Urinary system | |
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Details | |
Identifiers | |
Latin | systema urinarium |
MeSH | D014551 |
TA98 | A08.0.00.000 |
TA2 | 3357 |
FMA | 7159 |
Anatomical terminology |
The human urinary system, also known as the urinary tract or renal system, consists of the kidneys, ureters, bladder, and the urethra. The purpose of the urinary system is to eliminate waste from the body, regulate blood volume and blood pressure, control levels of electrolytes and metabolites, and regulate blood pH. The urinary tract is the body's drainage system for the eventual removal of urine. [1] The kidneys have an extensive blood supply via the renal arteries which leave the kidneys via the renal vein. Each kidney consists of functional units called nephrons. Following filtration of blood and further processing, wastes (in the form of urine) exit the kidney via the ureters, tubes made of smooth muscle fibres that propel urine towards the urinary bladder, where it is stored and subsequently expelled through the urethra during urination. The female and male urinary system are very similar, differing only in the length of the urethra. [2]
800–2,000 milliliters (mL) of urine are normally produced every day in a healthy human. This amount varies according to fluid intake and kidney function.
This section's factual accuracy is disputed .(March 2024) |
The urinary system refers to the structures that produce and transport urine to the point of excretion. In the human urinary system there are two kidneys that are located between the dorsal body wall and parietal peritoneum on both the left and right sides.
The formation of urine begins within the functional unit of the kidney, the nephrons. Urine then flows through the nephrons, through a system of converging tubules called collecting ducts. These collecting ducts then join together to form the minor calyces, followed by the major calyces that ultimately join the renal pelvis. From here, urine continues its flow from the renal pelvis into the ureter, transporting urine into the urinary bladder. The anatomy of the human urinary system differs between males and females at the level of the urinary bladder. In males, the urethra begins at the internal urethral orifice in the trigone of the bladder, continues through the external urethral orifice, and then becomes the prostatic, membranous, bulbar, and penile urethra. Urine exits the male urethra through the urinary meatus in the glans penis. The female urethra is much shorter, beginning at the bladder neck and terminating in the vulval vestibule.
Under microscopy, the urinary system is covered in a unique lining called urothelium, a type of transitional epithelium. Unlike the epithelial lining of most organs, transitional epithelium can flatten and distend. Urothelium covers most of the urinary system, including the renal pelvis, ureters, and bladder.
The main functions of the urinary system and its components are to:
Average urine production in adult humans is about 1–2 litres (L) per day, depending on state of hydration, activity level, environmental factors, weight, and the individual's health. Producing too much or too little urine requires medical attention. Polyuria is a condition of excessive urine production (> 2.5 L/day). Conditions involving low output of urine are oliguria (< 400 mL/day) and anuria (< 100 mL/day).
The first step in urine formation is the filtration of blood in the kidneys. In a healthy human, the kidney receives between 12 and 30% of cardiac output, but it averages about 20% or about 1.25 L/min.
The basic structural and functional unit of the kidney is the nephron. Its chief function is to regulate the concentration of water and soluble substances like sodium by filtering the blood, reabsorbing what is needed and excreting the rest as urine.
In the first part of the nephron, Bowman's capsule filters blood from the circulatory system into the tubules. Hydrostatic and osmotic pressure gradients facilitate filtration across a semipermeable membrane. The filtrate includes water, small molecules, and ions that easily pass through the filtration membrane. However, larger molecules such as proteins and blood cells are prevented from passing through the filtration membrane. The amount of filtrate produced every minute is called the glomerular filtration rate or GFR and amounts to 180 litres per day. About 99% of this filtrate is reabsorbed as it passes through the nephron and the remaining 1% becomes urine.
The urinary system is regulated by the endocrine system by hormones such as antidiuretic hormone, aldosterone, and parathyroid hormone. [3]
The urinary system is under influence of the circulatory system, nervous system, and endocrine system.
