42072060 fisiologi-ginjal

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  • 1. FISIOLOGIGINJAL Shofa chasani Bag. Fisiologi dan sub bag penyakit ginjal hipertensi Penyakit Dalam FK UNDIP/ RSUP DRKariadi Semarang

2. Fisiologi GINJAL

  • Regulation of body fluid osmolality and volume
  • Regulation of electrolyte balance
  • Regulation of acid-base balance
  • Excretion of metabolic product and foreign substance
  • Production and secretion of hormones

3. PHYSIOLOGY OF BODY FLUID 1.PHYSICOCHEMICAL PROPERTIES OF ELECTROLYTE SOLUTION 2.VOLUME OF BODY FLUID COMPARTMENTS 3.MESASUREMENT OF BODY FLUID VOLUME 4.COMPOSITION OF BODY FLUID COMPARTMENT 5.FLUID EXCHANE 4. VOLUMES OF BODY FLUID COMPARTMENT Total body water(TBW)=0,6BW=42 L ECF=1/3 TBW=14L ICF=2/3 TBW=28L Interstial fluid ECF =10,5L Plasma=1/4ecf 3.5L Cell mbr Cap. endotel 5. FLUID EXCHANG BETWEEN BODY FLUID COMPARTMEN Capillary fluid exchange : Fluid movement =Kf [(Pc +Oi)- (Pt=Oc)] Kf=filtration coeff of the cap. Wall Pc=hydrostatic pressure within the cap. Lumen. Oc= oncotic pressue of the plasma. Pt = hydrostatic pressure of the interstitium Oi = oncotic pressure of the interstitial fluid. 6. Celluler fluid exchange : osmotic pressure difference between ECF and ICF are responsible for fluid movementbetween these compartment 7. ALTERATION IN STARLING FORCE

  • .Increasing in capillary hydrostatic (Pc)
  • Decrease in plasma oncotic pressure(Oc)
  • Lymphatic obstruction.
  • Increase in capillary permiabelity.

8. THE ROLE OF THE KIDNEY VENOUS PRESSURE CAPILLARY HYDROS PRESSURE MOVE OF FLUID INTO INTERSTITIUM PLASMA VOLUME VOL RECEPTORS DETECTECF NaCl and H2O Reabsorption by The kidney Restore plasma volume 9. STRUCTURE AND FUNCTION OF THE KIDNEYS AND THE LOWER URINARY TRACT OBYECTIVES 1.Describe the location of the kidneys and their gross anatomical feature. 2.Describe the defferent parts of the nephron and their location within the cortex and medulla. 3.Identify the components of the glomerulus and the cell typeslocated in each component. 4.Describe the structur of glomerular capillaries and identifywhich structures are filtration barriers to plasma proteins. 10. OBYECTIVE 5.Describethe components of the yuxtaglomerular apparatus and the cells located in each component 6.Describe the bood supply to the kidneys. 7.Describe the innervation of the kidneys. 8.Describe the anatomy and physiology of thelower urinary tract. 11. STRUCTURE OF THE KIDNEYS 12. 13. 14. 15. Yuxtaglom: is one component of an important feedback mechanism that is involved in the autoregulation of RBF and GFR 16. GLOMERULAR FILTRATIONAND RENAL BLOOD FLOW OBJECTIVES 1. Describe the concepts of mass balance and clearence and explain how they are used to analyze renal trnsport 2. Define the three general process by which substances are handled by the kidneys:glom. Filtration, tub.reabsorb andtub. Secretion. 3. Explain the use of inulinand creatinine clearence to mea- sure the GFR. 4. Explain the use of p-aminohippuric acid (PAH) clearenceto measure renal plasma flow(RPF) 5. Describethe composition of theglom.ultrafiltrate, andidentify which molecule are not filtered by the glomerulus. 17. OBJECTIVES(cont.) 6. Explain how the los of negative charges on the glom. capillaries resultsin proteinuri. 7.Describe starling forces involved in the formation of the glom. Ultrafiltrate , and explain how charges in each force affect the glom.filtration rate. 8.Explain how the starling force change along the lengthof the glom. Capillaries. 9.Describe how changes in the renal plasma flowrate influence the GFR. 10.Explain autoregulation pf renal blood flow and the GFR and identify the factors responsible for autoregulation 11.Identify the major hormones that influence RBF. 12.Explain how and why hormones influence RBF despite autoregulation. 18. 19. RENAL CLEARENCE

  • GLOMERULAR FILTRATION
  • REABSORBTION
  • SECRETION

C x= Ux X V Px Cx=clearence x Ux=conc. x in urine V= urine flow rate/minute P= conc. x in plasma 20. MEASUREMENT OF GFRCLEARENCEOF INULIN Amount filtered = amount excreted GFR X Pin=Uin X VGFR=Uin X V Pin 21. MEASUREMENT OF RENAL PLASMA FLOWAND RENAL BLOOD FLOW. RPF= CLEARENCE OF PAHPAH LOW 0,12mg/ml RPF=Upah X V P pah RBF=RPF 1 - HCT 22. REQUIREMENTS FOR USE OF A SUBSTANCE TO MEASUREGFR

  • The substance must be freely filtered by the
  • glomerulus.
  • The substance must not be reabsorbedor
  • secreted by the nephron .
  • The substance must not be metabolized or
  • produce by the kidney.
  • 4.The substance must not alter GFR

23. 24. RENAL BLOOD FLOW RBF = 25% CARDIAC OUT PUT (1.25 L/min)

  • THE IMPORTANT FUCTION OF RBFINCLUDING:
  • Determining the GFR
  • Modifying the rate of solute and water reabsorption by
  • the proximal tubule.
  • Participating in the concentration and dilution of urine.
  • Delivering oxygen, nutrients and hormones to the nephron
  • cell and returning CO2 and reabsorbed fluid and solute to
  • general circulation.

