Upload
yuliasminde-sofyana
View
244
Download
0
Embed Size (px)
Citation preview
7/27/2019 FISIOLOGI DIURESIS
1/26
FISIOLOGI DIURESIS
dr. Rohmania Setiarini
7/27/2019 FISIOLOGI DIURESIS
2/26
Gross Anatomy of the Kidney
7/27/2019 FISIOLOGI DIURESIS
3/26
A. Renal Vein
B. Renal Artery
C. Ureter
D. Medulla
E. Renal Pelvis
F. Cortex
1. Ascending loop ofHenle
2. Descending loop of
Henle
3. Peritubular
capillaries
4. Proximal tubule
5. Glomerulus
6. Distal tubule
The Kidney and the Nephron
7/27/2019 FISIOLOGI DIURESIS
4/26
Major Functions of the Kidneys
1. Regulation of:
body fluid osmolarity and volumeelectrolyte balance
acid-base balance
blood pressure
2. Excretion of
metabolic products
foreign substances (pesticides, chemicals etc.)
excess substance (water, etc)
3. Secretion of
erythropoitin
1,25-dihydroxy vitamin D3(vitamin D activation)
reninrosta landin
7/27/2019 FISIOLOGI DIURESIS
5/26
The Nephron
Functional unit of the kidney
(1,000,000)
Responsible for urine formation:
Filtration
Secretion
Reabsorption
7/27/2019 FISIOLOGI DIURESIS
6/26
The Nephron
Blood flow -
afferent arteriole
efferent arteriole
Peritubular capillaries
vasa recta
Structure of nephron
glomerulus
proximal
convoluted
tubule (pct)
loop of Henle
descendinglimb
ascending
limb
distalconvoluted
tubule
many nephrons
connect to collecting
duct
7/27/2019 FISIOLOGI DIURESIS
7/26
Renal tubules
and collecting
duct
7/27/2019 FISIOLOGI DIURESIS
8/26
THE GLOMERULUS
7/27/2019 FISIOLOGI DIURESIS
9/26
Components of plasma cross the three layers of the glomerular barrier during filtration
Capillary endothelium
Basement membrane
Epithelium of Bowmans Capsule
The ability of a molecule to cross the membrane depends on size, charge, and shape
Plasma is filtered through the
glomerular barrier
7/27/2019 FISIOLOGI DIURESIS
10/26
Glomerular Filtration Rate
(GFR)
Measure of functional capacity of the
kidney Dependent on difference in pressures
between capillaries and Bowmans space
Normal = 120 ml/min =7.2 L/h=180 L/day!!
7/27/2019 FISIOLOGI DIURESIS
11/26
GFR 125 ml/min (180L/day)
(about 1% is excreted)
7/27/2019 FISIOLOGI DIURESIS
12/26
Filtration, reabsoption, and excretion rates of substances by the kidneys
Filtered Reabsorbed Excreted Reabsorbed
(meq/24h) (meq/24h) (meq/24h) (%)
Glucose (g/day) 180 180 0 100
Bicarbonate (meq/day) 4,320 4,318 2 > 99.9
Sodium (meq/day) 25,560 25,410 150 99.4
Chloride (meq/day) 19,440 19,260 180 99.1
Water (l/day) 169 167.5 1.5 99.1
Urea (g/day) 48 24 24 50Creatinine (g/day) 1.8 0 1.8 0
7/27/2019 FISIOLOGI DIURESIS
13/26
Reabsorption
Active Transportrequires ATP
Na+, K+ ATP pumps
Passive Transport-Na+ symporters (glucose, a.a., etc)
Na+ antiporters (H+)
Ion channels
Osmosis
7/27/2019 FISIOLOGI DIURESIS
14/26
What is Reabsorbed Where?
Proximal tubule- reabsorbs 65 % of filtered Na+as well as Cl-,
Ca2+, PO4, HCO3-.75-90% of H20. Glucose, carbohydrates,
amino acids, andsmall proteinsare also reabsorbed here.
