The urinary system is composed of two kidneys, two ureters, a urinary bladder, and a urethra (Figs. 6-1 and 6-2). The work of the urinary system is done by a specialized tissue in the kidneys called parenchymal tissue. The kidneys function to filter the blood and eliminate waste through the passage of urine. The ureters are thin, muscular tubes that move urine in peristaltic waves from the kidneys to the bladder. The urinary bladder is the sac that stores the urine until it is excreted. The bladder is lined with an epithelial mucous membrane of transitional cells. Underneath, a layer termed the lamina propria is composed of connective tissue that holds the blood vessels and nerves. The detrusor muscle is the final coat; it normally contracts to expel urine. The urethra is the tube that conducts the urine out of the bladder. The opening of the urethra is called the urinary meatus. The triangular area in the bladder between the ureters’ entrance and the urethral outlet is called the trigone. The ureters, bladder, and urethra are all stromal tissue, which is a supportive tissue.

Note

This chapter includes all the anatomy necessary to assign ICD-10 urinary system codes, including detail on the renal calyx, the trigone, and the ureteropelvic junction. See Appendix F for a complete list of body parts and how they should be coded.

The Kidney

Because the kidneys are primarily responsible for the functioning of the urinary system, it is helpful to look at them in greater detail. Each of the two kidneys is located high in the abdominal cavity, tucked under the ribs in the back and behind the lining of the abdominal cavity (retroperitoneal). The normal human kidney is about the size of a fist. The tough outer covering of the kidney is the renal capsule. If a kidney were sliced open, the outer portion, the cortex (pl. cortices), and the inner portion, called the medulla (pl. medullae), would be visible (Fig. 6-3). The renal pelvis and calyces (sing. calyx) are an extension of the ureter inside the kidney. The renal pyramids are triangular sections that extend from the renal medulla toward the renal pelvis. The downward point of the pyramid is referred to as the papilla. The term renal means “pertaining to the kidneys.” The ureteropelvic junction (UPJ) is the area where the ureter joins the renal pelvis. It is a common site of obstruction of the outward flow of urine from the kidney.

The hilum (pl. hila) is the location on the kidney where the ureter and renal vein leave the kidney and the renal artery enters. The cortex contains tissue with millions of microscopic units called nephrons (Fig. 6-4). Here in the tiny nephrons, blood passes through a continuous system of urinary filtration, reabsorption, and secretion that measures, monitors, and adjusts the levels of substances in the extracellular fluid.

The Nephron

The nephrons filter all the blood in the body approximately every 5 minutes. The renal afferent arteries transport unfiltered blood to the kidneys. Once in the kidneys, the blood travels through small arteries called arterioles and finally into tiny balls of renal capillaries, called glomeruli (sing. glomerulus). These glomeruli cluster at the entrance to each nephron. It is here that the process of filtering the blood to form urine begins.

Be Careful!

Calic/o, calyc/o, and cali/o are the combining forms for calyx, but calc/o is the combining form for calcium.

Be Careful!

It is easy to confuse the combining forms perone/o, which means fibula; perine/o, which means the space between external genitalia and the anus; and peritone/o, which means the abdominal lining.

artery = arteri/o

glomerulus = glomerul/o

The nephron consists of four parts: (1) the renal corpuscle, which is composed of the glomerulus and its surrounding Bowman’s capsule; (2) a proximal convoluted tubule; (3) the nephronic loop, also known as the loop of Henle; and (4) the distal convoluted tubule. As blood flows through the capillaries, water, electrolytes, glucose, and nitrogenous wastes are passed through the glomerular membrane and collected. The most common electrolytes are sodium (Na), chloride (Cl), and potassium (K). Blood cells and proteins are too large to pass through the glomerular membrane. Selective filtration and reabsorption continue along the renal tubules, with the end result of urine concentration and subsequent dilution occurring in the renal medulla. From there, the urine flows to the calyces and exits the kidney, flowing through the ureter into the bladder, where it is stored until it can be expelled from the body through the urethra.

urine = ur/o, urin/o

Exercise 1:

The Urinary System

Match the combining form with its term.

Decode the terms.

14. transurethral ____________________________________________________________________________________

15. paranephric _____________________________________________________________________________________

16. retroperitoneal __________________________________________________________________________________

17. suprarenal ______________________________________________________________________________________

18. perivesical ______________________________________________________________________________________

To practice labeling the urinary system, click on Label It.

