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PowerPoint® Lecture Slides prepared by Janice Meeking, Mount Royal College

C H A P T E R

Copyright © 2010 Pearson Education, Inc.

25

The Urinary System: Part B


Tubular Reabsorption

• A selective transepithelial process

• All organic nutrients are reabsorbed

• Water and ion reabsorption are hormonally regulated

• Includes active and passive process

• Two routes

• Transcellular

• Paracellular



• Transcellular route

• Luminal membranes of tubule cells

• Cytosol of tubule cells

• Basolateral membranes of tubule cells

• Endothelium of peritubular capillaries



• Paracellular route

• Between cells

• Limited to water movement and reabsorption of Ca2+, Mg2+, K+, and some Na+ in the PCT where tight junctions are leaky

Copyright © 2010 Pearson Education, Inc. Figure 25.13

Activetransport

Passivetransport

Peri-tubular

capillary

2

4

4

3

31

1 2 43

Filtratein tubulelumen

Transcellular

Paracellular

Paracellular

Tight junction Lateral intercellular space

Capillaryendothelialcell

Luminalmembrane

Solutes

H2O

Tubule cell Interstitialfluid

Transcellular

Basolateralmembranes

1 Transport across the luminal membrane.2 Diffusion through the cytosol.

4 Movement through the interstitial fluid and into the capillary.

3 Transport across the basolateral membrane. (Often involves the lateral intercellular spaces because membrane transporters transport ions into these spaces.)

Movement via thetranscellular route involves:

The paracellular routeinvolves: • Movement through leaky tight junctions, particularly in the PCT.


Sodium Reabsorption

• Na+ (most abundant cation in filtrate)

• Primary active transport out of the tubule cell by Na+-K+ ATPase in the basolateral membrane

• Na+ passes in through the luminal membrane by secondary active transport or facilitated diffusion mechanisms


Sodium Reabsorption

• Low hydrostatic pressure and high osmotic pressure in the peritubular capillaries

• Promotes bulk flow of water and solutes (including Na+)


Reabsorption of Nutrients, Water, and Ions

• Na+ reabsorption provides the energy and the means for reabsorbing most other substances

• Organic nutrients are reabsorbed by secondary active transport

• Transport maximum (Tm) reflects the number of carriers in the renal tubules available

• When the carriers are saturated, excess of that substance is excreted


Reabsorption of Nutrients, Water, and Ions

•Water is reabsorbed by osmosis (obligatory water reabsorption), aided by water-filled pores called aquaporins

• Cations and fat-soluble substances follow by diffusion


1 At the basolateral membrane, Na+ is pumped into the interstitial space by the Na+-K+

ATPase. Active Na+ transport creates concentration gradients that drive:

2 “Downhill” Na+ entry at theluminal membrane.

4 Reabsorption of water byosmosis. Water reabsorptionincreases the concentration of the solutes that are left behind. These solutes can then be reabsorbed asthey move down their concentration gradients:

3 Reabsorption of organic nutrients and certain ions by cotransport at the luminal membrane.

5 Lipid-solublesubstances diffuse by the transcellular route.

6 Cl– (and other anions), K+, and urea diffuse by the paracellular route.

Filtratein tubulelumen

GlucoseAmino acidsSome ionsVitamins

Lipid-solublesubstances

Nucleus

Tubule cell

Paracellularroute

Interstitialfluid

Peri-tubular

capillary

Tight junction

Primary active transport

Passive transport (diffusion) Secondary active transport

Transport protein

Ion channel or aquaporin

Cl–, Ca2+, K+

and otherions, urea

Cl–

3Na+

2K+

3Na+

2K+

K+

H2O

Na+

6

5

4

3

2

1


Reabsorptive Capabilities of Renal Tubules and Collecting Ducts

• PCT

• Site of most reabsorption

• 65% of Na+ and water

• All nutrients

• Ions

• Small proteins



• Loop of Henle

• Descending limb: H2O

• Ascending limb: Na+, K+, Cl



• DCT and collecting duct

• Reabsorption is hormonally regulated

• Ca2+ (PTH)

• Water (ADH)

• Na+ (aldosterone and ANP)



