dr. Sri L kul-urine

7/25/2019 dr. Sri L kul-urine

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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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dr. Sri L kul-urine