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Chapter 25Urinary System
Lecture 16
Marieb’s HumanAnatomy and
Physiology
Marieb Hoehn
2
Lecture Overview
• Tubular reabsorption and secretion
• Regulation of urine concentration and volume
• Urea and uric acid excretion
• Renal clearance
• Elimination of urine
3
Simplified Overview of Nephron Function
Renal corpuscle – provides the raw materials to the nephron for processing
PCT – reclaims those substances the body can use; gets rid of some things
DCT – gets rid of those substances the body doesn’t want or need; reabsorbs some more Na+, Ca2+
Collecting duct – provides the OPTION of reclaiming H2O or letting it pass out of the body
Obligatory H2O reabsorption…
4
Overview of Renal Function• Filtration (based primarily on size; but some electrical)
– Occurs exclusively in renal corpuscle– Occurs across the filtration membrane
• Nutrient and fluid reabsorption– Primarily in the proximal convoluted tubule (PCT) – 65%
vol.– Rest occurs in nephron loop , DCT, and collecting tubule
• Active secretion occurs primarily– PCT– DCT
• Regulation of final volume and solute concentration of urine– Nephron loops (juxtamedullary nephrons)– Collecting ducts Good overview slide…
5
Overview of Renal FunctionFigure from: Saladin, Anatomy & Physiology, McGraw Hill, 2007
You should know what is moved (red arrows indicate the most important items), and in what part of the nephron they are moved.
Keep in mind: Where Na+ goes, H2O and Cl- usually follow.
**See the Summary Table in your Study Guide for Exam 3
*
*
**
6
Tubular Reabsorption and Secretion
Secretion – elimination of substances by the body that did not leave the blood
at the glomerulus (blood tubule)
Figure from: Hole’s Human A&P, 12th edition, 2010
Reabsorption – reclaiming of substances in filtrate by body (tubule blood)
7
Tubular Reabsorption• Reabsorption by tubular cells is a selective process
– Diffusion– Osmosis– Carrier-mediated transport
• Facilitated diffusion• Active transport• Co- and counter-transport
– Occurs mainly in the proximal convoluted tubules (PCT)– Has a transport maximum, Tm, for most substances besides
Na+
• Tm is the rate at which solutes can be transported, e.g., 375 mg/min• Renal threshold is the plasma level (concentration) above which a
particular solute will appear in urine, e.g., 180 mg/dl
• Peritubular capillaries are well-suited for reabsorption– Low hydrostatic pressure– High degree of permeability– Higher colloid osmotic pressure due to filtration
8
Renal Clearance (C)• the rate (ml/min) at which a substance is removed from the plasma; volume of plasma from which the kidneys clear a particular substance in a given time (usually 1 minute)
• C (ml/min) = U * V / P
[U = urine concentration, V = rate of urine formation, P = plasma concentration]
• tests of renal clearance (Cx)• inulin clearance test (standard; Cinulin = GFR = 125 ml/min)• creatinine clearance test (easy to do; C = 140ml/min)• paraminohippuric acid (PAH) test
• tests of renal clearance are used to calculate glomerular filtration rate
Examples:- Cx = 125 ml/min (125 ml of ‘x’ is removed from the plasma every min = 100%)- Cx = 60 ml/min (some reabsorption of ‘x’ is occurring)- Cx = 0 ml/min (complete reasbsorption of ‘x’ is occurring) - Cx = 630 ml/min (secretion of ‘x’ is occurring)
9
Reabsorption in PCT
Figure from: Saladin, Anatomy & Physiology, McGraw Hill, 2007
65% of filtrate volume is reabsorbed in the PCT
All uric acid, about 50% of urea, and no creatinine is reabsorbed
8 mm Hg
COP
Tubular fluid
10
Reabsorption in the PCTSubstance Mechanism of
ReabsorptionNotes
Na+ (Cl-) Primary Active Transport Na+ reabsorption is the driving force for most
other reabsorption
H2O Osmosis Closely associated with movement of Na+
(Obligatory water reabsorption)
Glucose Secondary Active transport Limited # of molecules can be handled
(Tm = 375 mg/min); attracts H20
Amino Acids Secondary Active transport Three different active transport modalities; difficult
to overwhelm
Other electrolytes Secondary Active transport
11
Sodium and Water Filtration, Reabsorption, and Excretion
Because of the large volumes involved, small changes in tubular reabsorption amount to LARGE changes in excretion of Na+ and H2O (since “water follows salt”)
Figure from: Hole’s Human A&P, 12th edition, 2010
12
Tubular Secretion
Tubular secretion (reabsorption in reverse) moves substances from the blood into the tubular lumen (urine)
1. Getting rid of substances not already in filtrate
2. Eliminating undesirable substances reclaimed by passive process, e.g., urea
3. Ridding body of excess K+
4. Controlling blood pH
Figure from: Hole’s Human A&P, 12th edition, 2010
13
Secretion in the PCT and DCTIn the DCT potassium ions or hydrogen ions may be secreted in exchange for reabsorbed sodium ions. Reabsorption of Na+ in the DCT is increased by the hormone, aldosterone.
