adj.

尿の、尿中の、泌尿器の

関: urinary organ、urinary tract、urine、uro

WordNet

of or relating to the urinary system of the body
of or relating to the function or production or secretion of urine
liquid excretory product; "there was blood in his urine"; "the child had to make water" (同)piss, pee, piddle, weewee, water

PrepTutorEJDIC

尿の;泌尿(ひにょう)[器]の
尿,小便

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2019/07/08 20:35:30」(JST)

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The urinary system, also known as the renal system or urinary tract, 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 from the body by urination (voiding). The female and male urinary system are very similar, differing only in the length of the urethra.^[2]

Urine is formed in the kidneys through a filtration of blood. The urine is then passed through the ureters to the bladder, where it is stored. During urination, the urine is passed from the bladder through the urethra to the outside of the body.

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.

Structure[edit]

3D model of urinary system

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 through the external urethral meatus. The female urethra is much shorter, beginning at the bladder neck and terminating in the vaginal vestibule.

Development[edit]

Microanatomy[edit]

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.

Function[edit]

The main functions of the urinary system and its components are to

Regulate blood volume and composition (e.g. sodium, potassium and calcium)
Regulate blood pressure.
Regulate pH homeostasis of the blood.
Contributes to the production of red blood cells by the kidney.
Helps synthesize calcitrol the (active form of Vitamin D).
Stores waste product (mainly urea and uric acid) before it and other products are removed from the body.

Urine formation[edit]

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). Oliguria when < 400 mL (millilitres) are produced, and anuria one of < 100 mL per 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]

Regulation of concentration and volume[edit]

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[edit]

Urination is the ejection of urine from the urinary bladder through the urethra to the outside of the body. 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. In placental mammals the male ejects urine through the penis, and the female through the vulva.

Clinical significance[edit]

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. 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]}

References[edit]

^ "The Urinary Tract & How It Works | NIDDK". National Institute of Diabetes and Digestive and Kidney Diseases.
^ C. Dugdale, David (16 September 2011). "Female urinary tract". MedLine Plus Medical Encyclopedia.
^ Maton, Anthea; Jean Hopkins; Charles William McLaughlin; Susan Johnson; Maryanna Quon Warner; David LaHart; Jill D. Wright (1993). Human Biology and Health. Englewood Cliffs, New Jersey, USA: Prentice Hall. ISBN 0-13-981176-1.
^ Caldwell HK, Young WS III, Lajtha A, Lim R (2006). "Oxytocin and Vasopressin: Genetics and Behavioral Implications" (PDF). Handbook of Neurochemistry and Molecular Neurobiology: Neuroactive Proteins and Peptides (3rd ed.). Berlin: Springer. pp. 573–607. ISBN 0-387-30348-0.
^ Nielsen S, Chou CL, Marples D, Christensen EI, Kishore BK, Knepper MA (February 1995). "Vasopressin increases water permeability of kidney collecting duct by inducing translocation of aquaporin-CD water channels to plasma membrane". Proc. Natl. Acad. Sci. U.S.A. 92 (4): 1013–7. doi:10.1073/pnas.92.4.1013. PMC 42627. PMID 7532304.
^ Baba, T; Murabayashi, S; Tomiyama, T; Takebe, K (1990). "Uncontrolled hypertension is associated with a rapid progression of nephropathy in type 2 diabetic patients with proteinuria and preserved renal function". The Tohoku journal of experimental medicine. 161 (4): 311–8. doi:10.1620/tjem.161.311. PMID 2256104.
^ "Peripheral Neuropathy". Patient UK. Retrieved 2014-03-20.

External links[edit]

UpToDate Contents

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1. 男性における下部尿路症状 lower urinary tract symptoms in men
2. 急性複雑性膀胱炎および腎盂腎炎 acute complicated cystitis and pyelonephritis
3. 女性における尿失禁の治療 treatment of urinary incontinence in women
4. 乳児および1ヶ月以上の小児における尿路感染症：臨床的特徴および診断 urinary tract infections in infants and children older than one month clinical features and diagnosis
5. 急性膀胱炎：2歳以上の小児および思春期における臨床的特徴および診断 acute cystitis clinical features and diagnosis in children older than two years and adolescents

English Journal

Diving accidents: a cohort study from the Netherlands.

