by a capsular
space

 Opposite sides of the renal corpuscle are

called the vascular and urinary poles
• Vascular pole—the side of the corpuscle where the afferent © McGraw-Hill Education

arteriole enters the capsule and the efferent arteriole leaves

• Urinary pole—the opposite side of the corpuscle where the
renal tubule begins
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 THE RENAL TUBULE
 The renal tubule is a duct that leads away from the
glomerular capsule and ends at the tip of a medullary
pyramid. It is divided into 4 regions:
 Proximal convoluted tubule: arises from glomerular
capsule; is the longest and most coiled region
 Nephron loop: long U-shaped portion of renal tubule
made of thick (simple cuboidal epithelium) and thin
(simple squamous epithelium) segments
 Distal convoluted tubule: shorter and less coiled than
the proximal convoluted tubule; has a cuboidal
epithelium
 Collecting duct: receives fluid from several nephrons
 First three are parts of one nephron, while the last
one receives fluid from many nephrons
© McGraw-Hill Education

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 OUTLINE
1) OVERVIEW AND FUNCTIONS OF THE URINARY SYSTEM
2) ANATOMY OF THE KIDNEY
3) URINE FORMATION I: GLOMERULAR FILTRATION
4) URINE FORMATION II: TUBULAR REABSORPTION AND SECRETION
5) URINE FORMATION III: WATER CONSERVATION
6) COMPOSITION AND PROPERTIES OF URINE
7) CLINICAL APPLICATION

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 GLOMERULAR FILTRATION
 The kidneys convert blood plasma to urine in four
stages: glomerular filtration, tubular reabsorption,
tubular secretion, and water conservation
 Glomerular filtration is a process in which water and
some solutes in the blood plasma pass from
capillaries of the glomerulus into the capsular space
of the nephron
 To do so, fluid passes through three barriers that
constitute a filtration membrane

© McGraw-Hill Education

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 THE FILTRATION MEMBRANE
© McGraw-Hill Education

The Glomerular Filtration Membrane.

Small solutes pass through the
membrane into the filtrate (right) and
larger particles are turned back and
retained in the bloodstream (left)

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 THE FILTRATION MEMBRANE
 The filtration membrane consists of three barriers through which fluid passes:
 The fenestrated endothelium of the capillary
• Endothelial cells of the glomerular capillary have filtration pores of 70-90 nm in diameter
• Pores are highly permeable but small enough to exclude blood cells from the filtrate
 The basement membrane
• Consists of a proteoglycan gel that excludes molecules larger than 8 nm
• Even some smaller molecules are held back by a negative charge on the proteoglycans
 Filtration slits
• Podocytes of the glomerular capsule have extensions called foot processes that wrap around
the capillaries to form a barrier layer with 30 nm filtration slits
• Filtration slits are negatively charged and provide an additional obstacle to large anions

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 FILTRATION PRESSURE
 Glomerular filtration follows the same principles that govern filtration in other
blood capillaries, but there are significant differences in the magnitude of the
forces involved:
• The blood hydrostatic pressure (BHP) is much higher here than elsewhere; about 60 mm Hg
compared with 10 to 15 mm Hg in most other capillaries
• The hydrostatic pressure in the capsular space (CP) is about 18 mm Hg, compared with the
slightly negative interstitial pressures elsewhere
• The colloid osmotic pressure (COP) of the blood is about the same here as anywhere else, 32 mm
Hg
• The glomerular filtrate is almost protein-free and has no significant COP

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 FILTRATION PRESSURE
 Forces involved in glomerular filtration:
• Hydrostatic pressure difference (Glomerular
blood hydrostatic pressure or BHP – capsular
hydrostatic pressure or CP)
• The protein concentration difference
across the wall that creates an osmotic
force (colloid osmotic pressure or COP)
 Glomerular filtration rate is the amount of
filtrate formed per minute by the two
kidneys combined
• It can be calculated by multiplying the net
filtration pressure (NFP) by the filtration
coefficient (Kf)
• GFP = NFP × Kf
© McGraw-Hill Education