Other compounds are actively secreted as well, e.g., histamine, ammonia, creatinine, penicillin, phenobarbital.
Active Active and Passive
Figure from: Hole’s Human A&P, 12th edition, 2010
14
Where have we been; we are we going?
Renal corpuscle – provides the raw materials to the nephron for processing
PCT – reclaims those substances the body can use
DCT – gets rid of those substances the body doesn’t want or need; reabsorb some more Na+, Ca2+
Collecting duct – provides the OPTION of reclaiming H2O or letting it pass out of the body
300 mOsm/L
*Note osmolarity of fluid in PCT
Obligatory H2O reabsorption…
15
Overview of Facultative H2O Reabsorption
• Note that outflow of water from collecting duct is dependent upon the osmotic gradient in the medulla
Under influence of ADH
(Facultative water reabsorption)
Urea
Figure from: Hole’s Human A&P, 12th edition, 2010
Increasin
g concen
tration →
16
The Loop of Henle (Nephron Loop)
Figure from: Martini, Anatomy & Physiology, Prentice Hall, 2001
Crucial renal function is to keep the body fluids at about 300 mOsm (osmolarity of blood plasma) by varying the concentration of urine
The mechanism shown is called the “countercurrent multiplier”
SO HOW DOES THIS HELP?
Increasin
g concen
tration →
17
The Countercurrent Multiplier
• Recall that all movement of H2O occurs passively by osmosis
• We would like some mechanism to concentrate urine– Excrete more H2O when body fluids are tending to become
hypotonic (more dilute)– Excrete less H2O when body fluids are tending to become
hypertonic (more concentrated)• Utilizes two factors
– Hypertonicity of the peritubular fluid, established by the countercurrent multiplier
– Variable permeability of the collecting ducts to H2O depending upon levels of ADH
• We will use the phrase, “Water follows salt (solute) when it can”
18
Influence of ADH on H2O Reabsorption• Note that amount of water pulled out of collecting duct is dependent upon the osmotic gradient in the medulla that was established by the countercurrent multiplier.
Under influence of ADH
(Facultative water reabsorption)
Urea
Figure from: Hole’s Human A&P, 12th edition, 2010
21
Vasa Recta of Juxtamedullary Nephrons
Recall that the vasa recta is present in juxtamedullary nephron loops (which give the kidneys the ability to produce a concentrated urine)
The vasa recta functions to
1. Deliver blood to medullary cells
2. Return reabsorbed solutes and water in the medulla to the general circulation without disrupting the medullary concentration gradient
(Countercurrent Exchanger)
Figure from: Hole’s Human A&P, 12th edition, 2010
22
Urea and Uric Acid Excretion
Urea• product of amino acid catabolism (deamination)• plasma concentration reflects the amount or protein in diet• enters renal tubules through glomerular filtration• 50% reabsorbed• rest is excreted
Uric Acid• product of nucleic acid metabolism• enters renal tubules through glomerular filtration• 100% of filtered uric acid is reabsorbed• 10% secreted and excreted
23
Summary of Events in the Nephron/Collecting Duct
1. Filtrate produced
2. Reabsorption of 65% of filtrate
3. Obligatory water reabsorption
4. Reabsorption of Na+ and Cl- by active transport
5,6. Facultative reabsorption of water
7. Absorption of solutes and water by vasa recta
(Aldosterone)
(Aldosterone)
24
Diuretics
• Osmotic diuretics, e.g., mannitol, glucose• Drugs that block Na+/Cl- transport in PCT and DCT,
e.g., hydrochlorothiazide• High-ceiling/loop diuretics that reduce gradient along
nephron loop, e.g., furosemide (Lasix)• Aldosterone-blocking agents, e.g., spironolactone (K+
sparing), natriuretic peptides• ACE inhibitors, e.g., Captopril• Drugs with diuretic side-effects, e.g., alcohol (how?),
caffeine
A diuretic promotes the loss of water in the urine
25
Urine• Urine composition varies depending upon
– Diet– Level of activity
• Major constituents of urine– H2O (95%) – Creatinine (remember, NONE of this is reabsorbed)– Urea (most abundant solute), uric acid– Trace amounts of amino acids– Electrolytes– Urochrome (yellow color), urobilin, trace of bilirubin
• Normal urine output is 0.6-2.5 L/day (25-100 ml/hr)• Output below about 25 ml/hour = kidney failure
(oliguria - anuria)
26
Terms to know…
• Anuria – absence of urine
• Diuresis – increased production of urine
• Dysuria – difficult or painful urination
• Enuresis – uncontrolled (involuntary) urination
• Glycosuria (glucosuria) – glucose in the urine
• Hematuria – blood in the urine
• Oliguria – scanty output of urine
• Polyuria – excessive urine output
27
Elimination of Urine
• nephrons• collecting ducts• renal papillae• minor and major calyces• renal pelvis• ureters• urinary bladder• urethra• outside world
Flow of Urine
Know this…
28
Ureters• 25 cm long• extend downward posterior to the parietal peritoneum• parallel to vertebral column• in pelvic cavity, joins urinary bladder• peristaltic contractions
Mucous coat – transitional epithelium continuous with linings of the renal tubules and urinary bladderMuscular coat – smooth muscle in longitudinal and circular bundles; carries out peristalsis to move urine toward bladderFibrous coat (adventitia)– CT layer continuous with the renal capsule and peritoneum
Walls of the ureters:
Figure from: Hole’s Human A&P, 12th edition, 2010
29
Urinary Bladder [Cyst(o)]
Four layers:
