The Urinary System

•Also called the Excretory System

Kidneys
Bladder

Urinary System

Urethra Ureters
Meatus
The urinary system is the major excretory system of the body.
Some organs in other systems also eliminate wastes,
but they are not able to compensate in case of kidney failure.

The urinary system consists of two kidneys, the primary excretory

organs. Each kidney’s waste products are carried by a ureter to
a single urinary bladder. The waste is emptied from the urinary
bladder by the urethra. The kidneys each filter a large
volume of blood. Wastes from the blood are collected and form urine.

Urine consists of (1) excess water, (2) excess ions, (3) metabolic
wastes, including the protein by-product urea, and (4) toxic substances.

The kidneys can suffer extensive damage and still maintain

homeostasis. As long as about one-third of one kidney remains
functional, survival is possible. However, if the functional ability
of the kidneys fails completely death will result unless the person
receives medical treatment.
The major function include:
1. Excretion. The kidneys remove waste products from
the blood. Most of the waste products are metabolic
by-products of cell metabolism. Other waste products
are substances absorbed from the intestine. Many waste products
are toxic. Organs such as the skin, liver, lungs, and intestines
eliminate some of these waste products. However, if the kidneys
fail to function, these organs cannot remove sufficient wastes to
maintain homeostasis.

2. Regulation of blood volume and pressure. The kidneys play a

major role in controlling the extracellular fluid volume in the
body. The kidneys can produce either a large volume of diluted
urine or a small volume of concentrated urine, depending on the
hydration level of the body. Through urine production, the kidneys
regulate blood volume and blood pressure.
3. Regulation of the concentration of solutes in the blood.
The kidneys help regulate the concentration of the major
molecules and ions, such as glucose, Na+, Cl−, K+, Ca2+,
HCO3, and HPO4.
4. Regulation of extracellular fluid pH. The kidneys excrete
variable amounts of H+ to help regulate extracellular fluid pH.
5. Regulation of red blood cell synthesis. The kidneys secrete
a hormone, erythropoietin, which regulates the synthesis of
red blood cells in bone marrow.
6. Regulation of vitamin D synthesis. The kidneys play an
important role in controlling blood levels of Ca2+ by
regulating the synthesis of vitamin D
Sructures that are behind the
peritoneum are said to be
retroperitoneal. A layer of connective
tissue called the renal (derived from the
Latin word for kidney) capsule
surrounds each kidney. Around the
renal capsule is a thick layer of adipose
tissue, which protects the kidney from
mechanical shock. On the medial side
of each kidney is the hilum, where the
renal artery and nerves enter and where
the renal vein, ureter, and lymphatic
vessels exit the kidney. The hilum
opens into a cavity called the renal
sinus, which contains blood vessels,
part of the system for collecting urine,
and adipose tissue
The bases of several cone-shaped renal
pyramids are located at the boundary
between the cortex and the medulla. The tips
of the renal pyramids project toward the
center of the kidney. A funnel-shaped
structure called a calyx, surrounds the tip of
each renal pyramid. The calyces from all the
renal pyramids join to form a larger funnel
called the renal pelvis.
The renal pelvis then narrows to form a small
tube, the ureter, which exits the kidney and
connects to the urinary bladder.

