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RENAL AND BODY FLUID
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Ahmad Aulia Jusuf, MD, PhD
Department of Histology
Faculty of Medicine University of Indonesia
2009
INTRODUCTION
Urinary system
consists of
 two kidneys
 two ureters
 a urinary bladder
 a urethra
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INTRODUCTION
Functions of urinary system
 The maintenance of water and electrolyte homeostasis
 Excretion of many toxic metabolic waste products
 The end product of urinary system is urine
kidneys
ureter
outside of the body
urinary bladder
urethra
 In female
urethra is solely a urinary duct
 In male
it also serves as the pathway for ejaculation of the semen
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INTRODUCTION
Functions of urinary system
Has an endocrine function
 Renin : regulation of blood pressure
 Erythropoietin : stimulation of erythrocyte production
Converting the pro-vitamin D to active vit D
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KIDNEY
Anatomical appearance
 a large, reddish, beanshape organ
Location
 retroperitoneal area
 right side is lower than
left side
Wrapped by the
perirenal fat
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Kidney
Hemisections view
 Hillus
 Renal artery and vein
 lymph vessel
 ureter
 Cortex
 dark-brown and granular
renal corpuscle
proximal and distal
convoluted tubules
medullary rays
(processus of Ferreini)
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KIDNEY
Hemisection view
 Medulla
 renal pyramids
pyramid-shape,
pale,striated regions
Base of pyramids is
toward to cortex
apex of pyramids is
toward to medulla as
renal papilla (area
cribrosa)
 perforated by
ducts of Bellini
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KIDNEY
Hemisection view
 Medulla




minor calyces
major calyces
renal pelvis
cortical columns of
Bertini
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URINIFEROUS TUBULES
A functional unit
 nephron
 renal corpuscle
(Malphigian
corpuscle)
glomerulus
Bowman’s capsule
 Renal tubule
proximal and distal
convoluted tubule
loop of Henle
 collecting tubule
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NEPHRON
2 types
 cortical nephrons
 juxtamedullary
nephrons
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GLOMERULUS
A globular network of
anastomosing capillaries
 arise from branches of afferent
glomerular arteriole
 invaginates Bowman’s capsule
Vascular pole
invested by podocytes
 viseral layer of Bowman’s
capsule
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GLOMERULUS
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GLOMERULUS
Glomerular capillaries
 Fenestrated type capillaries
 Endothelium: thin
 Round fenestrated >>> (70100nm)
 Specific properties
Pore diaphragma (--)
Surface endothelium has
negatively charge
 due to the present of
glycoprotein called as
podocalxin
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GLOMERULUS
Glomerular capillaries
 the space between glomerular
capillaries are occupied by mesangium
 Connective tissue
Mesangial intraglomerular cells
Extracellular matrix, free from fibrous
elements
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GLOMERULUS
Mesangial intraglomerular
cells
 A specialized type of
pericytes
 Phagocytic cells
may participate in the
continuous turn over of basal
lamina
 Contratile and responds to
angiotensin II and other
vasoconstrictor
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GLOMERULUS
Mesangial intraglomerular
cells
 Has a specific receptor for
atriopeptides hormone
 secreted by myocardium
 Regulating in capillary
vasodilatation
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BOWMAN’S CAPSULE
Consists of
 Visceral layer
 Podocytes
 Completely invest the
glomerular
 Parietal layer
 Simple squamous
epithelium
 Continuous at the urinary
pole of renal corpuscle
(tubular pole) to the
proximal convoluted tubule
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BOWMAN CAPSULE
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BOWMAN’S CAPSULE
Podocytes
 Has the primary
processes
 embrace the capilleries
 give the secondary
processes (pedicles)
directly applied to the
lamina rara externa
 Filtration slit diaphragma
between pedicles
Small pores
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BOWMAN’S CAPSULE
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BOWMAN’S CAPSULE
Podocytes
 the plasma membrane
of pedicles has a
prominent glycocalyx
with (-) charged
 Significant component
of the filtration barrier
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GLOMERULAR BASEMENT
MEMBRANE
basal lamina