Aldosterone plays a central role in regulating blood pressure through its effects on the kidney. It acts on the distal tubules and collecting ducts of the nephron and increases reabsorption of sodium from the glomerular filtrate. Reabsorption of sodium results in retention of water, which increases blood pressure and blood volume. Antidiuretic hormone (ADH), is a neurohypophysial hormone found in most mammals. Its two primary functions are to retain water in the body and vasoconstriction. Vasopressin regulates the body's retention of water by increasing water reabsorption in the collecting ducts of the kidney nephron. [4] Vasopressin increases water permeability of the kidney's collecting duct and distal convoluted tubule by inducing translocation of aquaporin-CD water channels in the kidney nephron collecting duct plasma membrane. [5]
Urination, also sometimes referred to as micturition, is the ejection of urine from the urinary bladder to the outside of the body. Urine is ejected through the urethra from the penis or vulva in placental mammals and through the cloaca in other vertebrates. In healthy humans (and many other animals), the process of urination is under voluntary control. In infants, some elderly individuals, and those with neurological injury, urination may occur as an involuntary reflex. Physiologically, micturition involves coordination between the central, autonomic, and somatic nervous systems. Brain centers that regulate urination include the pontine micturition center, periaqueductal gray, and the cerebral cortex.
Urologic disease can involve congenital or acquired dysfunction of the urinary system. As an example, urinary tract obstruction is a urologic disease that can cause urinary retention.
Diseases of the kidney tissue are normally treated by nephrologists, while diseases of the urinary tract are treated by urologists. Gynecologists may also treat female urinary incontinence.
Diseases of other bodily systems also have a direct effect on urogenital function. For instance, it has been shown that protein released by the kidneys in diabetes mellitus sensitizes the kidney to the damaging effects of hypertension. [6]
Diabetes also can have a direct effect in urination due to peripheral neuropathies, which occur in some individuals with poorly controlled blood sugar levels. [7]
Urinary incontinence can result from a weakening of the pelvic floor muscles caused by factors such as pregnancy, childbirth, aging, and being overweight. Findings recent systematic reviews demonstrate that behavioral therapy generally results in improved urinary incontinence outcomes, especially for stress and urge UI, than medications alone. [8] [9] Pelvic floor exercises known as Kegel exercises can help in this condition by strengthening the pelvic floor. There can also be underlying medical reasons for urinary incontinence which are often treatable. In children, the condition is called enuresis.
Some cancers also target the urinary system, including bladder cancer, kidney cancer, ureteral cancer, and urethral cancer. Due to the role and location of these organs, treatment is often complicated.[ citation needed ]
Kidney stones have been identified and recorded about as long as written historical records exist. [10] The urinary tract including the ureters, as well as their function to drain urine from the kidneys, has been described by Galen in the second century AD. [11]
The first to examine the ureter through an internal approach, called ureteroscopy, rather than surgery was Hampton Young in 1929. [10] This was improved on by VF Marshall who is the first published use of a flexible endoscope based on fiber optics, which occurred in 1964. [10] The insertion of a drainage tube into the renal pelvis, bypassing the ureters and urinary tract, called nephrostomy, was first described in 1941. Such an approach differed greatly from the open surgical approaches within the urinary system employed during the preceding two millennia. [10]
In humans, the kidneys are two reddish-brown bean-shaped blood-filtering organs that are a multilobar, multipapillary form of mammalian kidneys, usually without signs of external lobulation. They are located on the left and right in the retroperitoneal space, and in adult humans are about 12 centimetres in length. They receive blood from the paired renal arteries; blood exits into the paired renal veins. Each kidney is attached to a ureter, a tube that carries excreted urine to the bladder.
The bladder is a hollow organ in humans and other vertebrates that stores urine from the kidneys. In placental mammals, urine enters the bladder via the ureters and exits via the urethra during urination. In humans, the bladder is a distensible organ that sits on the pelvic floor. The typical adult human bladder will hold between 300 and 500 ml before the urge to empty occurs, but can hold considerably more.
Azotemia, also spelled azotaemia, is a medical condition characterized by abnormally high levels of nitrogen-containing compounds in the blood. It is largely related to insufficient or dysfunctional filtering of blood by the kidneys. It can lead to uremia and acute kidney injury if not controlled.
