Urinary System - WordPress.com · Urinary System Kristine Krafts, M.D. 1 Urinary System Objectives • Describe the histologic features of the kidneys, ureters and bladder. • Describe

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Urinary SystemKristine Krafts, M.D.

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Urinary System Objectives

• Describe the histologic features of the kidneys, ureters and bladder.

• Describe the structures that comprise the renal filtration barrier and their role in formation of glomerular filtrate (provisional urine).

• Describe the role of the loop of Henle in concentrating urine.

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More Urinary System Objectives

• Describe how aldosterone and antidiuretic hormone (ADH) affect the renal tubules.

• Trace the pathway of urine flow along the nephron and urinary tract.

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Urinary System Lecture Outline

• Introduction

• Kidneys

• Ureters

• Urinary bladder

• Urethra

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• Introduction

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Functions of the Urinary System

• Filtration & excretion of cellular wastes from blood

• Regulation of fluid and electrolyte balance by selective reabsorption and excretion of water and solutes

• Production of the hormones renin and erythropoietin

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• Introduction

• Kidneys• Anatomic parts

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Renal hilum

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Major Anatomic Parts of the Kidney

Parenchyma• Cortex• Renal corpuscles• Medullary rays

• Medulla• Renal pyramids

• Renal columns

Renal sinus• Renal pelvis• Major and minor calyces• Nerves and vessels• Connective tissues

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Fibrous capsule

Minor calyces

Blood vesselsentering renalparenchyma

Renal sinus

Major calyces

Renal pelvis

Fat in renalsinusMinor calyces

Ureter

Cortex

Medulla(pyramid)

Papilla of pyramid

Renal column(of Bertin)

Medullary rays

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Renal columns

Renal pyramids

Renal columns

Renal cortex

Base of medullary pyramid

Renal papillae

Renal cortex

Renal pyramids

Base of medullary pyramid

Major calyx

Renal sinus

Major calyx

Minor calyces

Renal pelvis

Ureter

Renal medullary pyramid

Renal cortex

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• Introduction

• Kidneys• Anatomic parts• Blood flow

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Most important for you to

know

Blood Supply to

the Kidney

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Afferent arteriole

Blood Flow in the Kidney

Glomerular capillaries

Efferent arteriole

Peritubular capillaries

Supply cortical nephrons and proximal and distal

convoluted tubules

Vasa recta

Supply juxtamedullary nephrons, structures in the

medulla, and then loop back to cortex-medullary boundary

or

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Blood Supply to a Renal Corpuscle

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• Introduction

• Kidneys• Anatomic parts• Blood flow• The corpuscle

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A renal corpuscle consists of three things:

Glomerulus• A tuft of capillaries

Bowman’s capsule• The container that surrounds the glomerulus• Two layers: visceral (inner) and parietal (outer)

Urinary space• The space between the two layers of Bowman’s

capsule (where urine collects)

What’s a Renal Corpuscle?

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Macula densa of distal tubuleDistal tubule

Efferent arteriole

Vascular pole

Bowman’s capsule(visceral layer of podocytes)

Parietal layer

Urinary pole

Proximal convoluted tubule

Juxtaglomerular cells(modified smooth muscle)

Bowman’s capsule(parietal layer)

Afferent arteriole

Urinary space

Brush border (microvilli)

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Renal corpuscle

Glomerulus

Bowman’s capsule (parietal layer)

Urinary space

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Vascular and urinary poles

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Capillaries (blue) and podocytes (green)

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Primary processes

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Interdigitating secondary foot processes

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Glomerular capillaries & podocyte

Foot processes Podocyte

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• Podocytes have a central cell body with primary processes.

• Each primary process gives rise to secondary processes called pedicels (foot processes) that embrace the glomerular capillaries.

• Foot processes from different podocytes interdigitate. Spaces between pedicels are called filtration slits. A little diaphragm covers each filtration slit.

Podocytes

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• In addition to podocytes and glomerular capillary endothelial cells, mesangial cells are a third cell type present in the glomerulus.

• Functions of mesangial cells:• Physical support for glomerulus.• Phagocytosis of proteins and other debris from

the glomerular basal lamina.• Secretion of cytokines and other substances for

immune defense and repair.

Mesangial Cells

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• Introduction

• Kidneys• Anatomic parts• Blood flow• The corpuscle• The nephron

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Nephrons are the functional units of the kidney. They are the things that produce urine.

A nephron includes:

• The renal corpuscle

• Tubules• proximal convoluted tubule• loop of Henle• distal convoluted tubule

What’s a nephron?