The flow of urine through the kidneys is in

the following order:
1. From the tips of the renal pyramids into the
calyces
2. From the calyces into the renal pelvis
3. From the renal pelvis into the ureter
4. From the ureter into the bladder
ARTERIES AND VEINS OF THE
KIDNEYS
 Renal arteries – branch off the abdominal
aorta and enter the kidneys
 Interlobar arteries – pass bet. the renal
pyramids
 Arcuate arteries – arch bet. the cortex and
the medulla
 Interlobular arteries – branch off the
arcuate arteries and project into the cortex
 Peritubular capillaries – surround the
proximal convoluted and distal convoluted
tubules and the loops of Henle
 Vasa recta – specialized portions of the
peritubular capillaries that extend deep into
the medulla
BLOOD & NERVE SUPPLY OF KIDNEY
• Abundantly supplied with blood vessels
– receive 20% of resting cardiac output via renal arteries
• Functions of different capillary beds
– glomerular capillaries where filtration of blood occurs
• vasoconstriction & vasodilation of afferent & efferent arterioles produce
large changes in renal filtration
– peritubular capillaries that carry away reabsorbed substances
from filtrate
– vasa recta supplies nutrients to medulla without disrupting its
osmolarity form
• The nerve supply to the kidney is derived from the renal
plexus (sympathetic division of ANS). Sympathetic
vasomotor nerves regulate blood flow & renal resistance
by altering arterioles
Blood Flow Through the Kidney
INTERNAL ANATOMY OF THE
KIDNEYS
NEPHRONS: TYPES
There are two types of nephrons that have differing
structure and function
•A cortical nephron
– glomerulus in the outer portion of the cortex
– short loop of Henle
• penetrates only into the outer region of the medulla
•A juxtamedullary nephron
– glomerulus deep in the cortex close to the medulla
– long loop of Henle stretches through the medulla and
almost reaches the renal papilla
 CORTICAL NEPHRON
• 80-85% of nephrons are cortical nephrons
• Renal corpuscles are in outer cortex and loops
of Henle lie mainly in cortex
 JUXTA-MEDULLARY
NEPHRON
• 15-20% of nephrons are juxtamedullary nephrons
• Renal corpuscles close to medulla and long loops of Henle extend into
deepest medulla enabling excretion of dilute or concentrated urine
1. RENAL CORPUSCLE - filters the blood

2. PROXIMAL CONVOLUTED
TUBULE - returns filtered substances to
the blood

3. LOOP OF HENLE - helps conserve

water and solutes

4. DISTAL CONVOLUTED TUBULE -

rids the blood of additional wastes.
 fluid empties into a collecting duct
 COLLECTING DUCT - carries
the newly formed urine from the
cortex of the kidney toward the
renal papilla deep in the medulla.

 PAPILLARY DUCT – formed

merging of several collecting
ducts; larger-diameter tubule
 which empties into a minor
calyx.
RENAL CORPUSCLE
• Renal Corpuscle is about 200 μm
in diameter that is the filtration
portion of the nephron
• Consists of:
– Bowman’s capsule surrounds
capsular (urinary) space
• podocytes cover capillaries to
form visceral layer
• simple squamous cells form
parietal layer of capsule
– Glomerular capillaries arise from
afferent arteriole & form a ball of
yarn before emptying into efferent
arteriole
• Fenestrated endothelial cells
constitute the capillaries
• Renal corpuscle have a vascular
pole where the afferent arteriole
enters and the efferent arteriole
leaves, and a urinary pole where
proximal convoluted tubule begins
 Renal corpuscle has several unique
characteristics
1. Fenestrae - capillaries are highly
permeable due to the presence of fenestrae
 However, neither large proteins nor
blood cells can fit through them.

2. Filtration slits. between the cell

processes of the podocytes of the visceral
layer
3. High pressure.
glomerular capillaries have much higher pressure
than other capillaries

 afferent arteriole - supplies blood to the

glomerulus for filtration

 efferent arteriole - transports the filtered blood

away from the glomerulus (smaller diameter)
Filtration membrane consists:
1.fenestrated glomerular capillary endothelium (size: 70-100 nanometer) – blood cells cannot pass through
2.basement membrane - connective tissue with collagen. Collagen is negatively charged that repels proteins
thus preventing it from being filtered. Lamina densa covered by lamina rara on each side
3.podocyte cell processes (size: 10 to 40 nanometers) - Podocytes have cell body from which arise several
primary processes
• Podocytes are cells in Bowman's capsule that wrap around capillaries of the glomerulus.
• Podocytes make up the epithelial lining of Bowman's capsule, the third layer through which filtration of
blood takes place.
• Each primary process gives rise to many secondary processes (pedicels)
• Only the secondary processes have direct contact with the basal lamina
• Filtration slits , is a 25 nm wide elongated spaces between the secondary processes
• Filtration slits are covered by 6 nm thick diaphragm

