The Urinary System

Body cells produce wastes as a result of their normal metabolism. For

example, when cells break down amino acids, a toxic substance called
ammonia (NH3) is formed. In the liver, ammonia combines with carbon
dioxide, to form a substance called urea (CH4N2O). While less toxic than
ammonia, urea must still be eliminated by the body.

The primary function of the body’s urinary system is to regulate the composition and concentration of many
substances found in extracellular fluid, which is all body fluid found outside of cells. One of the major
functions of the urinary system is to remove urea. The urinary system does this by filtering out urea found in
blood plasma in the kidneys to form a fluid called urine, which is then removed. In addition to urine
formation, the kidneys perform other useful functions, as summarized in the table below.

Main Functions of the Kidneys

Excretion of wastes such Control of blood volume Regulation of blood Maintenance of
as urea through the which further influences solutes such as glucose acid/base balance (pH)
formation of urine blood pressure and salts of blood plasma

Organs of the Urinary System

The primary organs of the urinary system are the kidneys, two bean-shaped
structures found underneath the ribcage on either side of the spinal cord. In adults,
each kidney has a mass of 175 g (6 oz.) and is roughly the size of a fist. Extending from
the inward curve of each kidney is a tube called the ureter, which carries urine to the
urinary bladder. The urinary bladder is a collapsible sac that temporarily stores urine
until it is eliminated from the body. Urine leaves the bladder through another tube
called the urethra. The urethra extends through an opening near the vagina in
females and through the penis in males.

Internal Anatomy of the Kidney

As with the other organs of the body, the kidney's structure fits its
function. Each kidney consists of two distinct regions, an outer region
called the cortex and an inner region called the medulla. The medulla
is subdivided into a number of triangular sections called renal
pyramids, which are separated by inward extensions of the cortex
known as renal columns.

The tip of each renal pyramid ends and empties into a tiny cavity
called a minor calyx, which is where urine is first collected. Several
minor calyces combine to form a larger cavity called major calyx, and
all major calyces funnel into the largest cavity, an L-shaped space
called the renal pelvis, which delivers urine formed into the ureter
and then to the urinary bladder.
The renal cortex contains more than one million microscopic filtering units called nephrons. The nephron is
the basic functional unit of the kidney and is the structure in which urine forms. In its basic form, a nephron
consists of a twisting tubule that carries fluid called filtrate, and its surrounding blood vessels, including
arteries and arterioles.

Blood Supply of the Kidney

To gain a better understanding of how the nephrons filter blood, it is helpful to understand how blood flows
through the kidneys. Unfiltered arterial blood enters the kidneys through the large renal artery. This artery
divides into smaller arteries passing deeper into the renal medulla before branching into tiny arcuate arteries
(arcuate means bowed) which curve around the border of the cortex and medulla. These arteries then
subdivide into numerous microscopic afferent arterioles, which enter the nephrons.

Structures of the Nephron

Recall that the nephron is the basic functional unit of the kidney. Nephrons are responsible for the processes
of filtration, reabsorption and secretion, which work together to form urine and will be described in the
following section.

Within the nephron, the afferent arterioles deliver blood into a

tiny knot of capillaries called the glomerulus. In the glomerulus,
dissolved substances in blood are forced out of the capillary and
into the hollow walls of the surrounding Bowman’s capsule. The
remaining blood then exits the glomerulus via an efferent
arteriole. Importantly, the efferent arteriole then forms a web-
like network of peritubular capillaries that surround the nephron
tubules. These capillaries eventually drain into the renal vein,
which carries filtered blood out of the kidney.

The tubular portion of the nephron consists of several parts: the

proximal convoluted tubule, the loop of Henle (descending and
ascending limbs) and the distal convoluted tubule. The distal
convoluted tubule empties into the collecting duct, which carries
the filtrate, now called urine, into the renal pelvis.