Combining Forms for the Anatomy of the Urinary System

Meaning	Combining Form
artery	arteri/o
bladder	cyst/o, vesic/o
calyx	calic/o, cali/o, calyc/o
cell	cellul/o
cortex	cortic/o
glomerulus	glomerul/o
hilum	hil/o
kidney	nephr/o, ren/o
meatus	meat/o
medulla	medull/o
parenchyma	parenchym/o
peritoneum	peritone/o
renal pelvis	pyel/o
stroma	strom/o
trigone	trigon/o
ureter	ureter/o
urethra	urethr/o
urine, urinary system	urin/o, ur/o

Prefixes for the Anatomy of the Urinary System

Prefix	Meaning
extra-	outside
en-	in
par-	beside, near
retro-	backward

Suffixes for the Anatomy of the Urinary System

Suffix	Meaning
-al, -ar, -ic	pertaining to
-ation, -ion	process of

You can review the anatomy of the urinary system by clicking on Body Spectrum Electronic Anatomy Coloring Book, then Urinary.

Pathology

Term	Word Origin	Definition
anuria	an- without -uria urinary condition	Condition of no urine.
dysuria	dys- painful, abnormal -uria urinary condition	Condition of painful urination.
enuresis	en- in ur/o urine -esis state of	Also commonly known as “bed-wetting,” enuresis can be nocturnal (at night) or diurnal (during the day).
extrarenal uremia	extra- outside ren/o kidney -al pertaining to ur/o urine -emia blood condition	Excessive urea in blood (uremia) due to kidney failure caused by disease outside of the kidney (e.g., congestive heart failure).
extravasation of urine	extra- outside vas/o vessel -ation process of	Condition of urine leaking outside of the bladder and into surrounding tissues. May be due to trauma or a stone.
hematuria	hemat/o blood -uria urinary condition	Blood in the urine.
incontinence, urinary		Inability to hold urine.
nocturia	noct/i night -uria urinary condition	Condition of excessive urination at night.
oliguria	olig/o scanty, few -uria urinary condition	Condition of scanty urination.
polyuria	poly- excessive, frequent -uria urinary condition	Condition of excessive urination.
retention, urinary		Inability to release urine.
vesical tenesmus	vesic/o bladder -al pertaining to	Bladder spasms.

Term	Word Origins	Definition
acute nephritic syndrome	nephr/o kidney -itic pertaining to	Hypertension, hematuria, and proteinuria (protein in the urine) resulting from damage to the glomeruli.
nephrotic syndrome	nephr/o kidney -tic pertaining to	Abnormal group of signs in the kidney, characterized by proteinuria, hypoalbuminemia (abnormally low levels of albumin in the blood), and edema; may occur in glomerular disease and as a complication of many systemic diseases (e.g., diabetes mellitus). Also called nephrosis.

Term	Word Origin	Definition
hydronephrosis	hydr/o water nephr/o kidney -osis abnormal condition	Dilation of the renal pelvis and calices of one or both kidneys resulting from obstruction of the flow of urine.
pyelonephritis	pyel/o renal pelvis nephr/o kidney -itis inflammation	Bacterial or viral infection of the kidneys and renal pelvis.
pyonephrosis	py/o pus nephr/o kidney -osis abnormal condition	Pyogenic (pus-producing) infection of the kidney.
vesicoureteral reflux	vesic/o urinary bladder ureter/o ureter -al pertaining to re- back -flux flow	Abnormal backflow of urine from the bladder to the ureter.

Term	Word Origin	Definition
renal failure	ren/o kidney -al pertaining to	Inability of the kidneys to excrete wastes, concentrate urine, and conserve electrolytes. May be acute or chronic.
acute renal failure (ARF)		Sudden inability of the kidneys to excrete wastes, resulting from hemorrhage, trauma, burns, toxic injury to the kidney, pyelonephritis or glomerulonephritis, or lower urinary tract obstruction. Characterized by oliguria and rapid azotemia.
chronic kidney disease (CKD) (formerly chronic renal failure)		CKD is measured in stages of increasing severity, from 1 (mild damage with a normal glomerular filtration rate) to 5 (complete kidney failure requiring either dialysis or a renal transplant). Stage 5 is also called end-stage renal disease (ESRD) and is the most extreme form of CKD.

