URINARY SYSTEM

When foods containing proteins are used by cells in the body, waste products (urea creatinine and uric acid) are released into the bloodstream. Kidneys filter nitrogenous wastes when blood passes through the kidney and forms urine (composed of water, salts and acids). Urine leaves the body through the ureters, urinary bladder and urethra.

Functions of Kidney

Remove urea and nitrogenous wastes from the blood Maintains proper balance of water, electrolytes and acids in body fluids Secretes renin which raises the blood pressure to keep the blood moving through the kidney Erythropoietin is secreted by the kidney, which is a hormone that stimulates the red blood cell production in the bone marrow. Secretes active form of Vitamin D, necessary for the absorption of calcium from the intestine Degrade and eliminate hormones such as insulin and parathyroid hormone from the bloodstream.

ANATOMY OF THE URINARY SYSTEM

Kidneys are two bean shaped organs behind the abdominal cavity (retroperitoneal) on either side of the spine in the lumbar region. A cushion of adipose tissue and fibrous connective tissue surrounds each kidney for protection. Each kidney about the size of a fist weighs about 4 to 6 ounces. The kidneys consist of an outer cortex region and an inner medulla region. The hilum is a depression of the medial border of the kidney. Blood vessels and nerves pass through the hilum. The ureters are two muscular tubes (16 to 18 inches long) lined with mucous membrane. Ureters carry urine in peristaltic waves from the kidneys to the urinary bladder. The urinary bladder, a hollow, muscular sac, is a temporary reservoir for urine. The trigone is a triangular region at the base of the bladder where the ureters enter and the urethra exits. The urethra is a tube that carries urine from the urinary bladder to the outside of the body. The process of expelling urine through the urethra is called urination or voiding. The external opening of the urethra is the urinary meatus.

ANATOMY OF NEPHRON:

PHYSIOLOGY OF URINE FORMATION The final process in the formation of the urine is secretion of some substances from the blood stream into the renal tubule. These waste products of metabolism become toxic if allowed to accumulate in the body. Thus acids, drugs and potassium (as a salt) leave the body in urine. Each renal tubule now containing urine (95% water and 5% urea, creatinine, salts, acids, and drugs), ends in a large collecting tubule. The combination of glomerulus and a renal tubule forms a unit called a nephron. Each kidney contains about 1 million nephrons. All collecting tubules lead to the renal pelvis, a basin like area in the central part of the kidney. Small cup like regions of the renal pelvis are called calyces or calices (singular calyx or calix) The renal pelvis narrows into the ureter which carries the urine to the urinary bladder. The bladder, a muscular sac, temporarily stores the urine. Sphincter muscles control the exit area of the bladder to the urethra.

As the bladder fills and pressure increases at the base of the bladder, a individual notices a need to urinate and voluntarily relaxes sphincter muscles.

PATHOLOGY : KIDNEY CONDITION Glomerulonephritis Interstitial nephritis Nephrolithiasis Nephrotic syndrome (nephrosis) Polycystic kidney disease (PKD) Polynephritis Renal cell carcinoma (hydronephroma) Renal failure DESCRIPTION Inflammation of the glomeruli within the kidney Inflammation of the connective tissue that lies between the renal tubules Kidney stones (renal calculi) Group of clinical signs and symptoms caused by excessive protein loss in urine Multiple fluid filled sacs (cysts) within and on the kidney Inflammation of the lining of the renal pelvis and renal parenchyma Cancerous tumor of the kidney in adulthood Kidney decreases excretion of wastes as a result of impaired filtration function

PATHOLOGY: KIDNEY, URINARY BLADDER, & ASSOCIATED CONDITIONS CONDITION Renal hypertension Wilms tumor URINARY BLADDER Bladder cancer ASSOCIATED CONDITIONS Diabetes insipidus Diabetes mellitus DESCRIPTION High blood pressure resulting from kidney disease Malignant tumor of the kidney occuring in childhood Malignant tumor of the urinary bladder

Antidiuretic hormone is not secreted adequately, or the kidney is resistant to its effect Insulin is not secreted adequately or not used properly in the body

LABORATORY TESTS AND CLINICAL PROCEDURES TESTS OR PROCEDURES Blood urea nitrogen (BUN) Creatinine clearance X-RAY STUDIES CT scan Kidneys, ureters and bladder (KUB) Renal angiography Retrograde pyelogram (RP) DESCRIPTION Measurement of urea levels in blood. Measurement of the rate at which creatinine is cleared from the blood by the kidney X-ray images show multiple cross sectional and other views of organs and tissues X-ray examination of the kidney, ureter and bladder X-ray examination of the blood vessels of the kidney X-ray imaging of the renal pelvis and ureters after injection of contrast

Voiding cystourethrogram (VCUG) Ultrasonography Radioisotope scan Magnetic Resonance Imaging (MRI) Cystoscopy Lithotripsy Renal angioplasty Renal biopsy Renal transplantation Urinary catheterization

through a urinary catheter into the ureters from the bladder X-ray record (with contrast) of the urinary bladder and urethra obtained while the patient is voiding Imaging of urinary tract structures using high-frequency sound waves. Image of the kidney after injecting a radioactive substance (radioisotope) into the blood stream Changing magnetic field procedures images of the kidney and surrounding structures in three planes of the body Direct visualization of the urethra and urinary bladder with an endoscope (cystoscope) Urinary tract stones are crushed Dilation of narrowed areas in renal arteries Removal of kidney tissue for microscopic examination Surgical transfer of a kidney from a donor to a recipient Passage of a flexible, tubular instrument through the urethra into the urinary bladder

EXERCISE I MATCH THE FOLLOWING STRUCTURES WITH THE CORRECT DESCRIPTION COLUMN I 1. Voiding 2. Trigone 3. Renal cortex 4. Renal medulla 5. Urea 6. Erythropoietin 7. Renin 8. Electrolyte 9. Hilum 10. Calyx COLUMN II Hormone secreted by the kidney that stimulates formation of red blood cells Notch on the surface of the kidney where blood vessels and nerves enter Urination or micturition Nitrogenous waste Cup-like collecting region of the renal pelvis Small molecule that carries an electric charge in solution Inner region of the kidney Hormone made by the kidney, increases blood pressure Triangular area in the bladder Outer section of the kidney

II MATCH THE FOLLOWING PROCEDURES WITH THE CORRECT DESCRIPTION DESCRITPION 1. Excision of a kidney 2. Surgical incision into the kidney to remove a stone 3. Visual examination of the urinary bladder via endoscope 4. Crushing of stones 5. New opening of the ureters to a segment of ileum (in place of the bladder) 6. Surgical repair of the urethra 7. Creation of an artificial opening into the kidney (via catheter) from the outside of the body MEANING Cystectomy Cystoscopy Cystostomy Lithitripsy Nephrectomy Nephrolithotomy Nephrostomy

8. Surgical formation of an opening from the bladder to the outside of the body 9. Removal of urinary bladder 10. Incision of a ureter to remove a stone

Ureterolithotomy Urethroplasty Ureteroileostomy (ileal conduit)