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THE URINARY SYSTEMTHE URINARY SYSTEMPembentukan Urin dan Peran GinjalPembentukan Urin dan Peran Ginjal
Dalam Keseimbangan airan Tubu!Dalam Keseimbangan airan Tubu!
dr. Sri Lestari Sulistyo Rini,dr. Sri Lestari Sulistyo Rini,M.ScM.Sc
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The urinary system :
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Ginjal terletak retroperitonealGinjal terletak retroperitoneal
Sebuah ginjal 135-150 gr.Sebuah ginjal 135-150 gr.Ginjal menerima 20-30% cardiac
output
Aliran darah ke ginjal 1-1,5 ! mnt"arah #ang di$iltrai 1&0 ! hr
125 ml!mnt
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Renal Function
1. Elimination of Waste Products
2. Regulation of Fluid Balance3. Regulation of Acid-Base Balance
4. Nutrient Balance : - electroltes : Na!" #!"$l-"
$a!!"%g!!
- amino acids" glucose" &roteins
'itamin
(. Elimination" )eto*i+cation of )rug and ,o*ins. Endocrine Function : - ertro&oietin
- 'itamin ) metaolism
- renin
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Nefron Unit fungsional ginjal
- Sebuah ginjal terdiri dari + 1 juta nefron
- Nefron : - Glomerulus - Tubulus
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Struktur NefronStruktur Nefron
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A$$erent
Arteriole '$$erent
Arteriole
The NEPHRON:The FunctionalRenal Unit
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Urine formation
Eliminasi produk sisa metabolik Urea, Kreatinin, Asam urat, Sulfat,
Nitrat, Phosphat, dll.
Proses :. Filtrasi !lomerulus". Reabsorpsi tubulus#. Sekresi tubulus$. Ekskresi
Ekskresi % Filtrat & reabsorpsi ' sekresi
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p (0)
Steps in Urine Formation
1) GlomerularFiltration
2) TubularReabsorption
& Secretion
3) Water Reabsorption
(Conseration)
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Urine Formation Previe
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How the idney !or"s
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*gc gc *t
Filtrasi Glomerulus
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Filtrasi glomerulus
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Filtration !embrane
" Fenestrated endothelium
" #$-%$nm &ores e'(lude blood
(ells
" )asement membrane
" &roteogly(an gel* negative
(harge e'(ludes mole(ules
,nm
" blood &lasma # &rotein*
glomerular filtrate $.$/
" Filtration slits
" &odo(yte arms have &edi(els
ith negatively (harged
filtration slits* allo &arti(les
0 /nm to &ass
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Filtrasi Glomerulus
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Reabs"r#si dan Sekresi
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Reabs"r#si dan SekresiTubulus
Proximal Tubulus
Reabsorpsi 80% air dan garamReabsorpsi semua glukosa, asam amino
Reabsorpsi protein, urea, asam urat,
bicarbonat
Sekresi ion Hidrogen, asam-basa organik
Reabsorpsi
Aktif : glukosa, asam amino, natrium, dll
Pasif : air dan urea
Transport maximum ( Tm)maksimum substansi yang
di reabsorpsi per unit waktu
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P1 Nutrient 2glu(ose* amino a(ids3
reabsor&tion4 Normally 1$$ returned via (otrans&ort
ith Na+
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Trans&ort ma'imum 2Tm3
/ Reasor&tion 0ill return solutes to telood
/ Binding sites for trans&ort can ecomesaturated at ig le'els
/ olutes not reasor&ed are lost in teurine
/itamin $ is reasor&ed unless &lasma'alues are so ig tat trans&orters cantreasor an more 5 ten e*cess 'itamin$ lost in te urine
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$""# "% Henle
( )escendin! limb permeabel terhadap air
( Ascendin! limb impermeabel terhadap air
reabsorpsi Na dan *l
Tubulus Distal
Reabsorpsi Na, *l dan air
A)+ mempen!aruhi permeabilitas terhadap air
Reabsorpsi dan sekresi Kalium
Aldosteron mempen!aruhi reabsorpsi Natriumdan sekresi Kalium
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!e5anisme ounter(urrent
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6enal 6egulation6enal 6egulation
Saraf simpatisSaraf simpatis arteriol aferen & eferenarteriol aferen & eferen
vasokonstriksi, RBF menurunvasokonstriksi, RBF menurun
GFR menurunGFR menurun
HormonalHormonal Renin-AngiotensinRenin-Angiotensin
AldosteronAldosteron ADHADH
Atrial Natriuretic eptideAtrial Natriuretic eptide
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Renal Autore!ulation of FR
-P constrictafferent arteriole, dilateefferent
(
-P
dilate afferentarteriole, constrictefferent
( Stable for -P ran!e of /to 0/ mm+! 1s2stolic3
( *annot compensate fore4treme -P
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lomerular Filtration Rate1FR3
& Renal aut"regulati"n' Regulati"n "% N(P
' Ma)ula densa
& ells "% DT
& Sl"* +ltrate ,"*- l"*"sm"lalit. /l"* Na-l0 )auses dilati"n "%a1erent arteri"les
& Hig! ,"*- !ig!
