FISIOLOGI GINJAL

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FISIOLOGI GINJAL

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  • dr. Sri Lestari Sulistyo Rini, M.ScTHE URINARY SYSTEM

  • The urinary system :

  • Ginjal menerima + 20% cardiac outputAliran darah ke ginjal 1-1,5 L / mntDarah yang difiltrasi 180 L / hr 125 ml/mntGinjal terletak retroperitonealSebuah ginjal 135-150 gr.

  • Renal Function1. Elimination of Waste Products 2. Regulation of Fluid Balance3. Regulation of Acid-Base Balance4. Nutrient Balance : - electrolytes : Na+, K+, Cl-, Ca++,Mg++ - amino acids, glucose, proteins vitamin5. Elimination, Detoxification of Drug and Toxins6. Endocrine Function : - erytropoietin - vitamin D metabolism - renin

  • Nefron Unit fungsional ginjalSebuah ginjal terdiri dari + 1 juta nefronNefron : - Glomerulus - Tubulus

  • Struktur Nefron

  • The NEPHRON: The Functional Renal Unit

  • Urine formationEliminasi produk sisa metabolikUrea, Kreatinin, Asam urat, Sulfat, Nitrat, Phosphat, dll.

    Proses :Filtrasi glomerulusReabsorpsi tubulusSekresi tubulusEkskresi

    Ekskresi = Filtrat reabsorpsi + sekresi

  • p 904Steps in Urine Formation

    1) Glomerular Filtration

    2) Tubular Reabsorption & Secretion

    3) Water Reabsorption (Conservation)

  • How the Kidney Works

  • Filtrasi Glomerulus

  • Filtrasi glomerulus

  • Filtrasi Glomerulus

  • Reabsorpsi dan Sekresi TubulusProximal TubulusReabsorpsi 80% air dan garamReabsorpsi semua glukosa, asam aminoReabsorpsi protein, urea, asam urat, bicarbonatSekresi ion Hidrogen, asam-basa organik

    ReabsorpsiAktif : glukosa, asam amino, natrium, dllPasif : air dan urea

    Transport maximum ( Tm) maksimum substansi yang di reabsorpsi per unit waktu

  • Transport maximum (Tm)Reabsorption will return solutes to the bloodBinding sites for transport can become saturated at high levelsSolutes not reabsorped are lost in the urineVitamin C is reabsorped unless plasma values are so high that transporters cant reabsorb any more then excess vitamin C lost in the urine

  • Loop of HenleDescending limb permeabel terhadap airAscending limb impermeabel terhadap air reabsorpsi Na dan ClTubulus DistalReabsorpsi Na, Cl dan airADH mempengaruhi permeabilitas terhadap airReabsorpsi dan sekresi KaliumAldosteron mempengaruhi reabsorpsi Natrium dan sekresi Kalium

  • Mekanisme Countercurrent

  • Saraf simpatis arteriol aferen & eferen vasokonstriksi, RBF menurun GFR menurun

    Hormonal Renin-Angiotensin Aldosteron ADH Atrial Natriuretic Peptide

    Renal Regulation

  • Duktus kolegentes Reabsorpsi Na dan Cl dipengaruhi ADH

  • HormonesAldosteroneActs on distal convoluted tubule cells to stimulate active transport of 3 molecules of Na+ out of tubule (reabsorption) for every 2 molecules of K + brought into tubule (secretion)Water from tubule lumen follows Na+ by osmosis into blood

  • Antidiuretic hormone (ADH)Acts to increase the number of aquaporins (water channels) in the collecting duct membranesCollecting ducts travel through hyperosmotic medullaHigher levels of ADH increase the number of aquaporins allowing water to leave the duct and urine volume decreases

  • antidiuretic hormone (ADH).Long-Term Effect of Osmolarity on BPADHDistal Tubule

  • Aldosterone Release: the Renin-Angiotensin Pathway

  • Factors affecting the release of ADH.

  • Factors affecting release of Atrial Natriuretic Peptide.

  • Renal Function Test

  • Inulin Clearance

  • MIKSIVesika urinaria terisi reseptor regang sensorik N pelvikus (aferen) Medula Spinalis parasimpatis (eferen)

    Miksi otot-otot perineum & sphincter uretra externa relaksasi, otot detrusor kontraksi urine melalui uretra

  • p 921Conduction of Urine

  • p 923Micturition Reflex

  • MIKSI

  • Menjaga keseimbangan cairan tubuh homeostasis

    keseimbangan -jumlah volume -jumlah zat terlarut -konsentrasinya

    Asupan cairan : - larutan/air dalam makanan - hasil metabolisme KH ( tiap individu berbeda, tergantung kebiasaan, aktivitas, cuaca)

  • Pengeluaran cairan : -insensible water loss tidak dapat diatur dengan tepat, terjadi menerus evaporasi lewat kulit, paru-paru +700ml-keringat + 100ml, dipengaruhi aktivitas, suhu-feses + 100ml, meningkat pada diare-urin dalam pembentukannya terdapat mekanisme untuk menjaga keseimbangan cairan dan elektrolit

  • KOMPARTEMEN-KOMPARTEMEN CAIRAN TUBUH Cairan ekstraseluler : plasma,cairan interstisial, transeluler ( cairan dalam sinovial, peritonium,perikardium, intraokular, serebrospinal) Cairan intraseluler Prosentase cairan dipengaruhi umur, jenis kelamin, derajat obesitas

  • Circulating Volume control

  • Urine pH ~ 6.0Blood pH = 7.4Blood [HCO3-] = 24 mMBlood PCO2 = 40 mmHgPlasma osmolality = 285 mOsm/kg waterUrine osmolality (depends upon hydration status) = 600 mOsm/kg water (note that this can vary between 50-1200 depending on water intake etc.)

    Normal Urine & Blood

  • Buffer System

  • RENAL SYSTEMCARDIOVASCULAR SYSTEMRESPIRATORY SYSTEMAcid-base balanceGas exchange, ACEEffective circulating volume control, ECF osmolality, blood pressureAll of these are constantly changing, trying to maintain HOMEOSTASIS!Integration Renal Cardiovascular Respiratory System

  • TERIMA KASIH

    *Increase in Osmolarity Dehydration due to sweating, diarrhea, or excessive urine flow will cause an increase in osmolarity of the blood and a decrease in blood volume and blood pressure.

    Long-Term Effect of Osmolarity on BP As increased osmolarity is detected there is both a short and long-term effect. For the long-term effect, the hypothalamus sends a signal to the posterior pituitary to release antidiuretic hormone (ADH).

    Antidiuretic Hormone ADH increases water reabsorption in the kidney.

    ADH in Distal Convoluted Tubule ADH promotes the reabsorption of water from the kidney by stimulating an increase in the number of water channels in the distal convoluted tubules and collecting tubules (ducts). These channels aid in the movement of water back into the capillaries, decreasing the osmolarity of the blood volume and therefore blood pressure.