 Thicker membrane
 Elaborated by both
capillary endothelial
cells and podocytes
 Collagen type IV,
fibronectin, laminin and
proteoglycans
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GLOMERULAR BASEMENT
MEMBRANE
 ME: 3 layers
 Lamina rara externa
Between lamina densa
and viseral layer of
Bowman
 Lamina densa
Middle layer
 300 nm
 Collagen type IV
 Lamina rara interna
Between lamina densa
and endothelial cells of
capillaries
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GLOMERULAR FILTRATION
Filtration of blood plasma in glomerulus
A continous process
Essential for elimination of nitrogenous wastes
Control of extracellular fluid composition and
blood volume
Structural components of the filter
The fenestrated endothelium
Basal lamina
Filtration slit diaphragma
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CORTEX OF THE KIDNEY
Covered by
capsule, perirenal connective and adipose
tissues
Consist of
Renal corpuscle
Proximal and distal convoluted tubule
Juxtaglomerular complex
Medullary rays (processes of Ferreini)
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PROXIMAL CONVOLUTED TUBULE
 Prox convoluted
tubule
 Continuation of pars
parietal of Bowman’s
capsule
 A coil tube
 14 nm in length
 Acidophilic stained
 Simple cuboidal
epithelium with the
unclear boundaries
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PROXIMAL CONVOLUTED TUBULE
 A Coil tube
 The nucleus of cells
Round, blue, located
slightly far one to the
others
 The cytoplasm
Acidophilic due to the
present of granule
Brush border at the
surface cell toward to
the lumen
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PROXIMAL CONVOLUTED TUBULE
 Functions
 Reabsoption of
80% of all filtrated fluid from
the tubular filtrate
 Protein
 amino acid
 Glucose
 Water
 most ions and
electrolyte
 All of glucose, amino acids and
protein are reabsorbed
 Drains out the fluid with the
normal osmolarity
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DISTAL TUBULE
Distal tubule
 subdivided into 2 pars
 Pars recta (ascending thick
limb)
 continuation of ascending
thin limb of Henle’s loop
9 to 10 nm in length; 30-40
mm in diameter
located in the outer part of
medulla
not permeable to water and
urea
permeable to sodium and
chloride
 Pars convoluted (distal
convoluted tubule)
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DISTAL TUBULE
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DISTAL CONVOLUTED TUBULE
Distal convoluted tubule
 Continuation of ascending
thick limb of Henle loop
 Located in cortex
 Simple cuboidal cells with
the clear boundaries
 Nucleus : round, blue
 Cytoplasm: basophilic
granule
 Brush Border (-)
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DISTAL CONVOLUTED TUBULE
 Functions
 Reabsoption of sodium
ions from tubular fluid
 Secretion of hydrogen
and potassium ions into
tubular fluid (acid-base
balance)
 Controlled by hormone
aldosterone
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JUXTAGLOMERULAR APPARATUS
Composed of
 Macula densa
 Juxtaglomerular cells
 Extraglomerular mesangial
(Polkissen or Goormaghtigh
or lacis) cells
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JUXTAGLOMERULAR APPARATUS
 Macula densa
 Interpose between pars recta
and pars convoluted
 Lies between the afferent and
efferent glomerular arterioles
 The cells: tall and narrow
The nuclei of these cells
appear to be much closer
together
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JUXTAGLOMERULAR APPARATUS
 Functions
 Osmoreceptor for sodium
concentration
Juxtaglomerular cells
 Modified smooth muscle in
the tunica media of afferent
arteriole close to the renal
corpuscle
 Contain the granule
 Renin
 Erythropoetin
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JUXTAGLOMERULAR APPARATUS
Extraglomerular
mesangial cells
 Lacis or polkissen or
Goormaghtigh cells
 Located between afferent
and efferent arteriole and
macula densa
 Groups of small, flat and
bright cells with
cytoplasmic processes
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JUXTAGLOMERULAR APPARATUS
 Functions
 Not yet clear
 Give the signals of
sodium
concentration
changes
from the macula
densa to the
juxtaglomerular
cells
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JUXTAGLOMERULAR APPARATUS
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THE MEDULLA OF KIDNEY
Composed of a number of
renal pyramids
 Loop of Henle
 Collecting tubule of koligens
 Collecting or papillary duct of
Bellini
 Calyx minor
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MEDULLA OF KIDNEY
Collumna renalis of
Bertini
 The part of renal
cortex which is
located in the
medulla