• Mechanism of aldosterone

• Targets collecting ducts (principal cells) and distal DCT

• Promotes synthesis of luminal Na+ and K+ channels

• Promotes synthesis of basolateral Na+-K+ ATPases


Tubular Secretion

• Reabsorption in reverse

• K+, H+, NH4+, creatinine, and organic acids

move from peritubular capillaries or tubule cells into filtrate

• Disposes of substances that are bound to plasma proteins


Tubular Secretion

• Eliminates undesirable substances that have been passively reabsorbed (e.g., urea and uric acid)

• Rids the body of excess K+

• Controls blood pH by altering amounts of H+ or HCO3

– in urine


Regulation of Urine Concentration and Volume

• Osmolality

• Number of solute particles in 1 kg of H2O

• Reflects ability to cause osmosis


Regulation of Urine Concentration and Volume

• Osmolality of body fluids

• Expressed in milliosmols (mOsm)

• The kidneys maintain osmolality of plasma at ~300 mOsm, using countercurrent mechanisms


Countercurrent Mechanism

• Occurs when fluid flows in opposite directions in two adjacent segments of the same tube

• Filtrate flow in the loop of Henle (countercurrent multiplier)

• Blood flow in the vasa recta (countercurrent exchanger)


Countercurrent Mechanism

• Role of countercurrent mechanisms

• Establish and maintain an osmotic gradient (300 mOsm to 1200 mOsm) from renal cortex through the medulla

• Allow the kidneys to vary urine concentration


Cortex

Medulla


Countercurrent Multiplier: Loop of Henle

• Descending limb

• Freely permeable to H2O, which passes out of the filtrate into the hyperosmotic medullary interstitial fluid

• Filtrate osmolality increases to ~1200 mOsm


Countercurrent Multiplier: Loop of Henle

• Ascending limb

• Impermeable to H2O

• Selectively permeable to solutes

• Na+ and Cl– are passively reabsorbed in the thin segment, actively reabsorbed in the thick segment

• Filtrate osmolality decreases to 100 mOsm

Copyright © 2010 Pearson Education, Inc. Figure 25.16a

Loop of Henle

Osmolalityof interstitialfluid(mOsm)

Innermedulla

Outermedulla

Cortex Active transport

Passive transport

Water impermeable

(a) Countercurrent multiplier. The long loops of Henle of the juxtamedullary nephrons create the medullary osmotic gradient.

The ascending limb:• Impermeable to H2O• Permeable to NaClFiltrate becomes increasingly dilute as NaCl leaves, eventually becoming hypo-osmotic to blood at 100 mOsm in the cortex. NaCl leaving the ascending limb increases the osmolality of the medullary interstitial fluid.

Filtrate entering the loop of Henle is isosmotic to both blood plasma and cortical interstitial fluid.

The descending limb:• Permeable to H2O• Impermeable to NaClAs filtrate flows, it becomes increasingly concentrated as H2Oleaves the tubule by osmosis. The filtrate osmolality increases from 300 to 1200 mOsm.

H2O

H2O

H2O

H2O

H2O

H2O

H2O

NaCI

NaCI

NaCI

NaCI

NaCI


Urea Recycling

• Urea moves between the collecting ducts and the loop of Henle

• Secreted into filtrate by facilitated diffusion in the ascending thin segment

• Reabsorbed by facilitated diffusion in the collecting ducts deep in the medulla

• Contributes to the high osmolality in the medulla


Countercurrent Exchanger: Vasa Recta

• The vasa recta

• Maintain the osmotic gradient

• Deliver blood to the medullary tissues

• Protect the medullary osmotic gradient by preventing rapid removal of salt, and by removing reabsorbed H2O

Copyright © 2010 Pearson Education, Inc. Figure 25.16b

NaCIH2O

NaCIH2O

NaCIH2O

NaCIH2O

NaCIH2O

NaCIH2O

NaCIH2O

NaCIH2O

Vasa recta

To vein

Osmolalityof interstitialfluid(mOsm)

Blood fromefferent arteriole

Innermedulla

Outermedulla

Cortex

Passive transport

(b) Countercurrent exchanger. The vasa recta preserve the medullary gradient while removing reabsorbed water and solutes.