Fluid passes from the capillary through the filtration membrane into the Bowman’s capsule.
 GLOMERULAR
CAPILLARIES
• Glomerular capillaries have mesangial cells adhere to their
walls
• mesangial cells are contractile cells and have receptors for
angiotensin II, so it can reduce the glomerular flow
• mesangial cells contains also receptors for natriuretic factor
produced by the cardiac atria cells causing vasodilation and
relaxes mesangial cells
• mesangial cells also have several functions
– Support the glomerulus
– Produce extracellular matrix
– Immune response
– Outside the glomerulus in the vascular pole, form the
extraglomerular mesangial cells, which is part of the extraglomerular
apparatus
 GLOMERULAR
CAPSULE
BOWMAN’S CAPSULE
• The glomerular capsule
consists of visceral and
parietal layers
• The parietal layer consists
of simple squamous
epithelium supported by
basal lamina and thin
layer of reticular fibers
• Near the urinary pole the
epithelium becomes
cuboidal or low columnar
• The visceral layer
consists of modified
simple squamous
epithelial cells called
podocytes.
 JUXTAGLOMERULAR
APPARATUS
JUXTAGLOMERULAR APPARATUS -
important regulatory structure
located next to the glomerulus
RENIN – secreted by juxtaglomerular
apparatus
plays an important role in the regulation of
filtrate formation and blood pressure

1. JUXTAGLOMERULAR CELLS - cuff of

specialized smooth muscle cells; at the point
where the afferent arteriole enters the renal
corpuscle
2. MACULA DENSA - group of specialized
cells; part of the distal convoluted tubule of
the nephron lies between the afferent and
efferent arterioles
 JUXTAGLOMERULAR
APPARATUS

• Senses and regulates blood flow and composition

• Structure where afferent arteriole makes contact with ascending
limb of loop of Henle
• Consists of three cell types
– juxtaglomerular cells are modified muscle cells in arteriole, renin
secretion
– macula densa: sense NaCl concentration, regulates renin release.
It is thickened part of ascending limb
– the extraglomerular mesangial cells: unknown function
URINE PRODUCTION
 URINE PRODUCTION
There are 3 steps in the formation of urine:
1)Glomerular filtration;
2)Tubular Reabsorption and secretion; and
3)Water conservation.

Blood enters the Bowman’s capsule via the Afferent arteriole,

passes through a ball of capillaries called the GLOMERULUS leaves via

the Efferent arteriole.

The Afferent arteriole is significantly LARGER than the Efferent arteriole, creating a
blood flow with a LARGE INLET and SMALL OUTLET. As a result, the blood
hydrostatic PRESSURE in these capillaries is MUCH HIGHER than usual.
Hydrostatic and osmotic pressures DRIVE water and solutes FROM blood plasma,
through a FILTRATION MEMBRANE, INTO the capsular space of the nephron. The
filtration membrane acts like a sieve, allowing ONLY SMALL molecules to pass through.
These include water, inorganic ions, glucose, amino acids and various metabolic wastes
such as urea and creatinine; and make up the GLOMERULAR FILTRATE.
URINE PRODUCTION
The Left ventricle squirt 70 ml of
blood and it does that about 72
times a minute on average so if it
squirts out 70 ml times 72 in a
minute is about 5 liters a minute
(Cardiac Output)

20% of 5 liters of blood is

1 liter that goes to the
kidneys every minute
In a healthy person, the total
filtrate volume amounts to
between 150 and 180 liters a day.
However, only about 1% of this
is excreted as urine, the
remaining 99% is reabsorbed
BACK to the blood as the filtrate
flows through the long renal
tubule.
This is possible because the
Efferent arteriole, after exiting
the Bowman’s capsule,
BRANCHES OUT to form a
network of so-called Peritubular
capillaries, which SURROUND
the renal tubule.
The amount of filtrate produced per minute is called GLOMERULAR
FILTRATION RATE or GFR.

GFR is kept at a STABLE value by several FEEDBACK mechanisms within the

kidneys, known as Renal Autoregulation.

