Urinary System Function,

Assessment, and
Therapeutic Measures

Lindawati F. Tampubolon
 REVIEW OF
ANATOMY
AND
PHYSIOLOGY
 The purpose of urine formation is the
removal of potentially toxic waste
products from the blood; however, the
kidneys have other equally important
functions as well:
• Regulation of the blood volume,
composition, and pressure by the
excretion or conservation of water
• Regulation of the electrolyte balance of
the blood by the excretion or
conservation of minerals
• Regulation of the acid-base balance of the
blood by the excretion or conservation of ions
such as hydrogen or bicarbonate.
• Regulation of all of the above in tissue fluid.
• Production of erythropoietin, which then
stimulates erythocyte production in the bone
marrow.

The process of urine formation thus helps

maintain the normal composition, volume,
and pH of blood and tissue fluid.
 Kidneys
• The two kidneys are located in the upper
abdominal cavity behind the peritoneum on
each side of the vertebral column.

• The upper portions of both kidneys rest on

the lower surface of the diaphragm and are
enclosed and protected by the lower rib cage.

• The kidneys are cushioned by surrounding

adipose tissue, which is in turn covered by a
fibrous connective membrane called the renal
fascia; both help hold the kidneys in place.
Kidneys…

• On the medial side of each kidney is an

indentation called the hilus, where the
renal artery enters and the renal vein and
ureter emerge.
• The renal artery is a branch of the
abdominal aorta, and the renal vein
returns blood to the inferior vena cava.
• The ureter carries urine from the kidney
to the urinary bladder.
 Internal Structure of the Kidney

• A frontal section of the kidney shows three

distinct areas.
• The outermost area is the renal cortex,
which contains the parts of the nephrons
called renal corpuscles and convoluted
tubules.
• The middle area is the renal medulla, which
contains loops of Henle and collecting
tubules.
• The renal medulla consists of wedge-shaped
pieces called renal pyramids; the apex, or
papilla, of each pyramid points medially.
Internal Structure of the Kidney…

• The third area is a cavity called the renal

pelvis; it is formed by the expansion of
the ureter within the kidney at the hilus.

• Funnel-shaped extensions of the renal

pelvis, called calyces, enclose the
papillae of the renal pyramids.

• Urine flows from the pyramids into the

calyces, then to the renal pelvis, and
finally into the ureter.
 Nephron
• The nephron is the structural and
functional unit of the kidney.

• Urine is formed in the approximately 1

million nephrons in each kidney. The
two major parts of a nephron are the
renal corpuscle and the renal tubule.
Nephron…

• A renal corpuscle consists of a glomerulus

surrounded by a Bowman’s capsule.
• The glomerulus is a capillary network that
arises from an afferent arteriole and empties
into an efferent arteriole.

• The diameter of the efferent arteriole is

smaller than that of the afferent arteriole,
which helps maintain a fairly high blood
pressure in the glomerulus.
Nephron…

• Bowman’s capsule is the expanded end of a

renal tubule; it encloses the glomerulus. The
inner layer of Bowman’s capsule has pores
and is highly permeable; the outer layer has
no pores and is not permeable.

• The space between the inner and outer

layers contains renal filtrate, the fluid that
is formed from the blood in the glomerulus
and that will eventually become urine.
Nephron…

• The renal tubule continues from Bowman’s

capsule and consists of the proximal
convoluted tubule, the loop of Henle, and
the distal convoluted tubule.

• The distal convoluted tubules from several

nephrons empty into a collecting tubule.
Nephron…

• Several collecting tubules then unite to form

a papillary duct that empties urine into a
calyx of the renal pelvis.

• All the parts of the renal tubule are

surrounded by the peritubular capillaries,
which arise from the efferent arteriole and
receive the materials reabsorbed by the
renal tubules.
 Blood Vessels of the Kidney

• The pathway of blood flow through the kidney

is an essential part of the process of urine
formation.
• Blood from the abdominal aorta enters the
renal artery, which branches extensively
within the kidney into smaller arteries.
• The smallest arteries give rise to afferent
arterioles in the renal cortex.
Blood Vessels of the Kidney…

• From the afferent arterioles, blood flows into

the glomeruli (capillaries), to efferent
arterioles, to peritubular capillaries, to veins in
the kidney, to the renal vein, and finally to the
inferior vena cava. In this pathway are two
sets of capillaries; that is, two sites of
exchanges between the blood and the
surrounding tissues (in this case, the parts of
the nephrons).
• The exchanges that take place in the
capillaries of the kidneys form urine from
blood plasma.
 Formation of Urine

The formation of urine involves

three major processes:
glomerular filtration in the renal
corpuscles, tubular reabsorption,
and tubular secretion.
 Glomerular Filtration

• Filtration is the process by which blood

pressure forces plasma and dissolved
materials out of capillaries.
• In glomerular filtration, blood pressure
forces plasma, dissolved substances, and
small proteins out of the glomeruli and into
Bowman’s capsules.
• This fluid is then called renal filtrate.
Glomerular Filtration…

• The blood pressure in the glomeruli is

relatively high—about 55 mm Hg.
• The pressure in Bowman’s capsule is low,
and its inner layer is permeable, so that
approximately 20% to 25% of the blood that
enters glomeruli becomes renal filtrate in
Bowman’s capsules.
• The larger proteins and blood cells are too
large to be forced out of the glomeruli; they
remain in the blood.
Glomerular Filtration…

• Waste products such as urea and

ammoniaare dissolved in plasma, so
they pass to the renal filtrate, as do
dissolved nutrients and minerals.

• Renal filtrate is similar to blood plasma

except that there is far less protein and
no blood cells are present.
 Glomerular Filtration…

• The glomerular filtration rate (GFR) is the

amount of renal filtrate formed by the kidneys
in 1 minute; it averages 100 to 125 mL/min.
• The GFR may change if the rate of blood
flow through the kidney changes.
• If blood flow increases, the GFR increases,
more filtrate is formed, and urinary output
increases.
• If blood flow decreases, the GFR decreases,
less filtrate is formed, and urinary output
decreases.