The excretory system is a passive biological system that removes excess, unnecessary materials from the body fluids of an organism, so as to help maintain internal chemical homeostasis and prevent damage to the body. The dual function of excretory systems is the elimination of the waste products of metabolism and to drain the body of used up and broken down components in a liquid and gaseous state. In humans and other amniotes, most of these substances leave the body as urine and to some degree exhalation, mammals also expel them through sweating.
The ureters are tubes composed of smooth muscle that transport urine from the kidneys to the urinary bladder. In an adult human, the ureters typically measure 20 to 30 centimeters in length and about 3 to 4 millimeters in diameter. They are lined with urothelial cells, a form of transitional epithelium, and feature an extra layer of smooth muscle in the lower third to aid in peristalsis. The ureters can be affected by a number of diseases, including urinary tract infections and kidney stone. Stenosis is when a ureter is narrowed, due to for example chronic inflammation. Congenital abnormalities that affect the ureters can include the development of two ureters on the same side or abnormally placed ureters. Additionally, reflux of urine from the bladder back up the ureters is a condition commonly seen in children.
The nephron is the minute or microscopic structural and functional unit of the kidney. It is composed of a renal corpuscle and a renal tubule. The renal corpuscle consists of a tuft of capillaries called a glomerulus and a cup-shaped structure called Bowman's capsule. The renal tubule extends from the capsule. The capsule and tubule are connected and are composed of epithelial cells with a lumen. A healthy adult has 1 to 1.5 million nephrons in each kidney. Blood is filtered as it passes through three layers: the endothelial cells of the capillary wall, its basement membrane, and between the podocyte foot processes of the lining of the capsule. The tubule has adjacent peritubular capillaries that run between the descending and ascending portions of the tubule. As the fluid from the capsule flows down into the tubule, it is processed by the epithelial cells lining the tubule: water is reabsorbed and substances are exchanged ; first with the interstitial fluid outside the tubules, and then into the plasma in the adjacent peritubular capillaries through the endothelial cells lining that capillary. This process regulates the volume of body fluid as well as levels of many body substances. At the end of the tubule, the remaining fluid—urine—exits: it is composed of water, metabolic waste, and toxins.
The collecting duct system of the kidney consists of a series of tubules and ducts that physically connect nephrons to a minor calyx or directly to the renal pelvis. The collecting duct participates in electrolyte and fluid balance through reabsorption and excretion, processes regulated by the hormones aldosterone and vasopressin.
Renal physiology is the study of the physiology of the kidney. This encompasses all functions of the kidney, including maintenance of acid-base balance; regulation of fluid balance; regulation of sodium, potassium, and other electrolytes; clearance of toxins; absorption of glucose, amino acids, and other small molecules; regulation of blood pressure; production of various hormones, such as erythropoietin; and activation of vitamin D.
Hematuria or haematuria is defined as the presence of blood or red blood cells in the urine. "Gross hematuria" occurs when urine appears red, brown, or tea-colored due to the presence of blood. Hematuria may also be subtle and only detectable with a microscope or laboratory test. Blood that enters and mixes with the urine can come from any location within the urinary system, including the kidney, ureter, urinary bladder, urethra, and in men, the prostate. Common causes of hematuria include urinary tract infection (UTI), kidney stones, viral illness, trauma, bladder cancer, and exercise. These causes are grouped into glomerular and non-glomerular causes, depending on the involvement of the glomerulus of the kidney. But not all red urine is hematuria. Other substances such as certain medications and foods can cause urine to appear red. Menstruation in women may also cause the appearance of hematuria and may result in a positive urine dipstick test for hematuria. A urine dipstick test may also give an incorrect positive result for hematuria if there are other substances in the urine such as myoglobin, a protein excreted into urine during rhabdomyolysis. A positive urine dipstick test should be confirmed with microscopy, where hematuria is defined by three or more red blood cells per high power field. When hematuria is detected, a thorough history and physical examination with appropriate further evaluation can help determine the underlying cause.