GFR is also under SYMPATHETIC and HORMONAL control. GFR regulation is

generally achieved by CONSTRICTION or DILATION of the Afferent arteriole,
which causes the GLOMERULAR blood pressure to FALL or RISE, respectively.
 PROXIMAL CONVOLUTED TUBULES

• Longer than the distal convoluted

tubule, thus seen more near the renal
corpuscle in the cortex
• Consists of cuboidal cells
• Acidophilic cytoplasm , numerous
elongated mitochondria
• Brush border, abundant microvilli
• Large cells, 3-5 surround each tubule
• Lateral interdigitation connecting
lateral walls of cells, difficult to
distinguish boundaries between
adjacent cells
• Basal infoldings with mitochondria
(basal striations), characteristic of
cells with active ionic transport
 PROXIMAL CONVOLUTED TUBULES

• Functions
– Resorption of 80% water,
electrolytes through Na+, Ka+-
ATPase
– Resorption of 100% glucose and
amino acids
– Protein resorption: apical
canaliculi connecting microvilli
increase the absorption of
macromolecules by pinocytosis.
• Vacuoles and lysosomes are
more abundant in the apical
portion of the cytoplasm
– Secretion of creatinine and
organic acids and bases, so pH
modification
 LOOP OF HENLE

• Thick descending limb (60 μm)

– Cytology
• Similar to proximal convoluted
tubules
• Slightly fewer microvilli
• Less basolateral interdigitation
• Mitochondria are smaller and more
randomly oriented
– Function: Na+ and H2O reabsorption
• Thin tubule (12 μm)
– Cytology: Simple squamous epithelium
– Function
• Descending limb: permeable to H2O
and salt
• Ascending limb: impermeable to
H2O, permeable to salt and urea
• Concentration of the urine
 LOOP OF HENLE

• Thick ascending limb

– Cytology
• Cuboidal cells with apical
nuclei
• Numerous basal infoldings
with larger mitochondria
• Few and short microvilli
• Macula densa, part of
juxtaglomerular apparatus
– Function
• Cl- and Na+ transport into
basolateral spaces
• Establish a salt concentration
gradient in medulla for urine
concentration
 DISTAL CONVOLUTED
TUBULE

• Cytology
– Same as thick ascending limb
of loop of Henle
– Cells are flatter and smaller
than those of proximal
convoluted tubules, so more
cells will appear in cross section
• Function
– Na+ reabsorption, Ka+ secretion
(aldosterone)
– Reabsorption of bicarbonate,
hydrogen secretion, pH
increases
– Conversion of ammonia to
ammonium ions
 COLLECTING TUBULES AND
DUCTS
• Types
• Connecting tubule: 40 µm in
diameter, in cortex
• Cortical duct: medullary rays
• Medullary duct: medulla
• Papillary duct (of Bellini): 200 µm in
diameter, apex
• Epithelium: cuboidal to
columnar cells
• Principal cells: light stained cells,
cilium, short microvilli, basal
infoldings, permeable to H2O (H2O
channel, in the presence of
antidiuretic hormone)
• Intercalated cells: dark stained cells,
microplicae (folds), H+ secretion,
bicarbonate reabsorption. Absent in
inner medulla
 URINARY BLADDER & URINARY
PASSAGES
• Bladder and urinary passages store and conduct urine to the exterior
• All have the same histological structure:
• The mucosa
– Transitional epithelium
– Lamina propria
• Dense woven sheath of smooth muscle
– Calyces, renal pelvis and ureters: helical arrangement
– Distal part of ureter: longitudinal
– Bladder: run in every direction
– Bladder neck:
• Internal longitudinal. Distal to bladder neck become circular
– Surround prostatic urethra
– Extend to external urethral meatus in women
• Middle circular: ends at the bladder neck
• Outer longitudinal layer: continue to the prostate in men and to the external
urethral meatus in women
• Adventitia
• Serosa: upper part of the bladder
A. Empty bladder
B. Full bladder ureter
 URETHR
A
• Male urethra: consists of four parts
– Prostatic urethra
• Close to bladder, and ducts of prostate gland opens into it
• Transitional epithelium
• Dorsal and distal part have verumontanum (elevation protrudes into its interior)
– Closed tube (prostatic utricle) opens into the tip with no known function
• Ejaculatory ducts open on the sides of the verumontanum
– Membranous urethra
• 1 cm, surrounded by the external urethra sphincter (striated muscle)
• Stratified or pseudostratified columnar epithelium
– Bulbous and pendulous parts of urethra
• Located in the corpus spongiosum of the penis
• Lumen dilates distally forming the fossa navicularis
• Pseudostratified columnar with stratified squamous areas
• Litter’s glands: mucous glands found along the entire urethra and mostly in the
pendulous part
• Female urethra
– 4-5 cm long tube, lined by stratified squamous epithelium and areas of
pseudostratified columnar epithelium
– The mid part is surrounded by external urethral sphincter
Micturition (Voiding) or Urination
 Both sphincter muscles must open to
allow voiding
 The internal urethral sphincter is
relaxed after stretching of the
bladder
 Activation is from an impulse
sent to the spinal cord and then
back via the pelvic splanchnic
nerves
 The external urethral sphincter
must be voluntarily relaxed
 HOMEOSTASIS
• The urinary system maintains homeostasis in
several ways:
• Removal of urea (nitrogenous waste) from
the bloodstream.
• Control of water and salt balance in the
bloodstream.
• Involved in blood pressure regulation.
UREA REMOVAL
AMMONIA AND UREA
• Ammonia is toxic
and highly water
soluble.
• The liver turns
ammonia into urea,
which is less toxic
and less soluble.
WATER CONTROL
Antidiuretic Hormone (ADH)
Antidiuretic hormone (ADH) is a hormone that helps your kidneys manage the amount of
water in your body.