Loop of Henle- reabsorbs 25% of filtered Na+.
Distal tubule- reabsorbs 8% of filtered Na+.Reabsorbs HCO3-
Collecting duct- reabsorbs the remaining 2% of Na+only if the
hormone aldosteroneis present. H20depending on hormoneADH.
7/27/2019 FISIOLOGI DIURESIS
15/26
7/27/2019 FISIOLOGI DIURESIS
16/26
Secretion
Proximal tubuleuric acid, bile
salts, metabolites, some drugs, some
creatinine
Distal tubuleMost active secretion
takes place here including organic
acids, K+, H+, drugs, Tamm-
Horsfall protein (main componentof hyaline casts).
7/27/2019 FISIOLOGI DIURESIS
17/26
Hormones Produced by the
Kidney Renin:
Released from juxtaglomerular apparatus when lowblood flow or low Na+. Renin leads to production ofangiotensin II, which in turn ultimately leads to retention
of salt and water.
Erythropoietin: Stimulates red blood cell development in bone marrow.
Will increase when blood oxygen low and anemia (lowhemoglobin).
Vitamin D3: Enzyme converts Vit D to active form 1,25(OH)2VitD.
Involved in calcium homeostasis.
7/27/2019 FISIOLOGI DIURESIS
18/26
Renin, Angiotensin, Aldosterone:
Regulation of Salt/Water Balance
7/27/2019 FISIOLOGI DIURESIS
19/26
Aldosterone
A steroid hormone(mineralocorticoid) synthesizedfrom cholesterolby the enzyme aldosterone synthase.
It is formed in the outer-section (zona glomerulosa) of
the adrenal cortexof the adrenal gland. It helps regulate the body's electrolyte balance by
acting on the mineralocorticoid receptor(MR). It diminishes the excretion of Na+ions and therefore
water, and stimulates the excretion of K+ions by thekidneys.
Aldosterone is synthesized in reaction to increases ofangiotensin IIor plasmapotassium, which are present
in proportion to sodium deficiencies.
http://en.wikipedia.org/wiki/Steroid_hormonehttp://en.wikipedia.org/wiki/Cholesterolhttp://en.wikipedia.org/w/index.php?title=Aldosterone_synthase&action=edithttp://en.wikipedia.org/wiki/Zona_glomerulosahttp://en.wikipedia.org/wiki/Adrenal_cortexhttp://en.wikipedia.org/wiki/Adrenal_glandhttp://en.wikipedia.org/w/index.php?title=Mineralocorticoid_receptor&action=edithttp://en.wikipedia.org/wiki/Angiotensin_IIhttp://en.wikipedia.org/wiki/Blood_plasmahttp://en.wikipedia.org/wiki/Potassiumhttp://en.wikipedia.org/wiki/Potassiumhttp://en.wikipedia.org/wiki/Blood_plasmahttp://en.wikipedia.org/wiki/Angiotensin_IIhttp://en.wikipedia.org/w/index.php?title=Mineralocorticoid_receptor&action=edithttp://en.wikipedia.org/wiki/Adrenal_glandhttp://en.wikipedia.org/wiki/Adrenal_cortexhttp://en.wikipedia.org/wiki/Zona_glomerulosahttp://en.wikipedia.org/wiki/Zona_glomerulosahttp://en.wikipedia.org/wiki/Zona_glomerulosahttp://en.wikipedia.org/w/index.php?title=Aldosterone_synthase&action=edithttp://en.wikipedia.org/wiki/Cholesterolhttp://en.wikipedia.org/wiki/Steroid_hormone7/27/2019 FISIOLOGI DIURESIS
20/26
ADH (VASOPRESSIN)
A human hormone that is mainly released when the body islow on water.