The renal medulla is the innermost part of the kidney. The renal medulla is split up into a number of sections, known as the renal pyramids. Blood enters into the kidney via the renal artery, which then splits up to form the segmental arteries which then branch to form interlobar arteries. The interlobar arteries each in turn branch into arcuate arteries, which in turn branch to form interlobular arteries, and these finally reach the glomeruli. At the glomerulus the blood reaches a highly disfavourable pressure gradient and a large exchange surface area, which forces the serum portion of the blood out of the vessel and into the renal tubules. Flow continues through the renal tubules, including the proximal tubule, the loop of Henle, through the distal tubule and finally leaves the kidney by means of the collecting duct, leading to the renal pelvis, the dilated portion of the ureter.
Hydronephrosis describes hydrostatic dilation of the renal pelvis and calyces as a result of obstruction to urine flow downstream. Alternatively, hydroureter describes the dilation of the ureter, and hydronephroureter describes the dilation of the entire upper urinary tract.
Kidney development, or nephrogenesis, describes the embryologic origins of the kidney, a major organ in the urinary system. This article covers a 3 part developmental process that is observed in most reptiles, birds and mammals, including humans. Nephrogenesis is often considered in the broader context of the development of the urinary and reproductive organs.
A ureteral stent, or ureteric stent, is a thin tube inserted into the ureter to prevent or treat obstruction of the urine flow from the kidney. The length of the stents used in adult patients varies between 24 and 30 cm. Additionally, stents come in differing diameters or gauges, to fit different size ureters. The stent is usually inserted with the aid of a cystoscope. One or both ends of the stent may be coiled to prevent it from moving out of place; this is called a JJ stent, double J stent or pig-tail stent.
Pyelogram is a form of imaging of the renal pelvis and ureter.
Urologic diseases or conditions include urinary tract infections, kidney stones, bladder control problems, and prostate problems, among others. Some urologic conditions do not affect a person for that long and some are lifetime conditions. Kidney diseases are normally investigated and treated by nephrologists, while the specialty of urology deals with problems in the other organs. Gynecologists may deal with problems of incontinence in women.
Bladder outlet obstruction occurs when urine is unable to flow from the kidneys through the ureters and out of the bladder through the urethra. Decreased flow of urine leads to swelling of the urinary tract, called hydronephrosis. This process of decreased flow of urine through the urinary tract can begin as early as during intrauterine life and it prevents normal development of fetal kidneys and fetal urine. Low levels of fetal urine leads to low amniotic fluid levels and incomplete lung maturation. Older children and adults can also experience bladder outlet obstruction; however, this process is usually reversible and isn't associated with as many poor outcomes as in infants with congenital bladder outlet obstruction.
Duplicated ureter or duplex collecting system is a congenital condition in which the ureteric bud, the embryological origin of the ureter, splits, resulting in two ureters draining a single kidney. It is the most common renal abnormality, occurring in approximately 1% of the population.
The rock dove, Columbia livia, has a number of special adaptations for regulating water uptake and loss.
The kidneys are a pair of organs of the excretory system in vertebrates, which maintain the balance of water and electrolytes in the body (osmoregulation), filter the blood, remove metabolic waste products, and, in many vertebrates, also produce hormones and maintain blood pressure. In healthy vertebrates, the kidneys maintain homeostasis of extracellular fluid in the body. When the blood is being filtered, the kidneys form urine, which consists of water and excess or unnecessary substances, the urine is then excreted from the body through other organs, which in vertebrates, depending on the species, may include the ureter, urinary bladder, cloaca, and urethra.
The mammalian kidneys are a pair of excretory organs of the urinary system of mammals, being functioning kidneys in postnatal-to-adult individuals. The kidneys in mammals are usually bean-shaped or externally lobulated. They are located behind the peritoneum (retroperitoneally) on the back (dorsal) wall of the body. The typical mammalian kidney consists of a renal capsule, a peripheral cortex, an internal medulla, one or more renal calyces, and a renal pelvis. Although the calyces or renal pelvis may be absent in some species. The medulla is made up of one or more renal pyramids, forming papillae with their innermost parts. Generally, urine produced by the cortex and medulla drains from the papillae into the calyces, and then into the renal pelvis, from which urine exits the kidney through the ureter. Nitrogen-containing waste products are excreted by the kidneys in mammals mainly in the form of urea.
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