1. The Urinary System

2. Kidneys, ureters, urinary bladder & urethra Urine flows from each kidney, down its ureter to the bladder and to the outside via the urethra Filter the blood and return most of water and solutes to the bloodstream 10/21/20152

3. Organs of the Urinary System kidneys ureters urinary bladder urethra

4. کلیه ها عضو پشت صفاقی ،ازمهره دوازدهم پشتی تاسومین مهره کمری واقع شده اند. شریان کلیوی از آئورت شکمی وورید کلیوی نیز به ورید اجوف تحتانی می ریزد. اعصاب مثانه :سمپاتیک وپاراسمپاتیک(دفع ادرار) دقیق ترین راه اندازه گیری فیلتراسیون گلومرولی کلیرانس کراتینین توسط ادرار 24ساعته است. 10/21/20154

5. Urinary system Organ system that produces, stores, and carries urinergan systemurine Includes two kidneys, two ureters, the urinary bladder, two sphincter muscles, and the urethra.kidneysuretersurinary bladderurethra Humans produce about 1.5 liters of urine over 24 hours, although this amount may vary according to the circumstances.liters Increased fluid intake generally increases urine production. Increased perspiration and respiration may decrease the amount of fluid excreted through the kidneys.perspirationrespiration Some medications interfere directly or indirectly with urine production, such as diuretics.medicationsdiuretics 10/21/20155

6. Function 1.Remove nitrogenous wastes 2.Maintain electrolyte, acid-base, and fluid balance of blood 3.Homeostatic organ 4.Acts as blood filter 5.Release hormones: calcitriol & erythropoietin

7. Kidneys as Filters Diuretic- loose water; coffee, alcohol Antidiuretic- retain water; ADH Aldosterone- sodium & water reabsorption, and K + excretion GFR= 180 liters of blood/day 178-179 liters are reabsorbed back into blood Excrete a protein free filtrate

9. Maintaining Chemical Homeostasis The Urinary System

11. urine blood filtration tubular reabsorption and secretion General Functioning of the Kidney “refreshed” blood

12. renal capsule renal cortex renal medulla renal pelvis renal pyramids ureter Kidney Anatomy

13. renal artery renal vein nephron

14. urine blood filtration tubular reabsorption and secretion Nephron Functioning “refreshed” blood

15. vein artery afferent arteriole efferent arteriole glomerulus peritubular capillaries Bowman’s capsule proximal convoluted tubule distal convoluted tubule loop of Henle collecting duct

16. renal cortex renal medulla Each kidney contains over 1 million nephrons and thousands of collecting ducts Collecting duct Loop of Henle PCT DCT Glomerulus

17. Glomerular Filtration afferent arteriole glomerulus efferent arteriole Bowman’s capsule Filters blood; proteins can’t pass through

18. Composition of Glomerular Filtrate WaterWater Small Soluble Organic MoleculesSmall Soluble Organic Molecules Mineral IonsMineral Ions

19. Proximal Convoluted Tubule Reabsorbs: water, glucose, amino acids, and sodium. 65% of Na + is reabsorbed 65% of H 2 O is reabsorbed 90% of filtered bicarbonate (HCO 3 - ) 50% of Cl - and K +

20. Loop of Henle Creates a gradient of increasing sodium ion concentration towards the end of the loop within the interstitial fluid of the renal pyramid. 25% Na+ is reabsorbed in the loop 15% water is reabsorbed in the loop 40% K is reabsorbed in the loop

21. Distal Convoluted Tubule Under the influence of the hormone aldosterone, reabsorbs sodium and secretes potassium. Also regulates pH by secreting hydrogen ion when pH of the plasma is low. only 10% of the filtered NaCl and 20% of water remains

22. Collecting Duct Allows for the osmotic reabsorption of water. ADH (antidiuretic hormone)- makes collecting ducts more permeable to water-- produce concentrated urine

23. From the original 1800 g NaCl, only 10 g appears in the urine Urine Water- 95% Nitrogenous waste: urea uric acid creatinine Ions: sodium potassium sulfate phosphate

24. Hormonal Control of Kidney Function

25. low blood volume high plasma solute concentration hypothalamus heart receptors