CM Guideline Alert

14a Chronic Kidney Disease

1) Stages of Chronic Kidney Disease (CKD)

The ICD-10-CM classifies CKD based on severity. The severity of CKD is designated by stages 1-5. Stage 2, code N18.2, equates to mild CKD; stage 3, code N18.3, equates to moderate CKD; and stage 4, code N18.4, equates to severe CKD. Code N18.6, end-stage-renal disease (ESRD), is assigned when the provider has documented ESRD.

If both a stage of CKD and ESRD are documented, assign code N18.6 only.

2) Chronic Kidney Disease and Kidney Transplant Status

Patients who have undergone kidney transplant may still have some form of CKD because the kidney transplant may not fully restore kidney function. Therefore, the presence of CKD alone does not constitute a transplant complication. Assign the appropriate N18 code for the patient’s stage of CKD and code Z94.0, Kidney transplant status. If a transplant complication such as failure or rejection or other transplant complication is documented, see section I.C.19.g for information on coding complications of a kidney transplant. If the documentation is unclear as to whether the patient has a complication of the transplant, query the provider.

3) Chronic Kidney Disease with Other Conditions

Patients with CKD may also suffer from other serious conditions, most commonly diabetes mellitus and hypertension. The sequencing of the CKD code in relationship to codes for other contributing conditions is based on the conventions in the Tabular List. See I.C.9. Hypertensive chronic kidney disease. See I.C.19. Chronic kidney disease and kidney transplant complications.

Exercise 2:

Signs and Symptoms; Glomerular Diseases, Tubulointerstitial Diseases; Acute Kidney Failure; and Chronic Kidney Failure

____ 1. vesical tenesmus

____ 2. extravasation of urine

____ 3. extrarenal uremia

____ 4. hematuria

____ 5. enuresis

____ 6. urinary incontinence

____ 7. urinary retention

____ 8. anuria

____ 9. oliguria

____ 10. nocturia

____ 11. acute nephritic syndrome

____ 12. nephrotic syndrome

____ 13. pyonephrosis

____ 14. vesicoureteral reflux

____ 15. ARF

____ 16. ESRD

A inability to hold urine

B blood in the urine

C condition of scanty urination

D abnormal group of signs in the kidney, characterized by proteinuria, hypoalbuminemia, and edema

E abnormal backflow of urine from the bladder to the ureter

F inability to release urine

G excessive urea in blood due to kidney failure caused by some disease outside the kidney

H sudden inability of the kidneys to excrete wastes

I hypertension, hematuria, and proteinuria resulting from damage to the glomeruli

J pus-producing infection of the kidney

K spasms of the bladder

L condition of excessive urination at night

M bed-wetting

N condition of no urine

O condition of urine leaking out of the bladder and into surrounding tissues

P stage 5 CKD

Build the terms.

17. painful urinary condition ________________________________________________________________________

18. excessive (frequent) urinary condition ____________________________________________________________

19. abnormal condition of water in the kidney _______________________________________________________

Terms Related to Urolithiasis (N2Ø-N23)

Term	Word Origin	Definition
urolithiasis	ur/o urine, urinary system lith/o stone -iasis condition, presence of	Stones (calculi) anywhere in the urinary tract, but usually in the renal pelvis or urinary bladder. Depending on where the stone is located, the term is nephrolithiasis (kidney), ureterolithiasis (ureter), cystolithiasis (urinary bladder), or urethrolithiasis (urethra). Usually formed in patients with an excess of the mineral calcium. Also called urinary calculi (Fig. 6-5).

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Tags: Medical Terminology _ Anatomy for ICD-10 Coding

Jun 16, 2016 | Posted by admin in ANATOMY | Comments Off

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Term	Word Origin	Definition
nephrogenic diabetes insipidus	nephr/o kidney -genic pertaining to producing	Diabetes insipidus caused by a defect in the renal tubules causing them to be unresponsive to antidiuretic hormone (ADH).
nephropathy	nephr/o kidney -pathy disease process	Disease of the kidneys; a general term that does not specify a disorder.
nephroptosis	nephr/o kidney -ptosis drooping, sagging	Prolapse or sagging of the kidney.

ICD-10-CM Example from Tabular

N30 Cystitis

ICD-10-PCS Example from Index

Pyelography

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