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This whole thing (including all the

tubes except blood vessels)

is the nephron!

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Glomerulus

Efferentarteriole

Bowman’s capsule

Afferent arteriole

Interlobularartery

Arcuate v & aAscending& descendingloops (Henle)

Collectingtubule

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The three things that comprise the filter are:

• Fenestrated endothelial cells of the glomerular capillaries

• Glomerular basal lamina

• Filtration slits between foot processes (covered with a diaphragm)

The Renal Filtration Barrier

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Filtration barrier

Filtration slits

Urinary space

Capillary lumen

Fenestrated endothelial

cells

Glomerular basal lamina

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• Made from fused basal laminae of endothelial cells and podocytes.

• Lamina densa is a physical barrier (particles larger than 10 nm can’t easily cross).

• Lamina rara is a charge barrier (negatively charged proteins with a molecular weight greater than albumin can’t easily cross).

The Glomerular Basal Lamina

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Filtration barrier

Filtration slits

Urinary space

Capillary lumen

Glomerular basal lamina

Laminarara

Laminadensa

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• Hydrostatic pressure within the capillaries pushes water (and particles of the proper size, weight, and charge) from blood through the GBL into the urinary space.

• Whatever enters the urinary space becomes provisional or temporary urine.

• It will be excreted as urine unless it is reabsorbed in the nephron.

How does stuff get from blood into urine?

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• Reabsorption means a substance moves from the provisional urine into the blood.

• Secretion means a substance moves from blood into urine.

Reabsorption vs. Secretion

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• Introduction

• Kidneys• Anatomic parts• Blood flow• The glomerulus• The nephron • The tubules

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So many tubules! So little time.

• Proximal convoluted tubule and proximal straight tubule (= thick segment of descending limb)

• Thin segment of loop of Henle

• Distal straight tubule (= thick segment of ascending limb)

• Distal convoluted tubule

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Glomerulus

Proximal convolutedtubule

Distal convolutedtubule

Cortex

Collecting tubule fromadjacent nephron

Medulla

Collecting duct

Thin limb

Thick ascending limb

Loop of Henle

Thick descending limb

Papilla

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Cortex

Medulla

Maculadensa

Collectingtubule Arcuate vein

Arcuate artery

Thinsegment

Straighttubules

Descendinglimb

Ascendinglimb

Henle’sloop

Efferentarteriole

Distal convoluted tubule


Visceral leaf ofglomerularcapsule(podocytes)

Renal glomerulus

Parietal leaf ofglomerular (Bowman’s)capsule

Interlobularvein

Interlobularartery

Afferentarteriole

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Proximal Tubules

• Proximal convoluted tubule merges with Bowman’s capsule, is super long and winds extensively

• Tons of mitochondria (so cells look more eosinophilic than other tubular cells)

• Brush border (microvilli): lumen looks “fuzzy”

• Main job: reabsorption of water, NaCl, glucose and amino acids.

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Proximal convoluted tubules

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Proximal straight tubule

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Microvilli

Mitochondria

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A General Principle

• Proximal tubular cells have numerous mitochondria and a basal plasma membrane with many deep invaginations.

• Important general principle: numerous mitochondria + invaginations of basal plasma membrane suggest a cell is involved in active ion transport.

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The Loop of Henle

• Loop of Henle is in the medulla and is composed of thick and thin descending and ascending limbs.

• Important because it actively pulls ions out of the urine, creating high osmotic pressure in the connective tissue surrounding the loop.

• With this high osmotic pressure gradient, water passively leaves the urine as it goes through the medulla, creating a concentrated urine and preventing dehydration.

• The excess water is pulled into the vasa recta (smart).

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Glomerulus



Cortex


Medulla

Collecting duct

Thin limb


Loop of Henle


Papilla

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Different Nephrons have Different Loops

Juxtamedullary nephrons• Close to the border of the cortex and medulla• Have very long loops of Henle• They make the connective tissue of the medulla

hypertonic (so there’s high osmotic pressure and urine gets concentrated). Yay!

Cortical nephrons• Located higher in the cortex• Have very short loops of Henle.

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Juxtamedullary nephron (long loop)

Cortical nephron (piddly loop)

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Thin Segment of Loop of Henle

• Transition from proximal tubule to thin segment is abrupt.