ADH is also called arginine vasopressin. It’s a hormone made by the hypothalamus in
the brain and stored in the posterior pituitary gland. It tells your kidneys how much water
to conserve.

ADH constantly regulates and balances the amount of water in your blood. Higher water
concentration increases the volume and pressure of your blood. Osmotic sensors and
baroreceptors work with ADH to maintain water metabolism.

Osmotic sensors in the hypothalamus react to the concentration of particles in your blood.
These particles include molecules of sodium, potassium, chloride, and carbon dioxide.
When particle concentration isn’t balanced, or blood pressure is too low, these sensors
and baroreceptors tell your kidneys to store or release water to maintain a healthy range
of these substances. They also regulate your body’s sense of thirst.
REGULATING WATER
• Antidiuretic hormone
(ADH, also called
vasopressin) is part
of a negative
feedback system that
regulates water in the
mammalian body.
• ADH increases the
permeability of the
distal tubule,
allowing greater
water recovery.
BLOOD PRESSURE
CONTROL
 RENIN
The kidneys also produce Renin is an enzyme that helps control
prostaglandins, hormone-like your blood pressure and maintain
substances, made from lipid healthy levels of sodium and potassium
(fat). The substances are one in your body. Made by special cells in
way in which the production of your kidneys, renin is released into your
renin is stimulated. Renin is an bloodstream when your blood pressure
enzyme, also produced by the drops too low
kidneys, that plays an important • Renin is an enzyme released by the kidneys
role in the renin–angiotensin– in response to a drop in blood pressure.
aldosterone hormonal system, • Renin catalyzes the production of
which helps to control blood angiotensin, a hormone that causes arterioles
pressure. to constrict, raising blood pressure. This also
causes water retention.
The renin–angiotensin–aldosterone system,
RAAS, is a hormonal system that controls
blood pressure.
THE KIDNEYS PRODUCE TWO IMPORTANT
HORMONES
The kidneys make two main hormones, vitamin D and erythropoietin.

Vitamin D is essential for a number of different functions in the body. Most of

the vitamin D that is in the blood is inactive and it is modified by the kidney and
other tissues to activate it. Active vitamin D stimulates the uptake of calcium
from food, is important for the maintenance of healthy bones and also helps to
regulate the response of the immune system to infection.

