Exercise 26 Functional Anatomy of The Urinary System

1. Exercise 26 Functional Anatomy of The Urinary System

2. Gross Anatomy of the Human Urinary System Renal capsule a tough fibrous layer surrounding the kidney and covered in a thick layer of adipose tissue. It provides some protection from trauma and damage.

3. Organs of the Urinary System • Kidneys • Hilium • Ureters • Urinary bladder • Urethra • Renal Artery Figure 15.1a

5. Internal Anatomy of the Kidney Renal cortex —outer region; contains most of nephron structure Renal medulla —inside the cortex; contains inner collecting ducts Renal pelvis – basin continuous with ureter Renal columns —extensions of cortex-like material inward that separate the pyramids Calyces —cup-shaped structures, extensions of pelvis that funnel urine Renal or fibrous capsule -- a tough fibrous layer surrounding the kidney

6. Internal Anatomy of the Kidney

7. Functional Microscopic Anatomy of the Kidney m k l n o b a c Interlobular vein h e d f Interlobular artery g i j

8. n c a g e b h f d k

9. Glomerulus= site of filtrate formation Red arrows = Blood Blue arrows = Filtrate Glomerulus = a tiny ball-shaped structure composed of capillary blood vessels actively involved in the filtration of the blood to form urine . Bowman’s Capsule =Fluids from blood in the glomerulus are collected in the Bowman's capsule (i.e., glomerular filtrate) and further processed along the nephron to form urine.

10. Proximal convoluted tubule= primary site of tubular reabsorption Glucose, Amino Acids, Na+, and Water are being reabsorbed by the Proximal Convoluted Tubule

11. Collecting Ducts- collects the urine from the nephron and send it to the renal pelvis. nephrons Collecting Ducts- renal pelvis

12. Peritubular capillaries – receives substances from the tubular cells

13. Bowman’s Capsule: the inner membrane forms part of the filtration mechanism • There are two layers of cells that fluid (with its contents) has to pass through during filtration. The second layer is the visceral layer of the Bowman’s capsule, formed by podocytes The first layer is the endothelium of the glomerular capillary.

14. The renal corpuscle is where plasma is filtered from capillaries into the renal tubules. At the center of renal corpuscle is the glomerulus, a meshwork of capillaries. The glomerulus is surrounded by Bowman's capsule

15. Glomerulus and Bowman’s Capsule Visceral layer Parietal layer Podocytes make up the visceral layer of Bowman’s Capsule

16. Glomerulus is a high-pressure capillary bed The afferent arteriole feeding the glomerulus is larger than the efferent arteriole which drains the glomerulus The high pressure forces out fluid and blood components smaller than proteins from the glomerulus into the glomerular capsule

17. Proximal Convoluted Tubule The cuboidal cells of the proximal convoluted tubule have long microvilli (brush border) on their inside surface that dramatically increase the surface area for reabsorption from the filtrate. Filtrate What is the purpose of this brush border epithelium? Close up of brush border (microvilli)

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19. Glomerular capsule Proximal convoluted tubule Loop of Henle Distal convoluted tubule Collecting duct Nephron in Cortex Renal Cortex = nephron Medullary pyramid = collecting ducts Calyces Renal pelvis Ureter (Ureter) Bladder Urethra

20. Urinalysis: Characteristics of Urine • In 24 hours, about 1.0 to 1.8 liters of urine are produced • Nitrogenous wastes normally found in urine: • Urea, uric acid, creatine URIC ACID CREATINE UREA

21. Gout Uric acid is derived from the breakdown of DNA and RNA. This is taking place continuously in the body as large numbers of cells are produced and replaced, particularly from the blood. Purines are one type of nitrogenous base found in nucleic acids. In DNA and RNA, which are both nucleic acids, the major purines are guanine and adenine. Purines are found in many foods, including meat, shellfish, and sweetbreads Birds excrete most of their nitrogen in the form of uricacid, an oxidized purine.