The Four Steps to Urine Formation

The Four Main Steps to Urine Formation
• Filtration is the process of separating waste products from the blood.
• In the glomerulus, high blood pressure forces water and small dissolved
Filtration substances including salts, sugar, amino acids, wastes and urea out of the
blood, through the thin capillary walls, and into the Bowman’s capsule.
Location: Larger blood components like red blood cells and vital proteins remain in
glomerulus & the blood.
Bowman’s • This fluid, now called filtrate, flows through the nephron tubules.
capsule • The remaining blood then flows from the glomerulus into the efferent
arteriole, which then enters the peritubular capillaries that surround the
nephron tubules.
 • Reabsorption if the process where the blood reclaims useful substances
return from the filtrate, which is refined as it moves through the nephron
tubules.
• Water and other important substances, such as salts, glucose, and amino
acids are reabsorbed from the filtrate back into the blood in the
Reabsorption peritubular capillaries.
• Reabsorption occurs by two different processes: active transport and
Location: osmosis.
proximal • Glucose, amino acids and many ions (such as sodium) are reabsorbed by
tubule, loop active transport using carrier proteins found in the walls of the renal
of Henle, tubules.
distal tubule • As the concentration of sodium and other ions increases in the
peritubular capillaries, an osmotic gradient is created. Water then flows
out of the renal tubules to dilute the ions in the blood of the peritubular
capillaries. And since sodium and other ions are continually being taken
from the filtrate by active transport, roughly 99% of the water in the
filtrate is returned to the blood.
• Secretion is the opposite of reabsorption; it occurs when some
substances, such as waste products, are actively pushed out of the blood
Secretion in the peritubular capillaries and into the tubules to be excreted by the
body.
Location: • In the distal convoluted tubule and collecting duct, certain compounds
distal tubule, are moved into the filtrate by active transport. These compounds
collecting include urea, creatine, hydrogen ions, ammonia, toxins, and certain drugs
duct such as penicillin.
• After the first three steps, the filtrate contained within the nephron is
called urine.
• Excretion is removal of urine from the body.
Excretion • After processing in the convoluted tubules and loop of Henle, the urine
then moves into the collecting duct, which descents into the medulla.
Location: Because of the movement of ions during secretion in the previous step,
collecting the medulla is saturated with ions. Since the surrounding fluid is
duct, renal hypertonic, water is again drawn out of the collecting ducts by osmosis.
pelvis, This completes the return of water to the blood.
ureters, • The collecting duct empties into a minor calyx, which further connects to
bladder, a major calyx and finally, the renal pelvis. Urine then exits the kidney via
urethra the ureters, which descend into the urinary bladder, and out of the body
through the urethra.

The kidneys perform their function continuously. They filter the body’s entire blood supply, approximately 5
liters, as many as 400 times each day. With this enormous volume of blood flowing through them on a daily
basis, the kidneys process about 180 liters of filtrate daily. Despite all of this filtering, a person excretes only
1.5 liters of urine per day, on average.
Hormonal Control Over Kidney Function
Homeostasis is the body’s stable internal environment. This “steady state” condition is highly important
because the body’s cells, tissues and organs can only survive within a narrow range of conditions. The kidneys
help maintain homeostasis by controlling blood volume, blood pressure and blood solute concentration, also
known as osmolarity.

Blood volume and osmolarity is controlled by a hormone called antidiuretic

hormone (ADH), which stimulates the reabsorption of water by the
kidneys. Through a complex chemical mechanism, ADH opens membrane
pores in the distal convoluted tubule and collecting duct, making them
more permeable to water. As a result, more water is reabsorbed and blood
volume increases.

The secretion of ADH is stimulated when chemical receptors in a portion of

the brain called the hypothalamus detects a rise in sodium and other ions
in blood. For example, during dehydration, blood osmolarity increases as
there is less water. The hypothalamus triggers the pituitary to release ADH,
causing more water to be reabsorbed by the kidneys, which decreases
osmolarity. Conversely, when there is an excess amount of water in the
body, blood osmolarity decreases as the ions are more diluted. The
hypothalamus then inhibits the secretion of ADH, causing less water to be
reabsorbed, leaving more in the urine.