Smithuis JW1, Gips E2, van Rees Vellinga TP3, Gaakeer MI4.
International journal of emergency medicine.Int J Emerg Med.2016 Dec;9(1):14. doi: 10.1186/s12245-016-0109-4. Epub 2016 Mar 12.
BACKGROUND: Diving is, besides professional reasons, an increasingly popular leisure activity. Whilst statistically compared to other sports safe, diving accidents can result in serious complications. In order to treat this specific patient category adequately, early diagnosis is important. In this
PMID 26968856

Bladder and rectal incontinence without paraplegia or paraparesis after endovascular aneurysm repair.

Nishioka N1, Kurimoto Y2, Maruyama R3, Ujihira K4, Iba Y5, Hatta E6, Yamada A7, Nakanishi K8.
Surgical case reports.Surg Case Rep.2016 Dec;2(1):11. doi: 10.1186/s40792-016-0140-y. Epub 2016 Feb 11.
Spinal cord ischemia is a well-known potential complication of endovascular aneurysm repair (EVAR), and it is usually manifested by paraplegia or paraparesis. We describe a case in which spinal cord ischemia after EVAR presented by isolated bladder and rectal incontinence without other neurological
PMID 26943687

Recent advances in biosensor based diagnosis of urinary tract infection.

Kumar MS1, Ghosh S1, Nayak S1, Das AP2.
Biosensors & bioelectronics.Biosens Bioelectron.2016 Jun 15;80:497-510. doi: 10.1016/j.bios.2016.02.023. Epub 2016 Feb 9.
Urinary tract infections (UTIs) are potentially life threatening infections that are associated with high rates of incidence, recurrence and mortality. UTIs are characterized by several chronic infections which may lead to lethal consequences if left undiagnosed and untreated. The uropathogens are c
PMID 26890825

Elevated urinary levels of carcinogenic N-nitrosamines in patients with urinary tract infections measured by isotope dilution online SPE LC-MS/MS.

Hu CW1, Shih YM2, Liu HH3, Chiang YC4, Chen CM3, Chao MR5.
Journal of hazardous materials.J Hazard Mater.2016 Jun 5;310:207-16. doi: 10.1016/j.jhazmat.2016.02.048. Epub 2016 Feb 26.
N-nitrosamines (NAms) are well-documented for their carcinogenic potential. Human exposure to NAms may arise from the daily environment and endogenous formation via the reaction of secondary amines with nitrites or from bacteria infection. We describe the use of isotope dilution online solid-phase e
PMID 26937867

Japanese Journal

症例多剤耐性緑膿菌によるカテーテル関連尿路感染症に対して,polymyxin Bの膀胱内注入療法が奏効した1例

田地広明,柴垣泰郎,垣本隆行 [他]
内科 116(1), 171-174, 2015-07
NAID 40020521152

小児の尿路感染症 (特集抗菌薬の選択と上手な使い方! : 私の処方箋)

兼松明弘
臨床泌尿器科 = Japanese journal of clinical urology 69(8), 656-662, 2015-07
NAID 40020513793

無症候性細菌尿/カテーテル関連尿路感染症 (特集抗菌薬の選択と上手な使い方! : 私の処方箋)

重村克巳,荒川創一,藤澤正人
臨床泌尿器科 = Japanese journal of clinical urology 69(8), 652-655, 2015-07
NAID 40020513790

重症尿路感染症 (特集抗菌薬の選択と上手な使い方! : 私の処方箋)

和田耕一郎
臨床泌尿器科 = Japanese journal of clinical urology 69(8), 636-643, 2015-07
NAID 40020513780

Related Pictures

★リンクテーブル★

リンク元	「100Cases 14」「泌尿器」「uro」

「100Cases 14」

Urinary system
	1. Human urinary system: 2. Kidney, 3. Renal pelvis, 4. Ureter, 5. Urinary bladder, 6. Urethra. (Left side with frontal section); 7. Adrenal gland; Vessels: 8. Renal artery and vein, 9. Inferior vena cava, 10. Abdominal aorta, 11. Common iliac artery and vein; Transparent: 12. Liver, 13. Large intestine, 14. Pelvis
	Urinary system in the male. Urine flows from the kidneys via the ureters into the bladder where it is stored. When urinating, urine flows through the urethra (longer in males, shorter in females) to exit the body
Details
Identifiers
Latin	Systema urinarium
MeSH	D014551
TA	A08.0.00.000
FMA	7159
	Anatomical terminology [edit on Wikidata]

　　[★]

☆case14　複視

■glossary

diplopia n. 複視

筋力低下、筋無力、筋脱力 muscle weakness, muscular weakness

sunken

vt. sinkのpp.

adj.