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REGULATION OF GLOMERULAR FILTRATION RATE
 The glomerular filtration rate (GFR) is controlled by several mechanisms:
 Renal Autoregulation
• It is the ability of the nephrons to adjust their own blood flow and GFR without external
control, and in spite of changes in arterial blood pressure
 The Myogenic Mechanism
• This mechanism is based on the tendency of smooth muscle to contract when stretched
• When arterial blood pressure rises, it stretches the afferent arteriole and prevents blood flow
into the glomerulus from changing very much
 Tubuloglomerular Feedback
• The glomerulus receives feedback on the status of the downstream tubular fluid and adjusts
the GFR to regulate its composition, stabilize nephron performance, and compensate for
fluctuations in blood pressure
• It involves a structure called the juxtaglomerular apparatus found at the very end of the
nephron loop 22
REGULATION OF GLOMERULAR FILTRATION RATE
 Sympathetic control
• Sympathetic nerve fibers richly innervate the renal blood vessels
• In strenuous exercise, sympathetic stimulation and adrenal epinephrine constrict the
afferent arterioles
• This reduces GFR and urine output, and redirect blood from the kidneys to the heart,
brain, and skeletal muscles
 The Renin-Angiotensin-Aldosterone Mechanism
• Activated by a drop in blood pressure
• Sympathetic fibers stimulate the granular cells to secrete renin
• Renin acts on angiotensin in the blood plasma to split off a 10
amino acid peptide called angiotensin I, which is then converted to
angiotensin II by angiotensin converting enzyme (ACE) through
removal of 2 amino acids
• Angiotensin II stimulates the adrenal cortex to secrete aldosterone
(which increases blood pressure)
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 OUTLINE
1) OVERVIEW AND FUNCTIONS OF THE URINARY SYSTEM
2) ANATOMY OF THE KIDNEY
3) URINE FORMATION I: GLOMERULAR FILTRATION
4) URINE FORMATION II: TUBULAR REABSORPTION AND SECRETION
5) URINE FORMATION III: WATER CONSERVATION
6) COMPOSITION AND PROPERTIES OF URINE
7) CLINICAL APPLICATION

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URINE FORMATION II: TUBULAR REABSORPTION
AND SECRETION
 Conversion of the glomerular filtrate to
urine involves the removal and addition of
chemicals by tubular reabsorption and
secretion

© McGraw-Hill Education

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 THE PROXIMAL CONVOLUTED TUBULE
 The proximal convoluted tubule (PCT) reabsorbs about 65% of the glomerular
filtrate
 It also removes some substances from the blood and secretes them into the
tubule for disposal in the urine
 The PCT has a relatively great length and prominent microvilli, which increase its
absorptive surface area
 Its cells also contain abundant large mitochondria that provide ATP for active
transport
 The PCT alone accounts for about 6% of one’s resting ATP and calorie
consumption

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 TUBULAR REABSORPTION
 Tubular reabsorption is the process of reclaiming water and solutes from the
tubular fluid and returning them to the blood
 The PCT reabsorbs a greater variety of chemicals than any other part of the
nephron
 There are two routes of reabsorption:
• The transcellular route, in which substances pass through the cytoplasm and
out the base of the epithelial cells
• The paracellular route, in which substances pass through gaps between the
cells. As water travels through tight junctions of epithelial cells, it carries with it
a variety of dissolved solutesꟷa process called solvent drag

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 SODIUM
 Na+ is the most abundant cation in the glomerular filtrate
 Two types of transport proteins are responsible for sodium uptake into the tubule
epithelial cells:
(1) various symports that simultaneously bind Na+ and another solute such as
glucose, amino acids, or lactate
(2) an Na+-H+ antiport that pulls Na+ into the cell while pumping H+ out of the cell
into the tubular fluid
 Sodium is prevented from accumulating in the epithelial cells by Na+-K+ pumps on
the plasma membrane that pump Na+ out into the tissue fluid

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 OTHER ELECTROLYTES
 Potassium, magnesium, and phosphate ions pass through the paracellular route
with water
 Phosphate is also cotransported into the epithelial cells with Na+
 Roughly 52% of the filtered calcium is reabsorbed by the paracellular route, and
14% by the transcellular route in the PCT
 Another 33% of the calcium is reabsorbed later in the nephron, while the
remaining 1% is excreted in the urine