Another hormone that regulates kidney function is aldosterone, which is secreted by

the adrenal glands; endocrine organs that are found atop of the kidneys. The release
of aldosterone is triggered by low levels of sodium ions in the blood. Aldosterone acts
on the distal convoluted tubule and has three effects: it stimulates the reabsorption of
sodium ions; it causes the reabsorption of water since water molecules “follow”
sodium ions by osmosis; and it stimulates the release of potassium ions by tubular
secretion. Thus, aldosterone has the net effect of retaining both salt and water, which
helps to maintain correct levels of blood volume, pressure, and osmolarity.
Exploring Various Urinary Tract Disorders
The urinary system is prone to a variety of disorders, ranging from infections to chronic conditions. Here, we
delve into ten different urinary diseases, highlighting their causes, symptoms, and potential treatments.
1. Urinary Tract Infections (UTIs):
• Commonly caused by bacterial infections, UTIs can affect any part of the urinary tract, including
the bladder, urethra, and kidneys.
• Symptoms may include frequent urination, burning sensation during urination, cloudy or bloody
urine, and pelvic pain.
• Treatment typically involves antibiotics, increased fluid intake, and maintaining good hygiene
practices.

2. Kidney Stones (Nephrolithiasis):

• Kidney stones are solid mineral deposits that form in the kidneys or urinary tract when certain
substances become concentrated.
• Symptoms include severe pain in the back or side, nausea, vomiting, and blood in the urine.
• Treatment may involve pain management, increased fluid intake, and in some cases, surgical
removal of the stones.

3. Chronic Kidney Disease (CKD):

• CKD is a progressive condition characterized by the gradual loss of kidney function over time.
• Causes include diabetes, hypertension, autoimmune diseases, and genetic factors.
• Symptoms may include fatigue, swelling in the legs, changes in urine output, and electrolyte
imbalances.
• Management involves controlling underlying conditions, medications, and sometimes dialysis
or kidney transplantation.

4. Urinary Incontinence:
• Urinary incontinence refers to the involuntary leakage of urine, which can occur due to
weakened pelvic floor muscles, nerve damage, or hormonal changes.
• Symptoms vary depending on the type of incontinence and may include urgency, frequency,
and leakage during activities.
• Treatment options include lifestyle modifications, pelvic floor exercises, medications, and
surgical interventions.

5. Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS):

• IC/BPS is a chronic condition characterized by bladder pain, urinary urgency, and frequency,
often accompanied by pelvic discomfort.
• The exact cause is unknown, but factors such as inflammation and nerve dysfunction may
contribute.
• Treatment may include dietary modifications, physical therapy, medications, and bladder
instillations.

6. Urinary Retention:
• Urinary retention is the inability to empty the bladder completely, leading to discomfort and
urinary tract infections.
• Causes may include nerve damage, bladder outlet obstruction, medications, and neurological
conditions.
• Treatment depends on the underlying cause and may involve catheterization, medications, or
surgical procedures.
 7. Polycystic Kidney Disease (PKD):
• PKD is a genetic disorder characterized by the growth of numerous cysts in the kidneys, leading
to kidney enlargement and decreased function.
• Symptoms may include abdominal pain, high blood pressure, hematuria, and kidney stones.
• Treatment focuses on managing symptoms and complications, including blood pressure control
and dialysis or transplantation in advanced stages.

8. Overactive Bladder (OAB):

• OAB is a condition characterized by a sudden and uncontrollable urge to urinate, often
accompanied by frequency and nocturia.
• Causes may include nerve dysfunction, bladder irritation, or underlying medical conditions.
• Treatment options include behavioral therapies, medications, and neuromodulation
techniques.

9. Vesicoureteral Reflux (VUR):

• VUR is a condition where urine flows backward from the bladder into the ureters and
sometimes the kidneys, increasing the risk of urinary tract infections and kidney damage.
• It may be congenital or acquired and can lead to recurrent UTIs, kidney scarring, and renal
failure.
• Treatment may involve antibiotics, surgery to correct the reflux, or endoscopic procedures.

10. Bladder Cancer:

• Bladder cancer occurs when abnormal cells in the bladder multiply uncontrollably, forming
tumors.
• Symptoms may include hematuria, pelvic pain, urinary urgency, and weight loss.
• Treatment depends on the stage and may include surgery, chemotherapy, immunotherapy, or
radiation therapy.

Normal Urine Characteristics