Erythropoietin is produced when oxygen levels in the blood are low. It acts in
bone marrow to stimulate the production of mature red blood cells, to maintain
healthy oxygen levels in our tissues.
ERYTHROPOIETIN
• A second response to low blood pressure is the
release of erythropoietin, another hormone.
• Erythropoietin travels to the bone marrow and
stimulates the production of new blood cells.
Erythropoietin (EPO) is a glycoprotein hormone,
naturally produced by the peritubular cells of the
kidney, that stimulates red blood cell production.
Renal cortex peritubular cells produce most EPO in
the human body. PO2 directly regulates EPO
production. The lower the pO2, the greater the
production of EPO.
 Distribution of Body Fluid

 Intracellular fluid
(inside cells)
 Extracellular fluid
(outside cells)
 Interstitial fluid
 Blood plasma
 Maintaining Water Balance
 Normal amount of water in the human body
 Young adult females – 50%
 Young adult males – 60%
 Babies – 75%
 Old age – 45%
 Water is necessary for many body functions and
levels must be maintained
Maintaining Water Balance
 Water intake must equal water output
 Sources for water intake
 Ingested foods and fluids
 Water produced from metabolic processes
 Sources for water output
 Vaporization out of the lungs
 Lost in perspiration
 Leaves the body in the feces
 Urine production
 Maintaining Water Balance
 Diluted urine is produced if water intake is excessive
 Less urine (concentrated) is produced if large
amounts of water are lost
 Proper concentrations of various electrolytes must be
present
 The Link Between Water and Salt

 Changes in electrolyte balance causes water

to move from one compartment to another
 Alters blood volume and blood pressure
 Can impair the activity of cells
Regulation of Water and Electrolyte Reabsorption

 Regulation is primarily by hormones

 Antidiuretic hormone (ADH) prevents excessive water loss in
urine
 Aldosterone regulates sodium ion content of extracellular
fluid
 Triggered by the rennin-angiotensin mechanism
 Cells in the kidneys and hypothalamus are active
monitors
 Maintaining Acid-Base Balance in Blood

 Blood pH must remain between 7.35 and 7.45 to maintain homeostasis

 Alkalosis – pH above 7.45
 Acidosis – pH below 7.35
 Most ions originate as byproducts of cellular metabolism

CO2 is a regulator of blood pH. In the blood,

CO2 is carried in several different forms.
Approximately 80% to 90% is dissolved in
water, 5% to 10% is dissolved in the plasma,
and 5% to 10% is bound to hemoglobin.
Maintaining Acid-Base Balance in Blood
 Most acid-base balance is maintained by the kidneys
 Other acid-base controlling systems
 Blood buffers
 Respiration

The more CO2 in the blood, the higher the H+

concentration. On the other hand, the pH value is
inversely proportional to the amount of CO2 in the
blood. Therefore, the more CO2 in the blood, the lower
the blood pH will be.
 Blood Buffers
In the bloodstream, dissolved CO2 is neutralized by the bicarbonate-
carbon dioxide buffer system where it forms a weak acid, carbonic
acid (H2CO3). H2CO3 can dissociate into a hydrogen ion and
bicarbonate ion. This buffer system allows the body to maintain
physiologic pH
 Molecules react to prevent dramatic changes in hydrogen
ion (H+) concentrations
 Bind to H+ when pH drops
 Release H+ when pH rises
 Three major chemical buffer systems
 Bicarbonate buffer system
 Phosphate buffer system
 Protein buffer system
Respiratory System Controls of Acid-Base Balance
 Carbon dioxide in the blood is converted to
bicarbonate ion and transported in the plasma
 Increases in hydrogen ion concentration produces
more carbonic acid
 Excess hydrogen ion can be blown off with the
release of carbon dioxide from the lungs
 Respiratory rate can rise and fall depending on
changing blood pH
Renal Mechanisms of Acid-Base Balance

 Excrete bicarbonate ions if needed

 Conserve or generate new bicarbonate ions if needed
 Urine pH varies from 4.5 to 8.0
•Caffeine and alcohol are diuretics. Alcohol inhibits
ADH release, while caffeine interferes with its activity.
Part of the symptoms of a hangover are due to
dehydration. What causes the dehydration? And why is
a cup of coffee not a good cure for a hangover?