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THE LOOP OF HENLE
Consist of
 Pars recta of proximal
tubule (the thick
descending limb)
 The thin descending
limb
 The thin ascending limb
 The thick ascending
limb
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THE LOOP OF HENLE
 The parts of recta
 Straight part of
proximal tubule,
extends down to the
outer medulla
 Has the same
apperance to the
proximal convoluted
tubule with the smaller
diameter
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THE LOOP OF HENLE
The thin descending
and ascending limb
 The appearance similar
to the blood capillary
 Simple squamous
epithelium
 The lumen is round and
not contain the
erythrocytes
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THE LOOP OF HENLE
Thick ascending limb
 The appearance similar to distal convoluted tubule
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COLLECTING TUBULE
OF KOLIGENS
joins the distal convoluted
to collecting duct of Bellini
located in medulla
histologically
 similar to distal convoluted
tubule
 simple cuboidal cells with
visible cell membrane
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PAPILLARY DUCT OF BELLINI
Histologically
 simple columnar
epithelium
functions
 Passive reabsoption of water
(concentrate the osmolarity of
urine)
 influenced by ADH (antidiuretic
hormone /vasopressin)
 secretion of H+ and K+
 reabsorption of Na+ and HCO3-
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PAPILLARY DUCT OF BELLINI
 2 type of cells
 Principal cells
Cytoplasm: pale with
scanty organelles
short microvilli and a
single cilium
reabsorb Na+ and
secreted K+
 Intercalated cells
cytoplasm: dark due
to mitochondria and
polyribosome >>
reabsorb bicarbonate
and secrete H+
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CALYCES
Calyces
 Minor calyx
 A funnel-shaped chamber,
accept the urine leaving
the ducts of Bellini at the
area cribrosa
 lined by transitional
epithelium
 contains a thin smooth
muscle in lamina propria
 Major calyx
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RENAL INTERSTITIUM
Cortex of kidney
 connective tissue
 fibroblast
 macrophage
Medulla of kidney
 connective tissue >>
 fibroblast
 macrophage
 Laden interstitial cells
prostaglandin
medullipin I
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RENAL VASCULATURE
A. renalis (branch of aorta
abdominalis)
anterior &
posterior branch
segmental
artery
lobar artery
interlobaris artery
arcuate artery
interlobular
artery
afferent artery
Glomerular capillaries
efferent artery
vasa recta
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URETER
Cylindrical tube , 3- 4
mm in diameter, 25-30
cm in length
Histologically
 tunica mucosa
 transtitional epithelium
 tunica muscularis
 2/3 proximal
outer: circular
inner: longitudinal
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URETER
 Tunica muscularis
 1/3 distal
outer : longitudinal
middle: circular
inner: longitudinal
 Tunica adventisia
 fibrous connective
tissue
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URINARY BLADDER
Organ for storing
urine
 until the pressure
become sufficient to
induce the the urge for
voiding
consists of
 tunica mucosa
 transtitional epithelium
 lamina propria
 collagen and elastic
fibers
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URINARY BLADDER
 Tunica muscularis
 a thick coat
 3 interlaced layers of
smooth muscle
 arranged in
anastomosing bundle
 difficult to distinguished
 Tunica
adventisia/serosa
 a dense, irregular
collagen
 elastic fibers
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URETHRA
A single tubular
structure
 Communicates the
urinary bladder with the
outside
 In male
 longer than female
 Also as a route for
semen
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URETHRA
In female
 4-5 cm in length and 5-6
mm in diameter
 Lined by
 Transtitional epithelium
near the bladder
 Stratified squamous non
keratinized epithelium
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URETHRA
In male
 15-20 cm in length
 3 parts
 Pars prostatica
 Pars membranous
 Pars cavernosa (penile)
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URETHRA
Pars prostatica
 3-4 cm in length
 Lies entirely in the
prostate gland
 Lined by transtitional
epithelium
Pars membranous
 1-2 cm in length
 Pass through the perineal
membrane
 Lined by stratified
columnar epithelium
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URETHRA
Pars cavernosa (penile)
 The longest part (about
15 cm ) in length
 Located in the corpus
spongiose urethra
 Lined by stratified
columnar epithelium
stratified squamous
nonkeratinized epithelium
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