The vasa recta:• Highly permeable to H2O and solute• Nearly isosmotic to interstitial fluid due to sluggish blood flowBlood becomes more concentrated as it descends deeper into the medulla and less concentrated as it approaches the cortex.


Formation of Dilute Urine

• Filtrate is diluted in the ascending loop of Henle

• In the absence of ADH, dilute filtrate continues into the renal pelvis as dilute urine

• Na+ and other ions may be selectively removed in the DCT and collecting duct, decreasing osmolality to as low as 50 mOsm


Active transport

Passive transport

(a) Absence of ADH Large volumeof dilute urine

Collecting duct

Cortex

NaCI

NaCI

NaCI

Urea

Outermedulla

Innermedulla

DCT

H2O

H2O

Descending limbof loop of Henle


Formation of Concentrated Urine

• Depends on the medullary osmotic gradient and ADH

• ADH triggers reabsorption of H2O in the collecting ducts

• Facultative water reabsorption occurs in the presence of ADH so that 99% of H2O in filtrate is reabsorbed


Active transport

Passive transport

Small volume ofconcentrated urine

Cortex

NaCI

NaCI

NaCI Urea

Urea

H2O

H2O

H2O

H2O

H2O

H2O

H2O

Outermedulla

Innermedulla

(b) Maximal ADH

DCT

Descending limbof loop of Henle

Collecting duct

H2O

H2O


Diuretics

• Chemicals that enhance the urinary output

• Osmotic diuretics: substances not reabsorbed, (e.g., high glucose in a diabetic patient)

• ADH inhibitors such as alcohol

• Substances that inhibit Na+ reabsorption and obligatory H2O reabsorption such as caffeine and many drugs


Cortex

Outermedulla

Innermedulla

(a)

(b)

(c)

(e)

(d)

Na+ (65%)GlucoseAmino acids

H2O (65%) and many ions (e.g.Cl– and K+)

300

Milliosmols

600

1200

Blood pH regulation

H+,NH4

+

HCO3–

Somedrugs

Active transport(primary or secondary)Passive transport

(a) Proximal convoluted tubule: • 65% of filtrate volume reabsorbed • Na+, glucose, amino acids, and other nutrients actively transported; H2O and many ions follow passively • H+ and NH4

+ secretion and HCO3– reabsorption to

maintain blood pH (see Chapter 26) • Some drugs are secreted


H2O

(b) Descending limb of loop of Henle • Freely permeable to H2O • Not permeable to NaCl • Filtrate becomes increasingly concentrated as H2O leaves by osmosis

(a)

(b)

(c)

(e)

(d)

Cortex

Outermedulla

Innermedulla

300

Milliosmols

600

1200


Copyright © 2010 Pearson Education, Inc. Figure 25.18c

Na+

Urea

Cl–

Na+

Cl–

K+

(c) Ascending limb of loop of Henle • Impermeable to H2O • Permeable to NaCl • Filtrate becomes increasingly dilute as salt is reabsorbed

(a)

(b)

(c)

(e)

(d)

Cortex

Outermedulla

Innermedulla

300

Milliosmols

600

1200


Copyright © 2010 Pearson Education, Inc. Figure 25.18d

Na+; aldosterone-regulatedCa2+; PTH-regulatedCl–; follows Na+

(d) Distal convoluted tubule • Na+ reabsorption regulated by aldosterone • Ca2+ reabsortion regulated by parathyroid hormone (PTH) • Cl– cotransported with Na+

(a)

(b)

(c)

(e)

(d)

Cortex

Outermedulla

Innermedulla

300

Milliosmols

600

1200


Copyright © 2010 Pearson Education, Inc. Figure 25.18e

Blood pHregulation

Urea;increasedby ADH

Na+

K+

H+

HCO3–

NH4+

H2O regulatedby ADH

Regulated byaldosterone:

(e) Collecting duct • H2O reabsorption through aquaporins regulated by ADH • Na+ reabsorption and K+ secretion regulated by aldosterone • H+ and HCO3

– reabsorption or secretion to maintain blood pH (see Chapter 26) • Urea reabsorption increased by ADH

(a)

(b)

(c)

(e)

(d)