Many over-the-counter herbal diet aids claim to “detoxify”

the body or “flush fat.” Many of these contain dandelion
leaves, parsley, or other herbs known to be diuretics. If a
person tries these products and appears to lose pounds, what
is actually lost? Could there be health problems with using
these products?
 Diagnostic, Procedural and
Laboratory Terms

Urologists are physicians who specialize in disorders of the

male and female urinary tracts, and the male reproductive
system.

Common Tests Characteristics of Urine

•Normal urine is straw-colored
Urinalysis and clear
•Examination of the • Normal specific gravity (SG)
urine for its physical and range is from 4.5 to 8.0
chemical properties •Specific gravity measures the
•Obtained from clients amount of wastes, minerals
who fill a specimen and solids present in the urine
container or by urinary
catheterization
 Diagnostic, Procedural and
Laboratory Terms

Glucose
Casts
Albumin

Blood Abnormal Findings Ketones

in the Urine

Bilirubin
Phenylketones (PKU)
 Urinary Foley
bladder catheter
Diagnostic, Procedural and
Laboratory Terms
Types of Catheters

Foley catheter To urine

container
•An indwelling
catheter held in place
by an inflated balloon
in the bladder

Clip
•Midstream catch Drain
 Diagnostic, Procedural and
Laboratory Terms Condom
catheter
Types of Catheters
Tube
Condom catheter

•External catheter Leg

consisting of a rubber collection
sheath placed over the bag
penis
 Diagnostic, Procedural and
Laboratory Terms

Blood Tests

•Blood Urea Nitrogen (BUN)

•Creatinine Clearance Test

The presence of high amounts of urea or

creatinine in the blood shows that the kidney is
not properly filtering these substances.
 Diagnostic, Procedural and
Laboratory Terms
Imaging Tests
•Cystoscopy
-tubular instrument used to
examine the bladder
•Intravenous Pyelogram
-x-rays of the urinary tract after a
contrast medium is injected into
the bloodstream
•KUB
-x-ray of three parts of the urinary tract (kidney, ureter,
and bladder)
•Renal Scan
-radioactive imaging used to diagnose kidney disorders
 Diagnostic, Procedural and
Laboratory Terms

Urinary Tract Procedures

Dialysis
•Hemodialysis
-the process of filtering
blood outside the body in an
artificial kidney machine
that returns the blood back
to the body after filtering.

Peritoneal dialysis
(pictured)
-the insertion and removal
of a dialysis solution into
the peritoneal cavity.
 Diagnostic, Procedural and
Laboratory Terms

Extracorporeal Shock Wave Lithotripsy (ESWL)

-the breaking up of urinary

stones by using shock waves
from outside the body
 Pathological Terms

Urinary Tract Infection

Glomerulonephritis

Nephritis
Nephrosis
Inflammatory
&
Infectious Disorders
Hydronephrosis Cystitis

Nephroblastoma Polycystic kidney disease

 Pathological Terms

Terms Used to Describe Difficulties in Urination

anuresis polyuria

•No urinary output •Excessive urination

dysuria incontinence

•Involuntary discharge of
•Painful urination
urine or feces
enuresis oliguria
•Lack of bladder •Scanty urination
control
Parts of the urinary system
may be surgically removed
•Nephrectomy- removal of a kidney
•Ureterectomy- removal of a ureter
•Cystectomy- removal of the bladder

Surgical repair procedures

•Pyeloplasty- repair of the renal pelvis
•Cystoplasty- repair of the bladder
•Urethroplasty- repair of the urethra

A urostomy is the creation of an artificial opening in the

abdomen through which urine exits the body.
Other Surgical Procedures

Nephrolysis
•Removal of an adhesion in the kidney

Nephrolithotomy
•Removal of a kidney stone

Nephropexy
•Surgical fixation of the kidney

Nephrorrhaphy
•Suturing of a damaged kidney
Medications used for urinary conditions assist to:
•Relieve Pain (analgesic)

•Relieve Spasms (antispasmodic)

•Inhibit the growth of
microorganisms (antibiotic)

•Increase urine output

(diuretic)

•Decrease urine output

(antidiuretic)
 SYSTEMS PATHOLOGY
Acute Renal Failure

What is kidney failure?