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 GLUCOSE, NITROGENOUS WASTES, WATER
 Glucose
• Glucose is cotransported with Na+ into the epithelial cells of the PCT by symports
called sodium-glucose transporters (SGLTs)
• It is then removed from the basolateral surface of the cell by facilitated diffusion
 Nitrogenous wastes
• Urea passes through the epithelium with water (solvent drag)
• The nephron as a whole reabsorbs 40% to 60% of the urea in the tubular fluid
 Water
• The kidneys reduce about 180L of glomerular filtrate to 1 or 2L of urine each day
• Two-thirds of the water is reabsorbed by the PCT; transcellular absorption occurs by
way of water channels called aquaporins
• In the PCT, water is reabsorbed at a constant rate called obligatory water reabsorption

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 REABSORPTION IN THE PROXIMAL CONVOLUTED
TUBULE

© McGraw-Hill Education

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 TRANSPORT MAXIMUM
 There is a limit to the amount of solute that the renal
tubule can reabsorb because there are limited numbers
of transport proteins in the plasma membranes
 The maximum rate of reabsorption is called the
transport maximum (Tm), which is reached when the
transporters are saturated
 In individuals with high blood glucose level, glucose is
filtered faster than the renal tubule can reabsorb it, and
the excess passes in the urineꟷa condition called
glycosuria
 In untreated diabetes mellitus, the plasma glucose
concentration may exceed 400 mg/dL, so glycosuria is
one of the classic signs of the disease

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 TUBULAR SECRETION
 Tubular secretion is a process in which the renal tubule extracts chemicals from
the capillary blood and secretes them into the tubular fluid
 It serves three main purposes:
(1) It contributes to acid-base balance (pH) by secreting varying proportions of
hydrogen to bicarbonate ions
(2) It extracts wastes from the blood, including urea, uric acid, bile acids,
ammonia, and a little creatinine
(3) It clears drugs and contaminants from the blood, such as morphine,
penicillin, and aspirin

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 THE NEPHRON LOOP
 The primary function of the nephron loop is to
generate an osmotic gradient that enables the
collecting duct to concentrate the urine and conserve
water
 The loop also reabsorbs about 25% of the Na+, K+, and
Cl- and 15% of the water in the glomerular filtrate
 Cells in the thick segment of the ascending limb of the
loop transport salts (Na+, K+, and Cl-) from the tubular
fluid into the cytoplasm
 The ascending limb is impermeable to water; thus
water cannot follow the reabsorbed electrolytes, and
tubular fluid becomes very dilute

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 THE DISTAL CONVOLUTED TUBULE (DCT) AND
COLLECTING DUCT
• The DCT and collecting duct reabsorb variable
amounts of water and salts and are regulated by
several hormones particularly aldosterone,
natriuretic peptides, antidiuretic hormone, and
parathyroid hormone.
• There are two kinds of cells in the DCT and collecting
duct:
1) The principal cells are the more abundant; they
have receptors for the foregoing hormones and are
involved in salt and water balance.
2) The intercalated cells are fewer in number. They
reabsorb K+ and secrete H+ into the tubule lumen
and are involved mainly in acid-base balance.

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 OUTLINE
1) OVERVIEW AND FUNCTIONS OF THE URINARY SYSTEM
2) ANATOMY OF THE KIDNEY
3) URINE FORMATION I: GLOMERULAR FILTRATION
4) URINE FORMATION II: TUBULAR REABSORPTION AND SECRETION
5) URINE FORMATION III: WATER CONSERVATION
6) COMPOSITION AND PROPERTIES OF URINE
7) CLINICAL APPLICATION

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 Water reabsorption by the collecting duct

THE COLLECTING DUCT

 The collecting duct (CD) begins in the cortex, where
it receives tubular fluid from numerous nephrons
• As it passes through the medulla, it usually
reabsorbs water and concentrates the urine

 When urine enters the upper end of the CD, it is

isotonic (same osmolarity) with blood plasma (300
mOsm/L), but by the time it leaves the lower end, it
can be up to four times as concentrated (hypertonic
to the plasma)

© McGraw-Hill Education

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 CONTROL OF WATER LOSS
 Just how concentrated the urine becomes depends on the body’s state of
hydration
• For example, if you drink a large volume of water, you soon produce a large
volume of hypotonic urineꟷa response called water diuresis (urine osmolarity
may be as low as 50 mOsm/L)
 Dehydration causes the urine to be more concentrated. This stimulates the
pituitary to release ADH, which in turn increases water reabsorption and reduces
urine output (by transferring aquaporins from storage vesicles to the cell surface
or by inducing its transcription).
 When you are well hydrated, ADH secretion fails, and the tubule cells remove
aquaporins from the plasma membrane and store them in cytoplasmic vesicles.
The duct is less permeable to water, so more water remains in the duct and the
urine dilutes.

