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Urinary System Can Bring About the Course of Many Common Diseases

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Urinary System Can Bring About the Course of Many Common Diseases Urinary Histology N. Swailes, Ph.D. Department of Anatomy and Cell Biology Rm: B046A ML Tel: 5-7726 E-mail: [email protected] Required reading Mescher AL, Junqueira’s Basic Histology Text and Atlas, 12th Edition, Chapter 19: pp332-347 Ross MH and Pawlina W, Histology: A text and Atlas, 6th Edition, Chapter 20: pp698-723 Learning objectives 1) Describe the gross, visible organization of the kidney and relate this to its microanatomy. 2) Describe and identify histologically the path taken by blood and tubular fluid during urine formation in the kidneys. 3) Demonstrate the organization and briefly overview function of the juxtaglomerular apparatus. 4) Identify and discuss the functional significance of urinary epithelium. 5) Trace the flow of urine from renal papilla to external urethral meatus and comment on the histological properties of each region passed. 6) Think about how changes in the histological structure and function of the urinary system can bring about the course of many common diseases. Key terms cortex medullary ray medulla macula densa pyramid mesangial cells column ducts of Bellini nephron interlobar artery uriniferous tubule arcuate artery papilla intralobular artery major/minor calyx interlobular artery pelvis renin corpuscle urinary epithelium (transitional) glomerulus fenestrated capillaries Bowman’s capsule medullary ray proximal convoluted tubule juxtaglomerular cells distal convoluted tubule aldosterone collectung tubule/duct erythropoietin 1 | Page: Urinary Histology Swailes A1: Introduction & General Organization of the Urinary System During this lecture you will follow the entire length of the urinary system focusing in particular on the kidney and its tubular ultrastructure. You will discover some of the basic functions that the histological structure of the kidney is responsible for. The main function of the urinary system is to filter the blood and transport the resulting waste products, dissolved in water, to be temporarily stored and then excreted from the body. It also conserves salts, glucose, proteins and water to regulate blood pressure and influence the acid-base balance in the body. The regions of the organ system involved in these functions are: 1. Kidney and Nephron - filter the blood to remove waste products/toxins - conserve salts, glucose, proteins and water - help regulate blood pressure, hemodynamics and the acid-base balance of the body. 2. Ureters - transport urine created by the kidneys to the urinary bladder. 1 3. Bladder - a temporary storage organ for 2 urine. 4. Urethra - conveys urine from the bladder 3 out of the body during 4 micturition. 2 | Page: Urinary Histology Swailes A2: The Kidneys: An Overview The kidneys are glandular organs with both exocrine and endocrine properties. As a result they have two major functions: 1. Homeostasis: maintenance of a stable extracellular environment for normal cell function The kidneys play an important role in homeostasis. The byproduct of this function is the production of urine. The formation of urine is determined by three main processes that are controlled within specialized units of the kidney called nephrons. i. Filtration - blood plasma is selectively filtered at the glomerulus - the glomerular filtrate contains waste products of metabolism dissolved in water and enters the kidney tubules ii. Secretion - kidney tubules modify glomerular filtrate by secreting substances into it from surrounding capillaries. This helps maintain: + a. potassium balance in the body (by removing excess K from blood) + + b. acid-base balance (by removing H and NH4 from blood) iii. Reabsorption - kidney tubules reabsorb solutes and water. This helps maintain: a. extracellular fluid volume and blood pressure b. water conservation c. sodium balance in the body (by reabsorbing Na+ into the blood) 2. Secretion of hormones: regulate a range of processes around the body. i. Regulation of blood pressure - renin is produced in the kidneys - participates in regulation of blood pressure through renin-angiotensin- aldosterone system. ii. Stimulation of erythropoiesis - erythropoietin is produced in the kidneys - stimulates production of erythrocytes in the bone marrow 3 | Page: Urinary Histology Swailes A3: Gross Structure of the Kidney The kidneys are paired, Heinz baked bean-shaped organs located retroperitoneally on the posterior abdominal wall. The following structures exit/enter each kidney at the hilus: 1. Renal artery - branch of abdominal aorta - supply kidneys with ~22% of cardiac output 1 2. Renal vein - returns blood to inferior vena cava 3. Renal pelvis - funnel shaped region of ureter 2 4. Ureter - muscular tube that drains urine from 3 renal pelvis to the bladder Now examine the hemisected kidney and identify 4 the following internal structures: 5. Renal capsule - external CT layer of the kidney 5 6. Renal cortex 6 - outer part of the kidney 7 7. Renal medulla - inner ‘segmented’ part of the kidney. 