It causes the kidneys to conserve water by concentratingthe
urine. If there is not enough water in the body
The osmotic activity of the EC solution is increased stimulation of theOSMOTIC RECEPTORSin the hypothalamus stimulation of posteriorlobe of the pituitary gland activation of VASOPRESSIN increaseof the permeability of collecting ductus for the water reabsorption
HYPERTONIC URINE If there is too much water in the body
The increase volume stimulates VOLUME RECEPTORSin the heartand big veins and arteries decrease of the activation ofVASOPRESSIN decrease of the permeability of collecting ductus forthe water water is not reabsorbed ISO- or HYPOOSMOTIC
URINE
http://en.wikipedia.org/wiki/Waterhttp://en.wikipedia.org/wiki/Water7/27/2019 FISIOLOGI DIURESIS
21/26
Perubahan volum urin karena adanya vasopresin
GFR (ml/mnt) Reabsopsi
(%)
Volum urin
(L/hr)
Konsentrasi
urin
(mOsm/kg
H2O)
Urin&plasma
isotonik
125 98,7 2,4 290
Vasopresin
(max
antidiuresis)
125 99,7 0,5 1400
Vasopresin(-)
(diabetes
insipidus)
125 87,1 23,3 30
7/27/2019 FISIOLOGI DIURESIS
22/26
Kinin-kallikrein system
A kininis any of various structurally relatedpolypeptides, such as bradykininand kallikrein, thatact locally to induce vasodilationand contraction of
smooth muscle.A role in inflammation, blood pressurecontrol,
coagulationand pain.
Produced and stored in distal tubule
Function: vasodilatation
secretion of prostaglandins (PGE2)
decrease of vasoconstriction and antidiuretic effects ofangiotenzin II.
increase of vasodilatation and diuretic effect of kinins
http://en.wikipedia.org/wiki/Polypeptideshttp://en.wikipedia.org/wiki/Bradykininhttp://en.wikipedia.org/w/index.php?title=Kallikrein&action=edithttp://en.wikipedia.org/wiki/Vasodilationhttp://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Blood_pressurehttp://en.wikipedia.org/wiki/Coagulationhttp://en.wikipedia.org/wiki/Painhttp://en.wikipedia.org/wiki/Painhttp://en.wikipedia.org/wiki/Coagulationhttp://en.wikipedia.org/wiki/Blood_pressurehttp://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Vasodilationhttp://en.wikipedia.org/w/index.php?title=Kallikrein&action=edithttp://en.wikipedia.org/wiki/Bradykininhttp://en.wikipedia.org/wiki/Polypeptides7/27/2019 FISIOLOGI DIURESIS
23/26
Prostaglandins
A prostaglandinis any member of a group of lipidcompounds that are derived from fatty acidsandhave important functions in the animalbody.
Every prostaglandin contains 20 carbonatoms,including a 5-carbon ring.
Hormone-like substances
Function: Vasodilatation
Increase of perfusion
Decrease of water reabsorption
Decrease of active Na+transport in tubules
http://en.wikipedia.org/wiki/Lipidhttp://en.wikipedia.org/wiki/Fatty_acidhttp://en.wikipedia.org/wiki/Animalhttp://en.wikipedia.org/wiki/Carbonhttp://en.wikipedia.org/wiki/Carbonhttp://en.wikipedia.org/wiki/Animalhttp://en.wikipedia.org/wiki/Fatty_acidhttp://en.wikipedia.org/wiki/Lipid7/27/2019 FISIOLOGI DIURESIS
24/26
Tempat kerja obat diuretik
7/27/2019 FISIOLOGI DIURESIS
25/26
12/19/2013
PENUAAN
Penurunan nefron yg fungsional
Penurunan GFR. Glomerulus sedikit,
kerusakan pada aparatus filtrasi, penurunan
aliran darah ginjal Penurunan sensitivitas pada ADH shg byk
sodium hilang melalui urin.
Permasalahan dengan reflex kencing
7/27/2019 FISIOLOGI DIURESIS
26/26
PrAy 26
erim k sih