26. Hormonal Control of Kidney Function hypothalamus posterior pituitary antidiuretic hormone collecting ducts

27. Hormonal Control of Kidney Function

28. reduced blood pressure and glomerular filtrate juxtaglomerular apparatus renin

29. Hormonal Control of Kidney Function reninangiotensinogen angiotensin I angiotensin II

30. Hormonal Control of Kidney Function adrenal cortex aldosterone angiotensin II convoluted tubules

31. Urinary Bladder ureters internal sphincters external sphincters urethra

32. Bladder 1.Mucosa (transitional epithelium) 2.Muscular layer (detrusor muscle): 3 layers of smooth muscle 3.Fibrous adventia

33. Internal urethral sphincter: Smooth muscle Involuntary control More superiorly located External Urethral sphincter: Skeletal muscle Voluntary control Posteriorly located Sphincter Muscles on Bladder

34. When bladder fills with 200 ml of urine, stretch receptors transmit impulses to the CNS and produce a reflex contraction of the bladder (PNS) Diuresis (Micturition) When is incontinence normal?

35. Distension of the Urinary Bladder

36. Why do doctors ask for a urine sample? Urinalysis characteristics: smell- ammonia-like pH- 4.5-8, ave 6.0 specific gravity– more than 1.0; ~1.001- 1.003 color- affected by what we eat: salty foods, vitamins

37. odor- normal is ammonia-like diabetes mellitus- smells fruity or acetone like due to elevated ketone levels diabetes insupidus- yucky asparagus--- Odor

38. pH- range 4.5-8 ave 6.0 vegetarian diet- urine is alkaline protein rich and wheat diet- urine is acidic

39. Color- pigment is urochrome Yellow color due to metabolic breakdown of hemoglobin (by bile or bile pigments) Beets or rhubarb- might give a urine pink or smoky color Vitamins- vitamin C- bright yellow Infection- cloudy Color

40. Water: s.g. = 1g/liter; Urine: s.g. ~ 1.001 to 1.030 Pyelonephritus- urine has high s.g.; form kidney stones Diabetes insipidus- urine has low s.g.; drinks excessive water; injury or tumor in pituitary Specific Gravity

41. Glucose- when present in urine condition called glycosuria (nonpathological) [glucose not normally found in urine] Indicative of: Excessive carbohydrate intake Stress Diabetes mellitus Abnormal Constitutes of Urine

42. Albumin-abnormal in urine; it’s a very large molecule, too large to pass through glomerular membrane > abnormal increase in permeability of membrane Albuminuria- nonpathological conditions- excessive exertion, pregnancy, overabundant protein intake-- leads to physiologic albuminuria Pathological condition- kidney trauma due to blows, heavy metals, bacterial toxin Abnormal Constitutes of Urine

43. Ketone bodies- normal in urine but in small amts Ketonuria- find during starvation, using fat stores Ketonuria is couples w/a finding of glycosuria-- which is usually diagnosed as diabetes mellitus RBC-hematuria Hemoglobin- Hemoglobinuria- due to fragmentation or hemolysis of RBC; conditions: hemolytic anemia, transfusion reaction, burns or renal disease Abnormal Constitutes of Urine

44. Bile pigments- Bilirubinuria (bile pigment in urine)- liver pathology such as hepatitis or cirrhosis WBC- Pyuria- urinary tract infection; indicates inflammation of urinary tract Casts- hardened cell fragments, cylindrical, flushed out of urinary tract WBC casts- pyelonephritus RBC casts- glomerulonephritus Fatty casts- renal damage Abnormal Constitutes of Urine

45. Uc: اگر کمتر از 1000 کولونی = طبیعی کمتراز 10000 کولونی = مشکوک بالای 100000 کولونی = عفونی کلیرانس : غلظت ماده A درادرار ضربدر حجم ادراردرزمان معین تقسیم بر غلظت ماده A درپلاسما Residual urine KUB IVP عدم مصرف مایعات ،تخلیه روده با روغن کرچک پیلوگرافی رتروگراد CTS سیستویورتروگرافی آنژیوگرافی کلیه اولتراسونوگرافی بررسی رادیو ایزوتوپ بیوپسی کلیه سیستوسکوپی نفروسکوپی 10/21/201545

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