• Brush border pretty much ends

• Simple squamous epithelium

• Nuclei bulge a little into lumen

• Surrounded by capillaries (vasa recta)

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Glomerulus



Cortex


Medulla

Collecting duct

Thin limb


Loop of Henle


Papilla

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Cortex

Medulla

Maculadensa


Arcuate artery

Thinsegment

Straighttubules

Descendinglimb

Ascendinglimb

Henle’sloop

Efferentarteriole




Renal glomerulus


Interlobularvein

Interlobularartery

Afferentarteriole

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Thin limbs

Vasa recta

Vasa recta

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Distal Straight Tubule

• Transition from thin segment to distal straight tubule is abrupt.

• Simple cuboidal epithelium; cells smaller

• Brush border gone

• Re-enters cortex, returns to renal corpuscle and attaches to afferent arteriole at macula densa (function unclear)

• Juxtaglomerular apparatus cells are here too (make the hormone renin, which helps control blood pressure)

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Glomerulus



Cortex


Medulla

Collecting duct

Thin limb


Loop of Henle


Papilla

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Cortex

Medulla

Maculadensa


Arcuate artery

Thinsegment

Straighttubules

Descendinglimb

Ascendinglimb

Henle’sloop

Efferentarteriole




Renal glomerulus


Interlobularvein

Interlobularartery

Afferentarteriole

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Distal straight tubule

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Cortex

Medulla

Maculadensa


Arcuate artery

Thinsegment

Straighttubules

Descendinglimb

Ascendinglimb

Henle’sloop

Efferentarteriole




Renal glomerulus


Interlobularvein

Interlobularartery

Afferentarteriole

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Macula densa

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Juxtaglomerular apparatus (makes renin) and macula densa (who knows what it does)

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Distal Convoluted Tubule

• Begins at vascular pole of renal corpuscle

• Looks like distal straight tubule

• Function: finish concentrating urine

• Aldosterone (a hormone made by the adrenal glands) increases sodium reabsorption by the distal convoluted tubular cells. Water follows (in the collecting duct), and the urine becomes even more concentrated.

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Glomerulus



Cortex


Medulla

Collecting duct

Thin limb


Loop of Henle


Papilla

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Cortex

Medulla

Maculadensa


Arcuate artery

Thinsegment

Straighttubules

Descendinglimb

Ascendinglimb

Henle’sloop

Efferentarteriole




Renal glomerulus


Interlobularvein

Interlobularartery

Afferentarteriole

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Distal convoluted tubules

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Collecting Tubules

• Lined by simple cuboidal epithelium

• Cool-looking apical membrane bulges into lumen

• Sensitive to antidiuretic hormone (ADH), which is made by the hypothalamus and stored in the posterior pituitary.

• When there’s ADH around, special aquaporin channels (water channels) open up and allow water to pass through the cells.

• This helps concentrate urine.

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Collecting ducts

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What happens after the collecting ducts?

• Urine flows from collecting ducts in renal into the minor calyx, to the major calyx and to the renal pelvis.

• The minor and major calyces and renal pelvis are lined by transitional epithelium.

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Minor calyx

Major calyx

Renal pelvisUreter

Collecting ducts in renal papilla

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2

3

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Urine flow from collecting ducts out to ureter

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• Introduction

• Kidneys

• Ureters

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What happens after urine leaves the kidney?

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Ureters

• Ureters are paired ducts which conduct urine from the kidney to the bladder.

• Transitional epithelium lines the ureters which is cool, because it’s impermeable to water and ions.

• Two layers of smooth muscle are present in the wall; peristaltic contraction of the smooth muscle moves urine along the ureter.

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Ureter: super low-power view

The mucosa has lots of infoldings!

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Ureter: super low-power view

epithelium

lamina propria

muscularis externa

adventitia

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Ureter: transitional epithelium

epithelium

laminapropria

muscularis externa

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Ureter: Umbrella cells

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• Introduction

• Kidneys

• Ureters

• Urinary bladder

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Bladder

• Expandable vessel for the storage of urine.

• Transitional epithelium lines the bladder (impermeable to water!)

• Composed of four layers, like ureters.

• Large bundles of smooth muscle in the wall.

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Bladder: transitional epithelium and lamina propria

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Bladder: muscularis externa (3 layers)

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2

3

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Bladder: umbrella cells

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• Introduction

• Kidneys

• Ureters

• Urinary bladder

• Urethra

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Urethra

• The urethra conveys urine from the bladder to the exterior.

• Epithelium is variable along its length.

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Urethra: Epithelium varies from stratified or pseudostratified columnar to stratified squamous

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• Introduction

• Kidneys

• Ureters

• Urinary bladder

• Urethra

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Urinary System - WordPress.com · Urinary System Kristine Krafts, M.D. 1 Urinary System Objectives • Describe the histologic features of the kidneys, ureters and bladder. • Describe