1. Mucous layer (transitional epi.)
2. Submucous coat
3. Muscular coat
4. Serous layer
Muscular layer runs in all directions (detrusor muscle) under parasympathetic control. Contraction compresses the bladder and causes urine to flow into urethra
Temporary reservoir for storage of urine
Note the internal sphincter at neck of bladder
Frontal section, anterior posterior
Figure from: Hole’s Human A&P, 12th edition, 2010
30
Urinary Bladder and Urethra - Female
Urinary bladder is inferior to the uterus and is separated from the rectum by the vagina.
Note the short urethra (about 4 cm)
Note the passage of the urethra through the urogenital diaphragm that forms the external urethral sphincter
Pelvic region, midsagittal section
Figure from: Martini, Anatomy & Physiology, Prentice Hall, 2001
31
Urinary Bladder and Urethra - Male
Base of the urinary bladder lies between the rectum and pubis symphysis.
Pelvic region, midsagittal section
Figure from: Martini, Anatomy & Physiology, Prentice Hall, 2001
32
Urinary Bladder and Urethra - Male
Note the long urethra (about 18-20 cm). There are three sections to the male urethra:
- Prostatic urethra - Membranous urethra - Penile urethra
Note the passage of the urethra through the urogenital diaphagm that forms the external urethral sphincter
Figure from: Saladin, Anatomy & Physiology, McGraw Hill, 2007
33
The Pelvic Diaphragm (Female)
These are DEEP muscles that form the pelvic floor and extend between the pubic bones
Figure from: Hole’s Human A&P, 12th edition, 2010
34
Cross Section of UrethraExtends from neck of bladder to exterior
Epithelium varies from
- Transitional at neck of bladder
- Stratified columnar at midpoint
- Stratified squamous near external urethral meatus
Figure from: Hole’s Human A&P, 12th edition, 2010
35
Micturition (Urination) Reflex
• trigger = bladder distention & stimulation of stretch receptors• micturition center activated in sacral portion of spinal cord
• parasympathetic nerve impulses cause detrusor muscle to contract (short reflex) and internal urethral sphincter to open• need to urinate is sensed (spinal cord -> thalamus - > cortex) - urge to urinate at about 150-200 ml of urine - discomfort at about 300 ml of urine - maximum capacity of bladder is about 600-1000 ml
• voluntary (tonal) contraction of external urethral sphincter prevents urination and also closes the internal sphincter
• when decision is made to urinate, external and internal urethral sphincters relax, detrusor muscle contracts, and urine is expelled
36
Micturition Reflex
Figure from: Saladin, Anatomy & Physiology, McGraw Hill, 2007
37
Life-Span Changes
• kidneys appear scarred and grainy • kidney cells die• by age 80, kidneys have lost a third of their mass• kidney shrinkage due to loss of glomeruli• proteinuria may develop• renal tubules thicken• harder for kidneys to clear certain substances• bladder, ureters, and urethra lose elasticity• bladder holds less urine
38
Review
• Urine formation is a product of – Filtration– Tubular reabsorption– Tubular secretion
• Tubular reabsorption– Reclaims important substances in the filtrate– Takes place primarily in the PCT– Uses diffusion, osmosis, and carrier-mediated
transport
39
Review
• Tubular secretion – Rids the body of substances that have not been
filtered or are present in excess– Takes place throughout the tubules– Is mainly dependent upon active transport
• Regulation of urine concentration and volume– Results from a combination of
• Countercurrent multiplier in loop of Henle
• Responsiveness of the DCT and collecting ducts to ADH and aldosterone
– Is critical to homeostasis
40
Review
• Urine composition – Is variable– Depends upon both diet and activity– Consists of mostly water plus
• Creatinine
• Urea
• Uric acid
• Traces of amino acids
• Electrolytes
41
Review• Elimination of Urine
– Know pathway of urine flow– Ureters transport urine from kidney to urinary
bladder– Urinary bladder
• is a temporary storage site for urine• has muscular coat (detrusor) under parasympathetic
control
– Urethra is the conduit for urine from the bladder to the exterior
• Varies in length between males (18-20 cm) and females (4 cm)
• Has different types of epithelium along its length
42
Review
• Micturition (urination) reflex– Begins with distension of urinary bladder– Activates mild contraction of the detrusor
muscle– Sends impulses to higher brain centers– Requires voluntary relaxation of the external
urethral sphincter in order for urination to occur