22. Substances absent from filtrate and urine • Blood proteins • Red blood cells • Hemoglobin • White blood cells (pus) • RBCs • White blood cells (pus) • Hemoglobin Albumin

23. Substances present in filtrate but not in urine product • Urine is what remains after the filtrate has lost most of its water, nutrients, and necessary ions Glucose & Amino Acids Glucose Amino acid “Alanine”

24. Purpose:Routine urinalyses are performed for several reasons: • A urinalysis demonstrates kidney function • which maintains: • Electrolyte balance • Acid-base balance • Fluid balance of the blood A routine urinalysis usually includes the following tests: color, transparency, specific gravity, pH, protein, glucose, ketones, blood, bilirubin, nitrite, urobilinogen, and leukocyte esterase. Some laboratories include a microscopic examination of urinary sediment with all routine urinalysis tests ■general health screening to detect renal and metabolic diseases ■diagnosis of diseases or disorders of the kidneys or urinary tract ■monitoring of patients with diabetes

25. Yellow Urine Urobilin (urochrome was the original name given to the pigment thought to give urine its color. It is now known that several related pigments are responsible, so the original name has been dropped.) resulting from the breakdown of heme.

26. Urine specific gravity Urine specific gravity is a laboratory test that measures the concentration of all chemical particles in the urine. The apparent specific gravity is simply the ratio of the weights of equal volumes of sample and water in air. Urine would have a higher specific gravity than water because it weighs more than water Normal specific gravity range in urine The normal range of specific gravity in human urine is from 1.003 to 1.030. Values outside this range may be the result of specimen dilution, adulteration or may be indicative of a number of health related problems.

27. Abnormal Specific Gravity Results A very high specific gravity means very concentrated urine, which may be caused by not drinking enough fluid, loss of too much fluid (excessive vomiting, sweating, or diarrhea), or substances (such as sugar or protein) in the urine. Very low specific gravity means dilute urine, which may be caused by drinking too much fluid, severe kidney disease, or the use of diuretics.

28. Color/Specific Gravity/Volume The greater the solute concentration, the the higher the specific gravity, deeper the yellow, the smaller the volume

29. Ideal urine Why Pee is Cool 'Normal' urine ranges from clear to deep amber. Urine gets it's color from the pigment urochrome. The more fluids you consume, the more diluted your urine becomes causing it to appear light in color.

30. Dark Urine Darker yellow urine usually signifies dehydration. The urochrome is much more concentrated because of the lack of fluids. Generally, increasing your fluid intake can improve this.

31. Neon yellow urine Neon yellow urine can certainly catch you off guard but this is typically caused by nothing more than your daily multivitamin. Vitamin B in particular has the ability to cause the fluorescent shading.

32. Orange urine Believe or not, consuming large amounts of carrots or squash can actually turn your urine orange. It's the carotene that is responsible for the strange hue. Orange urine can also be caused by certain medications including some blood thinners and laxatives.

33. Blue/green urine Asparagus and certain medications can actually cause a slight green coloring in the urine. Also, a rare disorder called familial hypercalcemia can cause bluish urine.

34. Red urine There are several causes of red urine. Some aren't serious at all like the consumption of beets, rhubarb and certain medications. While others can be life threatening like lead or mercury poisoning. One of the most common reasons for red urine is the presence of blood. Blood in the urine can be caused by strenuous exercise, a urinary tract infection or something more serious like bladder cancer which is why it is essential to see your doctor if you detect it.

35. Dark brown urine Dark brown or tea-colored urine is sometimes mistaken for bloody urine.  Dark brown urine can be a symptom of very serious liver disorders including cirrhosis and hepatitis.  It is imperative you get to an emergency room if your urine is tea-colored for proper testing.  Other causes include eating excessive amount of fava beans and certain medications.

36. Urinary Tract Infections Urinary tract infection occurs as a result of the infestation of a certain bacteria called E. coli. E. coli or Escherichia coli is a resident flora of the intestines, but once it gets in contact with the urinary tract, it can pose the threat of developing UTI. Urinary tract infection can give rise to different signs and symptoms but the most discomforting of all these is the pain and burning sensation that one may feel during urination. Bladder fullness and increased urinary frequency may also occur as a result. Unlike the normal appearance of the urine, a person with UTI may notice a cloudy and foul smelling urine output. Once your doctor diagnoses UTI, he or she will prescribe you with antibiotics as well as urinary analgesics to lessen the pain. A high urine pH may be due to: (Alkaline) •Gastric suction •Kidney failure •Kidney tubular acidosis •Urinary tract infection •Vomiting A Vegetarian Diet can result in increased alkalinity of urine