Cortex

Outermedulla

Innermedulla

300

Milliosmols

600

1200

Active transport(primary or secondary) Passive transport


Renal Clearance

• Volume of plasma cleared of a particular substance in a given time

• Renal clearance tests are used to

• Determine GFR

• Detect glomerular damage

• Follow the progress of renal disease


Renal Clearance

RC = UV/P

RC = renal clearance rate (ml/min)

U = concentration (mg/ml) of the substance in urine

V = flow rate of urine formation (ml/min)

P = concentration of the same substance in plasma


Renal Clearance

• For any substance freely filtered and neither reabsorbed nor secreted by the kidneys (e.g., insulin),

RC = GFR = 125 ml/min

• If RC < 125 ml/min, the substance is reabsorbed

• If RC = 0, the substance is completely reabsorbed

• If RC > 125 ml/min, the substance is secreted (most drug metabolites)


Physical Characteristics of Urine

• Color and transparency

• Clear, pale to deep yellow (due to urochrome)

• Drugs, vitamin supplements, and diet can alter the color

• Cloudy urine may indicate a urinary tract infection



• Odor

• Slightly aromatic when fresh

• Develops ammonia odor upon standing

• May be altered by some drugs and vegetables



• pH

• Slightly acidic (~pH 6, with a range of 4.5 to 8.0)

• Diet, prolonged vomiting, or urinary tract infections may alter pH

• Specific gravity

• 1.001 to 1.035, dependent on solute concentration


Chemical Composition of Urine

• 95% water and 5% solutes

• Nitrogenous wastes: urea, uric acid, and creatinine

• Other normal solutes

• Na+, K+, PO43–, and SO4

2–,

• Ca2+, Mg2+ and HCO3–

• Abnormally high concentrations of any constituent may indicate pathology


Ureters

• Convey urine from kidneys to bladder

• Retroperitoneal

• Enter the base of the bladder through the posterior wall

• As bladder pressure increases, distal ends of the ureters close, preventing backflow of urine


Ureters

• Three layers of wall of ureter

1. Lining of transitional epithelium

2. Smooth muscle muscularis

• Contracts in response to stretch

3. Outer adventitia of fibrous connective tissue


Lumen

AdventitiaCircularlayerLongitudinallayer

TransitionalepitheliumLaminapropria


Renal Calculi

• Kidney stones form in renal pelvis

• Crystallized calcium, magnesium, or uric acid salts

• Larger stones block ureter, cause pressure and pain in kidneys

• May be due to chronic bacterial infection, urine retention, Ca2+ in blood, pH of urine


Urinary Bladder

• Muscular sac for temporary storage of urine

• Retroperitoneal, on pelvic floor posterior to pubic symphysis

• Males—prostate gland surrounds the neck inferiorly

• Females—anterior to the vagina and uterus


Urinary Bladder

• Trigone

• Smooth triangular area outlined by the openings for the ureters and the urethra

• Infections tend to persist in this region


Urinary Bladder

• Layers of the bladder wall

1. Transitional epithelial mucosa

2. Thick detrusor muscle (three layers of smooth muscle)

3. Fibrous adventitia (peritoneum on superior surface only)


Urinary Bladder

• Collapses when empty; rugae appear

• Expands and rises superiorly during filling without significant rise in internal pressure


Ureter

Trigone

Peritoneum

Rugae

Detrusor muscle

Bladder neck

Internal urethralsphincterExternal urethralsphincterUrogenital diaphragm

Urethra

External urethralorifice

Ureteric orifices

(b) Female.


Urethra

• Muscular tube

• Lining epithelium

• Mostly pseudostratified columnar epithelium, except

• Transitional epithelium near bladder

• Stratified squamous epithelium near external urethral orifice


Urethra

• Sphincters

• Internal urethral sphincter

• Involuntary (smooth muscle) at bladder-urethra junction

• Contracts to open

• External urethral sphincter

• Voluntary (skeletal) muscle surrounding the urethra as it passes through the pelvic floor


Urethra

• Female urethra (3–4 cm):

• Tightly bound to the anterior vaginal wall

• External urethral orifice is anterior to the vaginal opening, posterior to the clitoris


Ureter

Trigone

Peritoneum

Rugae

Detrusor muscle

Bladder neck

Internal urethralsphincterExternal urethralsphincterUrogenital diaphragm

Urethra

External urethralorifice

Ureteric orifices

(b) Female.