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 THE COUNTERCURRENT MULTIPLIER
 The ability of the collecting duct to concentrate urine depends on the osmotic
gradient of the renal medulla
 The ECF osmolarity is four times as great deep in the medulla as in the cortex
 We would therefore expect salt to diffuse toward the cortex, however, there is a
mechanism that overrides this; the nephron loop, which acts as a countercurrent
multiplier
• It continuously recaptures and returns salt to the deep medullary tissue
• It is called a multiplier because it multiplies the osmolarity deep in the medulla,
and a countercurrent mechanism because it is based on fluid flowing in
opposite directions

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 THE COUNTERCURRENT MULTIPLIER
 The nephron loop and collecting duct work
together to maintain a gradient of
osmolarity in the renal medulla
• The countercurrent multiplier of the
nephron loop concentrates NaCl in the
lower medulla
• Urea diffuses from the collecting duct
into the medulla

 In addition to the countercurrent multiplier,

the gradient of osmolarity in the renal
medulla is maintained by a counter
exchange system
© McGraw-Hill Education

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 THE COUNTERCURRENT EXCHANGE SYSTEM
 The large volume of water reabsorbed by the kidney is
picked up and carried away by the vasa recta, which
returns it into the bloodstream
 The vasa recta are the straight arterioles (that enter the
medulla) and the straight venules (that leave the
medulla) of the kidneys
 The vasa recta forms the countercurrent exchange
system
• As it flows downward into the medulla, water
diffuses out of the capillaries
• As it flows back up to the cortex, it absorbs water
• More water is being absorbed than being released,
hence maintaining a high osmolarity in the renal
medulla
© McGraw-Hill Education

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 OUTLINE
1) OVERVIEW AND FUNCTIONS OF THE URINARY SYSTEM
2) ANATOMY OF THE KIDNEY
3) URINE FORMATION I: GLOMERULAR FILTRATION
4) URINE FORMATION II: TUBULAR REABSORPTION AND SECRETION
5) URINE FORMATION III: WATER CONSERVATION
6) COMPOSITION AND PROPERTIES OF URINE
7) CLINICAL APPLICATION

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 COMPOSITION AND PROPERTIES OF URINE
 The basic composition and properties of urine are as follow:
• Appearance: Depending on the body’s state of hydration, urine varies from
almost colorless to deep amber (yellow-orange)
• Odor: Distinctive but not necessarily repellent. A rotten odor may indicate urinary
tract infection.
• Specific gravity: Proportional to solute concentration (g/ml)
• Osmolarity: Varies from 50 mOsm/L in a very hydrated person to 1200 mOsm/L
in a dehydrated person
• pH: mildly acidic, with a pH of about 6.0
• Chemical composition: 95% water and 5% solutes by volume (urea is the most
abundant solute)

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 URINE VOLUME
 An average adult produces 1 to 2 L of urine per day
 An output of >2 L/day is called diuresis or polyuria
• Fluid intake and some drugs can temporarily increase output to as much as 20
L/day
 An output of <500 mL/day is called oliguria, and an output of 0 to 100 mL/day is
called anuria
• Low output can result from kidney disease, dehydration, circulatory shock, and
prostate enlargement

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 RENAL FUNCTION TESTS
 Renal clearance is the volume of blood plasma from which a particular waste is
completely removed in 1 minute
 It represents the net effect of 3 processes:
Glomerular filtration of the waste
+ Amount added by tubular secretion
- Amount removed by tubular reabsorption
 Clearance can be assessed indirectly by collecting samples of blood and urine, measuring
the waste concentration in each, and measuring the rate of urine output
 Suppose the following values were obtained for urea:
U (urea concentration in urine) = 6.0 mg/mL
V (rate of urine output) = 2 mL/min
P (urea concentration in plasma) = 0.2 mg/mL
Then renal clearance (C) is: C = UxV/P; = (6.0 mg/mL)(2 mL/min.)/0.2 mg/mL = 60 mL/min