"sm"lalit. )auses)"ntra)ti"n "% 2GA
)ells- 3as")"nstri)ti"n
! kt k l t! kt k l t
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!uktus kole"entes!uktus kole"entes
Reabsorpsi NaReabsorpsi Na
#an Cl#an Cl
#ipen"aru$i %!#ipen"aru$i %!
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ormonesormones
/%l#osterone%l#osterone5%cts on #istal conolute# tubule%cts on #istal conolute# tubule
cells to stimulate actie transportcells to stimulate actie transport
of 3 molecules of Naof 3 molecules of Na''out ofout of
tubule (reabsorption) for eer 2tubule (reabsorption) for eer 2
molecules of molecules of ''brou"$t intobrou"$t into
tubule (secretion)tubule (secretion)5Water from tubule lumen follo*sWater from tubule lumen follo*s
NaNa''b osmosis into bloo#b osmosis into bloo#
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/%nti#iuretic $ormone (%!)%nti#iuretic $ormone (%!)5%cts to increase t$e number of%cts to increase t$e number of
a+uaporins (*ater c$annels) in t$ea+uaporins (*ater c$annels) in t$ecollectin" #uct membranescollectin" #uct membranes
5 Collectin" #ucts trael t$rou"$Collectin" #ucts trael t$rou"$$perosmotic me#ulla$perosmotic me#ulla
5 i"$er leels of %! increase t$ei"$er leels of %! increase t$e
number of a+uaporins allo*in"number of a+uaporins allo*in"*ater to leae t$e #uct an# urine*ater to leae t$e #uct an# urineolume #ecreasesolume #ecreases
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+omeotaticontrol
inoling
Aldoterone
Formation of !ater ores
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Formation of !ater ores"
#ec$anism of %asopressin Action
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Aldoterone eleae/ the enin-Angiotenin
*atha#
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actor a$$ecting the releae o$ A"+.
actor a$$ecting releae o$ Atrial atriuretic
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actor a$$ecting releae o$ Atrial atriuretic
*eptide.
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rine ompoitionrine ompoition
aout '() *ater
+usuall contains urea, uric acid, and creatinine
reak do*n product from creatine p$osp$ate usedup in muscles.
+ma contain trace amounts of amino acids and
varing amounts of electroltes
+volume varies *it$ fluid intake, diuretics caffeine &
alco$ol. and environmental factors $eat, $umidit.
6 l F ti T t
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6enal Fun(tion Test
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,nulin,nulin
ClearanceClearance
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!78S7
%esika urinaria terisireseptor regang
sensorikN pelvikus aferen.
#edula Spinalis
parasimpatis eferen.
#iksiotot-otot perineum & sp$incter
uretra e/terna relaksasi, otot detrusorkontraksiurine melalui uretra
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*onduction of Urine
4i t iti $l
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p (23
4icturition e$le
!78S7
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!78S7
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4enjaga keeimbangan cairan tubuh
homeotai
keeimbangan -jumlah olume
-jumlah 6at terlarut -konentrain#a
Aupan cairan / - larutan!air dalam makanan
- hail metabolime 7+
8 tiap indiidu berbeda,
tergantung kebiaaan, aktiita, cuaca9
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*engeluaran cairan /
-inenible ater lo tidak dapat diatur
dengan tepat, terjadimeneru
eaporai leat kulit,
paru-paru :;00ml
-keringat : 100ml, dipengaruhi aktiita,
uhu
-$ee : 100ml, meningkat pada diare
-urin dalam pembentukann#a terdapat
mekanime untuk menjaga
keeimbangan cairan dan elektrolit
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7
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) d ; t ) l
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" 9rin5ing
eating
&rovides
ater
" 8idney
(onserves
ater soout&ut 4
inta5e
)ody ;ater )alan(e
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Bod !ater Balance
ir(ulating
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ir(ulating
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=hirt
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=hirt
+
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rine p+ B C.0?lood p+ D ;.)
?lood E+
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)uffer System
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RENAL SYSTEM
CARDIOVASCULAR
SYSTEM
RESPIRATORY
SYSTEM
Acid-base
balance
Gas exchange, ACE
Effective circulatingvolume control,
ECF osmolality,blood pressure
All of t$ese are
constantl c$anging,
tring to maintain
H0#10S2AS3S4
7ntegration 6enal = ardiovas(ular =
6es&iratory System
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TERIMA KASIHTERIMA KASIH
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