Urethra

• Male urethra

• Carries semen and urine

• Three named regions

1. Prostatic urethra (2.5 cm)—within prostate gland

2. Membranous urethra (2 cm)—passes through the urogenital diaphragm

3. Spongy urethra (15 cm)—passes through the penis and opens via the external urethral orifice


Ureter

Trigone of bladder

Prostate

Membranous urethra

Prostatic urethra

Peritoneum

RugaeDetrusor muscle

Bladder neckInternal urethral sphincter

External urethral sphincterUrogenital diaphragm

Spongy urethraErectile tissue of penis

Ureteric orificesAdventitia

(a) Male. The long male urethra has three regions: prostatic, membranous and spongy.

External urethral orifice


Micturition

• Urination or voiding

• Three simultaneous events

1. Contraction of detrusor muscle by ANS

2. Opening of internal urethral sphincter by ANS

3. Opening of external urethral sphincter by somatic nervous system


Micturition

• Reflexive urination (urination in infants)

• Distension of bladder activates stretch receptors

• Excitation of parasympathetic neurons in reflex center in sacral region of spinal cord

• Contraction of the detrusor muscle

• Contraction (opening) of internal sphincter

• Inhibition of somatic pathways to external sphincter, allowing its relaxation (opening)


Micturition

• Pontine control centers mature between ages 2 and 3

1. Pontine storage center inhibits micturition:

• Inhibits parasympathetic pathways

• Excites sympathetic and somatic efferent pathways

2. Pontine micturition center promotes micturition:

• Excites parasympathetic pathways

• Inhibits sympathetic and somatic efferent pathways


Somatic motornerve activity

External urethralsphincter opens

Sympatheticactivity

Parasympatheticactivity

Urinary bladderfilling stretches

bladder wall

Spinalcord

Promotes micturitionby acting on all threespinal efferents

Inhibits micturitionby acting on all three spinal efferents

Allow or inhibit micturitionas appropriate

Brain

Simplespinalreflex

Spinalcord

Inhibits

Parasympathetic activitySympathetic activitySomatic motor nerve activity

Pontine micturitioncenter

Pontine storagecenter

Higher braincenters

Detrusor musclecontracts; internalurethral sphincter

opens

Afferent impulsesfrom stretch

receptors

Micturition


Developmental Aspects

• Three sets of embryonic kidneys forming succession

1. Pronephros degenerates but pronephric duct persists

2. Mesonephros claims this duct and it becomes the mesonephric duct

3. Metanephros develops by the fifth week, develops into adult kidneys and ascends


Degeneratingpronephros

Urogenitalridge

Developingdigestive tract

Mesonephros

Duct toyolk sac

Allantois

Hindgut

Uretericbud

CloacaMesonephric duct(initially, pronephric duct)

(a) Week 5


Degeneratingpronephros

(b) Week 6

Mesonephros

Mesonephricduct

Duct to yolksac Allantois

Body stalk

Urogenitalsinus RectumUreteric bud

Metanephros



• Metanephros develops as ureteric buds that induce mesoderm of urogenital ridge to form nephrons

• Distal ends of ureteric buds form renal pelves, calyces, and collecting ducts

• Proximal ends become ureters

• Kidneys excrete urine into amniotic fluid by the third month

• Cloaca subdivides into rectum, anal canal, and urogenital sinus

Copyright © 2010 Pearson Education, Inc. Figure 25.23c

Urogenitalsinus(developingurinarybladder)

Metanephros(kidney)

Gonad

Rectum

(c) Week 7

Copyright © 2010 Pearson Education, Inc. Figure 25.23d

(d) Week 8

Gonad

Kidney

Urinary bladder

Urethra

Anus

Ureter Rectum



• Frequent micturition in infants due to small bladders and less-concentrated urine

• Incontinence is normal in infants: control of the voluntary urethral sphincter develops with the nervous system

• E. coli bacteria account for 80% of all urinary tract infections

• Streptococcal infections may cause long-term renal damage

• Sexually transmitted diseases can also inflame the urinary tract

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