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 RENAL FUNCTION TESTS
 The glomerular filtration rate is often used as an indicator of kidney disease but
is hard to measure because urine gets secreted and reabsorbed
 GFR can be measured by injecting a polysaccharide called inulin (it doesn’t get
secreted or reabsorbed), and subsequently measuring the rate of urine output
and the concentrations of inulin in the blood and urine
• For inulin, GFR is equal to the renal clearance. Suppose, for example, that a patient’s plasma
concentration of inulin is P = 0.5 mg/mL, the urine concentration is U = 30 mg/mL, and urine
output is V = 2 mL/min
• GFR = UV/P = (30 mg/mL)(2 mL/min.)/0.5mg/mL = 120 mL/min.

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 MICTURITION
 The act of urination is called micturition
 It is initiated by a nervous reflex (spinal
micturition reflex) which causes the
smooth muscle of the bladder walls to
contract and to expel the urine
 The bladder muscles are innervated by
parasympathetic ganglions, but also by
somatic motor neurons allowing for
voluntary control over micturition

© McGraw-Hill Education

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 OUTLINE
1) OVERVIEW AND FUNCTIONS OF THE URINARY SYSTEM
2) ANATOMY OF THE KIDNEY
3) URINE FORMATION I: GLOMERULAR FILTRATION
4) URINE FORMATION II: TUBULAR REABSORPTION AND SECRETION
5) URINE FORMATION III: WATER CONSERVATION
6) COMPOSITION AND PROPERTIES OF URINE
7) CLINICAL APPLICATION

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 DIABETES AND DIURETICS
 Diabetes is a metabolic disorder resulting in chronic polyuria (high urine output)
• In most cases, the polyuria results from a high concentration of glucose in the renal
tubule
• Glucose osmotically retains water in the tubule, so more water passes in the urine and a
person may become severely dehydrated
 Diuretics
• A diuretic is any chemical that increases urine volume
• Some diuretics, such as caffeine, act by dilating the afferent arteriole and thus increase
the glomerular filtration rate
• Others act by reducing tubular reabsorption of water (ex: alcohol inhibits ADH secretion
and thereby reduces reabsorption in the collecting duct)
• Diuretics are commonly administered to treat hypertension and congestive heart failure
by reducing the body’s fluid volume and blood pressure

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 KIDNEY STONES
 A kidney stone (or renal calculus) is a hard granule of calcium or © McGraw-Hill Education

phosphate salts, and sometimes other components such as uric

acid
 Kidney stones form in the renal pelvis and are usually small
enough to pass unnoticed in the urine flow
 Some, however, grow as large as a few centimeters and block
the renal pelvis or ureter, which can lead to the destruction of
nephrons Kidney stones

 Its causes include hypercalcemia (excess calcium in blood),

dehydration, pH imbalances, urinary tract infections, or an
enlarged prostate
 Treatment include some stone-dissolving drugs, and lithotripsy
(treatment with shock waves)

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 INCONTINENCE
 Incontinence is the inability to consciously control urination
 It can result from aging, bladder irritation, pressure on the bladder in pregnancy,
full bladder (overflow incontinence), or brief surges in bladder pressure as in
laughing or coughing (stress incontinence)
 Incontinence can also result from spinal cord injuries
• In individuals with spinal cord injuries, the voluntary control over urination is
lost because of disconnection between the brain and the lower spinal cord
• In such individuals, urine can only be released from the spinal micturition reflex

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RENAL INSUFFICIENCY AND HEMODIALYSIS
 Renal insufficiency is a state in which the kidneys cannot maintain homeostasis
due to extensive destruction of their nephrons
• Causes include hypertension, kidneys infection, trauma, ischemia or hypoxia, and poisoning by
heavy metals
• Nephrons can regenerate and restore kidney function over time

 Hemodialysis is a medical procedure for

artificially clearing wastes from the blood
when the kidneys are not adequately doing so
• Blood is pumped from the radial artery of the forearm
to a dialysis machine and returned to the patient by
way of a vein
© McGraw-Hill Education
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53 The End