沈没した、沈んだ、水中の

沈下した、一段低いところにある

落ち込んだ、くぼんだ

3,4-ジアミノピリジン 3,4-diaminopyridine 3,4-DAP K+チャネル阻害薬;ランバート・イートン筋無力症治療

■症例

43-year-old woman

cheif complaint: diplopia

present history: diplopia and holding her head up ; more marked in the evenings, for the last 3 months. difficulty of chewing. voice has become quieter. weight loss (3kg / 6months). non-smoker. drinks about 15 units/week. no regular medication.

past history: no significant previous medical illnesses.

family history: lives with her husband and three children.

・診察 examination

looks well.

organ systems: normal; cardiovascular, respiratory, and abdominal systems.

muscle power; grossly normal. decrease after testing a movement repetitively.

motor function: normal; tone, coordination, reflexes and sensation.

bilateral ptosis. exacerbated by prolonged upward gaze

eye: normal; pupillary reflexes, eye movements, and funduscopy

■答え

diagnosis: myathenia gravis

differential diagnoses:

CASES

上位and/or下位運動ニューロン motor neurone disease　運動ニューロン疾患：線維束性攣縮。進行例では筋力低下

筋 muscular dystrophy　筋ジストロフィー：ある種の筋肉が選択的に筋力低下する。家族歴がある。

筋 dystrophia myotonica　強直性筋ジストロフィー：咬筋、側頭筋、胸鎖乳突筋の筋萎縮、四肢遠位端の筋萎縮。顔貌が特徴的(前頭部脱毛、無表情、窪んだ頬)。家族歴ある。筋電図が診断に有用(急降下爆撃音)。

筋 polymyositis　多発筋炎：普通は皮疹と関節痛が出現。CKが上昇。筋生検が診断に有用

筋 myopathy　ミオパチー：甲状腺中毒性ミオパチー、甲状腺機能低下症によるミオパチー、クッシング症候群によるミオパチー、アルコール性のミオパチー

神経筋接合部？ non-metastatic associations of malignancy (paraneoplastic syndrome(傍腫瘍性症候群 = 腫瘍随伴症候群)のこと)：胸腺腫の症例の10%に重症筋無力症がみられる。ランバート・イートン筋無力症症候群は小細胞癌と関連がある。

HIM.2674

神経筋接合部 congenital myasthenia syndrome　先天性筋無力症症候群
神経筋接合部 drug-induced myasthenia　薬剤性筋無力症

Treatment with penicillamine (used for scleroderma or rheumatoid arthritis) may result in true autoimmune MG, but the weakness is usually mild, and recovery occurs within weeks or months after discontinuing its use.

　重症筋無力症の誘発：ペニシラミン(強皮症や関節リウマチの治療に用いられる)。

　　mildだし、薬剤の中断で改善する。

Aminoglycoside antibiotics or procainamide can cause exacerbation of weakness in myasthenic patients; very large doses can cause neuromuscular weakness in normal individuals.