25. REGULATION OF RENAL BLOOD FLOW hemorrhage Arterial blood pressure Intra renal receptors Renin secretion Plasma renin Plasma angiotensin Constriction of Renal arterioles RBF and GFR Activity of renal Symphatic nerves Carotic sinus and Aortic arch reflexs 26. RENAL TRANSPORT MECHANISM NaCL AND WATER REABSORPTION ALONG THE NEPHRON OBJECTIVE 1.Explainthe three processes involved in the production of urine a. filtrationb. reabsorptionc. secretion.. 2.Describe the magnitude of the processes of filtration and reab- sorption by the nephron. 3.Describe the composition of normal urine. 4.explain the basic transport mechanisms present in each nephron segment. 5.Describe how water reabsorption is coupled to Na+ reabsorp tion in the proximal tubule. 6.Explain how solutes, but not water , are reabsorbed by the thick ascending limb of Henles loop. 27. OBJECTIVE-COUNT . 7. Describe how Starling forces regulate solute and waterreabsorptionacross the proximal tubule. 8. Explain glomerulotubular balance and its phy- siological significance . 9. Identify the major hormones that regulate NaCland water reabsorption by its nephron segment 28. COMPOSITION OF URINE SUBSTANCECONCENTRATION Na+50- 150 meq/l K+20- 70meq/l NH4-30-50meq/l Ca++5-12meq/l Mg++2-18meq/l Cl -50- 130 meq/l PO420-40meq/l Urea200 400 mM Kreatinin6-20mM pH5-7 Osmolality500 -800 mOsm/Kg H2O others0 29. Tubuler fluid Paracelluler pathway Transcelluler pathway Tight junction Apical cell membrane Lateral intercellular space blood Na+ K+ Na+ Na+ Basolateral membrane Capillary Basement membrane ATP ATP ATP 30. Tubular fluid blood Na+ X Na+ H+ HCO3 K+ Na+ ATP X CO2 + H2O CA First half of proximal tubule 31. Tubular fluid blood NaCl H2O Na+ Cl- organics H2O 0rganics Na+Cl- organic Na+Cl- organics Na+Cl- H2O 32. Tubular fluid CL- Na+ Na+ Na+Na+ H+ Hbase Base Cl- Cl- Na+ Cl- Hbase K+ ATP K+ Cl- blood Second half of proximal tubule 33. Some organic secreted by the proximal tubule Endogenous anionsDrug cAMPacetazolamide Bile saltschlorothiazide Hippurate(PAH)furosemide Oxalatepenicillin Prostaglandinsprobenecid Uratesalicylate(aspirin) hidrochlorthiazide bumetanide 34. Some organic cations secreted by the proximal tubule Endogenous cationsDrugs Creatinineatropine Dopamineisoproterenol Epinephrinecimetidine Norepinephrinemorphine quinine amiloride 35. Tubular fluid A- PAH (OA - ) Na+ K+ Na+ Di/tri carboxylase Di/tri carboxylase PAH(OA-) ATP BLOOD 36. REGULATION OF ECF OBJECTIVE

  • Recognize the vital role Na plays in determining the
  • volume of the ECF compartment.
  • Explain theconcept of effective circulating volume
  • and its role in the regulation of renal Na+ excretion.
  • Describe the mechanisms by which the body monitors
  • the effective circulating volume ( volume receptors )

37. OBJECTIVEcont. 4. Identify the major signals acting on the kidney to alter their excretion of Na+. 5. Describe the regulation of Na+ reabsorption in each of the various portion of the nephron and how changes in effective circulating volume affect these regulatory mechanisms. 6. Explain the pathophysiology of edema formation and the role of Na+ retention by the kidneys 38. CONCEPT OF EFFECTIVE CIRCULATING VOLUME Effective circulating volume Volume sensors KidneyAlteration in NaCl excretion 39. ECF VOLUME RECEPTORS Vasculerlow pressure cardiac atria pulmonary vasculature high pressure carotid sinus aortic arch yuxtaglomeruler apparatus of the kidney (afferent arteriole) Central nervous system Hepatic 40. SIGNALS INVOLVED IN THE CONTROL OF RENAL NaClANDWATER EXCRETION Renal sympathetic nerves (activity NaCl excretion ) 1.Glomerular filtration rate2.Renin secretion 3.Prox, tubule and thick ascending limb of Henles loop NaCl reabsorption 41. SIGNALS INVOLVED IN THE CONTROL OF RENAL NaClANDWATER EXCRETIONcont

  • Renin Angiotensin aldosteron
  • (secretion :NaCl axcretion )
  • Angiotensin II levels stimulate prox.
  • tubule NaCl reabsorption.
  • Aldosteron levels stimulate thick ascend limb of Henles loopand collect.Duct NaCl reabsorption.
  • ADH secretion

42. SIGNAL INVOLVED IN THE CONTROL OF RENAL NaCl AND WATER EXCRETIONcont

  • Atrial Natriuretic Peptide (Secretion :NaCl excretion)
  • GFR
  • Renin secretion.