Kidney failure (also called renal failure) means one or both kidneys can no longer
function well on their own. Sometimes, kidney failure is temporary and comes on
quickly. Other times, it is a chronic condition that can get worse slowly over a long
time.

Kidney failure may sound serious, and it is. But treatments such as dialysis and kidney
transplant help many people with limited kidney function continue to live fulfilling
lives.
What do the kidneys do?
The kidneys have several jobs. One of the most important is helping your body
eliminate toxins. Most people have two working kidneys, but people can live well as
long as at least one is working correctly.
When the kidneys don’t work effectively, waste products build up in your body. If
this happens, you might feel sick. In the most serious situations, kidney failure can
be life-threatening. However, many people can manage kidney failure with the right
treatment.
What causes kidney failure?
The most common causes of kidney failure are diabetes and high blood pressure. Sometimes, though,
kidney failure happens quickly due to an unforeseen cause.
When the kidneys lose function suddenly (within hours or days), it’s called acute kidney failure (or
acute kidney injury). This type of kidney failure is often temporary. Common causes of acute kidney
failure can include:
•Autoimmune kidney diseases
•Certain medications
•Severe dehydration
•A urinary tract obstruction
•Uncontrolled systemic disease like heart or liver disease
Kidney failure usually doesn’t happen overnight. Chronic kidney disease refers to a group of health
conditions that affect how well your kidneys function over time. If left untreated, chronic kidney
disease can lead to kidney failure.
The biggest causes of kidney failure from chronic kidney disease are:
•Diabetes: Unmanaged diabetes can lead to uncontrolled blood sugar levels. Consistently high blood
sugar can damage the body’s organs, including the kidneys.
•High blood pressure: High blood pressure (hypertension) means blood travels through your body’s
blood vessels with increased force. Over time, untreated high blood pressure levels can damage the
kidneys’ tissue.
Other causes of chronic kidney disease include:
•Polycystic kidney disease, a hereditary condition where cysts (fluid-filled sacs) grow inside your
kidneys.
•Glomerular diseases, such as glomerulonephritis, which affect how well the kidneys can filter waste.
•Lupus and other autoimmune diseases that can affect multiple body systems.
What are the symptoms of kidney failure?
In early stages of kidney disease, many people experience few or no
symptoms. It’s important to note that chronic kidney disease can still
cause damage even though you feel fine.
Chronic kidney disease and kidney failure can cause different
symptoms for different people. If your kidneys aren’t working
properly, you may notice one or more of the following signs:
•Fatigue (extreme tiredness)
•An upset stomach or vomiting
•Confusion or trouble concentrating
•Swelling, especially around your hands or ankles
•More frequent bathroom trips
•Muscle spasms (muscle cramps)
•Dry or itchy skin
•Poor appetite or metallic taste of food
How is kidney failure treated?
Kidney failure treatment is determined by the cause and extent of the problem. Treating your chronic medical
condition can delay the progression of kidney disease. If your kidneys start losing their function gradually, your
doctor may use one or more methods to track your health. By watching you closely, your doctor can help you
maintain your kidneys’ function as long as possible.
Your doctor may gauge your kidney function with:
•Routine blood tests
•Blood pressure checks
•Medication
Because the kidneys serve such an important purpose, people in kidney failure need treatment to keep them
alive. The main treatments for kidney failure are:
•Dialysis: This treatment helps the body filter the blood (doing the job that the kidneys can no longer perform).
• In hemodialysis, a machine regularly cleans your blood for you. People often receive this kidney
failure treatment at a hospital or dialysis clinic, 3 or 4 days each week.
• Peritoneal dialysis cleans the blood in a slightly different way using a dialysis solution and a
catheter. Sometimes, people can do their treatment at home.
•Kidney transplant: In kidney transplant surgery, doctors place a healthy kidney in your body to take over the
job of your damaged organs. This healthy kidney, called a donor organ, may come from a deceased donor or a
living donor, who may be a friend or family member. People can live well with one healthy kidney.