8. Renal papilla 8 - region of the renal medulla that projects into a minor calyx. 9. Minor calyx - numerous narrow tributaries that drain 9 urine away from each renal papilla to a 10 major calyx. 10. Major calyx - formed when two or more minor calyces unite, they drain into the renal pelvis. 11. Vasculature (see later) 11 - a network of vessels branching from the renal artery and draining to the renal vein. 4 | Page: Urinary Histology Swailes A4. Renal Lobes The cortex and medulla of each kidney can be divided into 8-15 renal lobes composed of: 1. Renal cortex - forms the base of the renal lobe 2. Renal column - extensions of renal cortex into the 1 renal medulla - note that only half a column flanks a pyramid on each side 3. Renal pyramid - pyramidal shaped region of the 2 medulla deep to the renal cortex 3 4. Renal papilla - the apex of the renal lobe - contains numerous tiny holes known as area cribrosa The uriniferous tubule - is the functional unit of the kidney 4 - produces and modifies urine - is an epithelial lined tube 6 5 - originates in the renal cortex 4 - terminates at the renal papilla. - has two embryologically distinct components: i. The nephron 1 - derived from the metanephros 2 1. Bowman’s capsule 2. Proximal convoluted tubule (PCT) 3a 3. Loop of Henle a. Thick descending limb (TDL) 3b b. Thin descending limb (tDL) c. Thin ascending limb (tAL) 3c d. Thick ascending (TAL) 3d 4. Distal convoluted tubule (DCT) 5. Connecting tubule ii. The collecting duct - derived from the ureteric bud 6. Collecting duct 5 | Page: Urinary Histology Swailes A5. Renal Blood Supply The vessels within the kidney are often named according to their location within the kidney. Efferent arteriole Glomerulu Interlobular Arcuate Peritubular s a. a. capillaries (around convoluted Afferent arteriole Interlobar tubules) a. Segmental Vasa recta a. (around loop of Henle) Renal a. Interlobular v. Arcuate v. Interlobar v. Renal v. Clinical Correlation: Erythropoietin (EPO) Interstitial cells associated with the peritubular capillaries release the hormone EPO into the bloodstream. EPO targets red blood cell precursors in the bone marrow and is essential for their successful development into healthy erythrocytes. Recombinant EPO is a common blood-doping agent used by athletics cheats to increase efficiency of the oxygen delivery system by increasing circulating erythrocyte levels. 6 | Page: Urinary Histology Swailes 3 A6. Renal Lobules 1 The kidney can be further differentiated into lobules. A renal lobule is centered about a medullary ray and is flanked on each side by interlobular arteries. 1. Medullary ray - a series of collecting ducts that extend from the cortex into the medulla and 2 drain a collection of local nephrons. 2 2. Interlobular artery - branches of the arcuate arteries that supply the renal cortex. 3. Renal lobule - region of a renal lobe located between two interlobular arteries - contains nephrons that drain into the collecting ducts within a medullary ray. Follow the flow of blood through the kidney to the glomerulus: what happens next? A7. Renal Corpuscles (glomerulus + Bowman’s capsule) This arrangement creates the barrier for filtration of blood: 1. Vascular pole Efferent Vascular pole Blood reaches the vascular pole of the renal arteriole corpuscle and then travels into the: i. Afferent arteriole - supplies the glomerulus - is wider than the efferent arteriole ii. Efferent arteriole - after passing through the glomerulus blood leaves via the efferent arteriole - goes on to supply the peritubular and/or vasa recta capillaries that run in close proximity to the kidney tubules. iii. Mesangial cells Afferent - specialized extra- and intra-glomerular cells Extraglomerular arteriole - phagocytic to keep the glomerulus clean mesangial cells - contractile to control blood flow through the glomerulus 7 | Page: Urinary Histology Swailes Podocyte 2. Glomerulus The glomerulus forms the surface across which filtration occurs. It is composed of: i. Fenestrated endothelial cells - contain pores 70-90nm wide. - form a barrier to blood cells and macromolecules whose diameter exceeds this. Primary ii. Basal lamina Pedicel process - lamina rara interna (closest to endothelial cells) - lamina densa (middle and thickest layer) - lamina rara externa (closest to podocytes) iii. Visceral layer of the Bowman’s capsule - aka “podocytes” - highly modified epithelial cells - primary processes run along the long axis of Slit the capillary diaphragm iv. Pedicels - foot-like processes branching from the primary processes of podocytes - interdigitate with neighboring
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