　重症筋無力症の悪化：アミドグリコシド系抗菌薬、プロカインアミド

　　MGの患者の筋脱力が悪化する。

神経筋接合部 Lambert-Eaton myasthenic syndrome　ランバート・イートン筋無力症症候群：全身の筋肉が冒されるが、特に下肢の近位筋が冒される。MGと同じように～70%の患者で脳神経所見(眼瞼下垂、複視など)が認められる。MGと違うのは(1)反射が消失・減弱すること、(2)自律神経系の変化(口渇、勃起不全)を生じる、(3)神経刺激検査で漸増(waxing)が見られることである。病因は神経筋接合部のP/Q type calcium channelsに対する抗体の出現であり、85%の患者で見いだされる。治療はMGのように血漿交換や免疫抑制薬が使われる。3,4-DAPやpyridostigmineは症状に対する治療のために用いる。前者は運動神経の終末部でカルシウムチャネルをブロックし活動電位を延長させる。後者はアセチルコリンエステラーゼを阻害してシナプスにおける神経伝達物質の濃度を上げる。
精神疾患 neurasthenia　神経衰弱症：歴史的な用語。器質的な障害を伴わない筋無力症のような脱力を伴う症候群。患者は筋脱力や疲労を訴えてやってくる。筋肉の検査では器質的変化は認めないが"jerky release"あるいは"give-away weakness"が認められる。患者の主訴は反復動作による筋力低下よりむしろ疲労や感情鈍麻である。
内分泌疾患 hyperthyroidism　甲状腺機能亢進症：MGが疑われる患者にはthyroid function testをルーチンにやる。甲状腺機能異常は筋無力症の筋力低下を大きくすることがある。
神経筋接合部 botulism　ボツリヌス症：ボツリヌス毒素はシナプス前膜からの神経伝達物質の開口分泌を妨げる。症状はbulbar weakness (複視、構音障害、嚥下困難)。感覚障害はない。深部腱反射は初期には保たれている。進行すれば反射は見られなくなる。筋脱力は全身性。呼吸困難に陥ることがある。精神状態は正常。自律神経症状(麻痺性イレウス、便秘、urinary retention、瞳孔の散大、瞳孔の反応性低下、口渇)。確定診断は血清中の毒素の検出だけど、見つかることはまれ。神経伝導検査(nerve conduction studies)：compound muscle action potentials (CMAPs)の低下。高頻度の刺激で振幅が増加。治療：intubation for airway protection、呼吸補助、aggressive inpatient supportive care(e.g., nutrition, DVT prophylaxis)。馬の抗毒素を検査結果が帰ってくる前に投与する(？)。
上位運動ニューロン intracranial mass lesions　頭蓋内占拠病変：複視はintracranial mass lesionが外眼筋の神経を圧迫することにより生じる。
筋 progressive external ophthalmoplegia　進行性外眼筋麻痺：外眼筋の筋脱力を伴う。四肢の近位筋の筋力低下やそのほかの全身症状を伴うことがある。ミトコンドリアの異常を有する。

■参考文献

HIM = Harrison's Principles of Internal Medicine 17th Edition

CASES = 100 Cases in Clinical Medicine Second edition

IMD = 内科診断学第2版

「泌尿器」

　　[★]

英: urinary tract、urinary organ, urinary organs, urinary
ラ: organa urinaria, organa uropoetica
関: 尿、尿中、尿路、泌尿器系

「uro」

　　[★]

comb form.

尿

関: urinary、urine

[NIH-1] "The Urinary Tract & How It Works | NIDDK". National Institute of Diabetes and Digestive and Kidney Diseases.

[2] C. Dugdale, David (16 September 2011). "Female urinary tract". MedLine Plus Medical Encyclopedia.

[3] Maton, Anthea; Jean Hopkins; Charles William McLaughlin; Susan Johnson; Maryanna Quon Warner; David LaHart; Jill D. Wright (1993). Human Biology and Health. Englewood Cliffs, New Jersey, USA: Prentice Hall. ISBN 0-13-981176-1.

[isbn0-387-30348-0-4] Caldwell HK, Young WS III, Lajtha A, Lim R (2006). "Oxytocin and Vasopressin: Genetics and Behavioral Implications" (PDF). Handbook of Neurochemistry and Molecular Neurobiology: Neuroactive Proteins and Peptides (3rd ed.). Berlin: Springer. pp. 573–607. ISBN 0-387-30348-0.

[pmid7532304-5] Nielsen S, Chou CL, Marples D, Christensen EI, Kishore BK, Knepper MA (February 1995). "Vasopressin increases water permeability of kidney collecting duct by inducing translocation of aquaporin-CD water channels to plasma membrane". Proc. Natl. Acad. Sci. U.S.A. 92 (4): 1013–7. doi:10.1073/pnas.92.4.1013. PMC 42627. PMID 7532304.

[6] Baba, T; Murabayashi, S; Tomiyama, T; Takebe, K (1990). "Uncontrolled hypertension is associated with a rapid progression of nephropathy in type 2 diabetic patients with proteinuria and preserved renal function". The Tohoku journal of experimental medicine. 161 (4): 311–8. doi:10.1620/tjem.161.311. PMID 2256104.

[7] "Peripheral Neuropathy". Patient UK. Retrieved 2014-03-20.

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urinary