37. Starvation and Urine pH A low urine pH may be due to: (ACID) •Diabetic ketoacidosis •Diarrhea •Starvation Normal Range is 4.5-8.0. Average is 6.0 • Ketones are chemicals in the liver as a consequence of the breakdown of fat. • When the body can't use it's glucose for energy the body burns fat for energy instead. Ketones then accumulate in the blood. • If the body produces too many ketones the blood becomes acidic, this is called 'KETOACIDOSIS' and can be life threatening! High Protein diet can cause urine to become acidic

38. Albuminuria Albumin is a protein. Albuminuria (Al-byoo-mih-noo-ree-uh) is having too much protein in the urine. Albuminuria can be a first sign of diabetic kidney disease. Other causes of albuminuria are high blood pressure, congestive heart failure, the metabolic syndrome, or kidney damage from nephrotic syndrome. Albuminuria occurs in about 10% of pregnant women. Apart from the measurement of blood pressure, dipstick analysis of urine for protein is the most commonly performed antenatal screening test. The presence of proteinuria is seen as a possible indication of many complications in pregnancy, from urinary tract infection to chronic renal disease and it remains central to the diagnosis of pre-eclampsia in a hypertensive pregnancy.

39. Glycosuria Glycosuria (gly-koh-SOOR-ee-ah) is the presence of glucose in the urine. Ordinarily, urine contains no glucose because the kidneys are able to reclaim all of the filtered glucose back into the bloodstream. Glycosuria is nearly always caused by elevated blood glucose levels, most commonly due to untreated diabetes mellitus. But could also be due to eating massive quantities of candy. Rarely, glycosuria is due to an intrinsic problem with glucose reabsorption within the kidneys themselves. Glycosuria leads to excessive water loss into the urine with resultant dehydration.

40. Hematuria Hematuria is the presence of red blood cells in the urine. It may be idiopathic and/or benign, or it can be a sign that there is a kidney stone or a tumor in the urinary tract (kidneys, ureters, urinary bladder, prostate-(In males only), and urethra), ranging from trivial to lethal. If white blood cells are found in addition to red blood cells, then it is a signal of urinary tract infection. If there are enough red cells, the urine can become bright red, pink or cola colored. Often, however, the urine appears completely normal because there is not enough blood to cause a color change. In this case, the condition is called "microscopic" hematuria.

41. Hemoglobinuria Hemoglobinuria: The presence of free hemoglobin in the urine, which may make the urine look dark. Normally, there is no hemoglobin in the urine. Hemoglobinuria is a sign of a number of abnormal conditions, such as bleeding and paroxysmal nocturnal hemoglobinuria.

42. Ketonuria Ketonuria is a medical condition in which ketone bodies are present in the urine. It is seen in conditions in which the body produces excess ketones as an alternative source of energy. It is seen during starvation or more commonly in type I diabetes mellitus. Production of ketone bodies is a normal response to a shortage of glucose, meant to provide an alternate source of fuel from fatty acids. To test a cow for ketosis with a ketone strip you can make her urinate by rubbing her gently right beneath the vulva.

43. Pyuria Pyuria is the presence of pus (leukocytes or white blood cells) in the urine. It is a laboratory finding in many diseases, most commonly infection in the urinary system. E. Coli in urine

44. Kidney Stones, AKA Renal Calculi

45. Kidney Stones, AKA Renal Calculi Struvite stones are mostly found in women who have a urinary tract infection. These stones can grow very large and can block the kidney, ureter, or bladder. If urine becomes excessively concentrated and solutes begin to precipitate. The biggest risk factor for kidney stones is not drinking enough fluids. Kidney stones are more likely to occur if you make less than 1 liter of urine a day. That's slightly more than a quart. Uric acid stones are more common in men than in women. They can occur with gout or chemotherapy

46. Cloudy Urine ? Due to bacteria growing in urine that break down urea to form ammonia

47. Crystals in Urine Specimen Hypercalciuria, or excessive urinary calcium excretion, occurs in about 5-10% of the populationand is the most common identifiable cause of calcium kidney stone disease.