THE URINARY SYSTEM

Pembentukan Urin dan Peran Ginjal

Dalam Keseimbangan Cairan Tubuh

dr. Sri Lestari Sulistyo Rini,

M.Sc

The urinary system :

Ginjal terletak retroperitoneal

Sebuah ginjal 135-150 gr.
Ginjal menerima 20-30% cardiac
output
Aliran darah ke ginjal 1-1,5 L / mnt
Darah yang difiltrasi 180 L / hr
125 ml/mnt

Renal Function
1. Elimination of Waste Products
2. Regulation of Fluid Balance
3. Regulation of Acid-Base Balance
4. Nutrient Balance : - electrolytes : Na +, K+,
Cl-,
Ca++,Mg++
- amino acids, glucose, proteins
vitamin
5. Elimination, Detoxification of Drug and Toxins
6. Endocrine Function : - erytropoietin
- vitamin D metabolism
- renin

Nefron Unit fungsional ginjal

- Sebuah ginjal terdiri dari + 1 juta nefron
- Nefron : - Glomerulus
- Tubulus

Struktur Nefron

The NEPHRON:
The Functional
Renal Unit

Afferent
Arteriole
Efferent
Arteriole

Urine formation
Eliminasi produk sisa metabolik
Urea, Kreatinin, Asam urat, Sulfat,
Nitrat, Phosphat, dll.
Proses :
1. Filtrasi glomerulus
2. Reabsorpsi tubulus
3. Sekresi tubulus
4. Ekskresi
Ekskresi = Filtrat reabsorpsi + sekresi

Steps in Urine Formation

1) Glomerular
Filtration
2) Tubular
Reabsorption
& Secretion
3) Water Reabsorption
(Conservation)

p 904

Urine Formation Preview

How the Kidney Works

Filtrasi Glomerulus

Pgc

gc

Pt

Filtrasi glomerulus

Filtration Membrane
Fenestrated endothelium
70-90nm pores exclude blood
cells
Basement membrane
proteoglycan gel, negative
charge excludes molecules >
8nm
blood plasma 7% protein,
glomerular filtrate 0.03%
Filtration slits
podocyte arms have pedicels
with negatively charged
filtration slits, allow particles
< 3nm to pass

Filtrasi Glomerulus

Reabsorpsi dan Sekresi

Tubulus
Proximal Tubulus
Reabsorpsi 80% air dan garam
Reabsorpsi 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

PCT Nutrient (glucose, amino acids)

reabsorption = Normally 100% returned via cotransport
with Na+

Transport maximum (Tm)

Reabsorption will return solutes to the
blood
Binding sites for transport can become
saturated at high levels
Solutes not reabsorped are lost in the
urine
Vitamin 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 Henle
Descending limb permeabel terhadap air
Ascending limb impermeabel terhadap air
reabsorpsi Na dan Cl

Tubulus Distal
Reabsorpsi Na, Cl dan air
ADH mempengaruhi permeabilitas terhadap air
Reabsorpsi dan sekresi Kalium
Aldosteron mempengaruhi reabsorpsi Natrium
dan sekresi Kalium

Mekanisme Countercurrent

Renal Regulation

Saraf simpatis arteriol aferen & eferen

vasokonstriksi, RBF menurun
GFR menurun
Hormonal Renin-Angiotensin
Aldosteron
ADH
Atrial Natriuretic Peptide

Renal Autoregulation of GFR

BP constrict
afferent arteriole, dilate
efferent
BP dilate afferent
arteriole, constrict
efferent
Stable for BP range of 80
to 170 mmHg (systolic)
Cannot compensate for
extreme BP

Glomerular Filtration Rate

(GFR)

Renal autoregulation
Regulation of NFP
Macula densa

Cells of DCT
Slow filtrate flow, low
osmolality (low Na,
Cl) causes dilation of
afferent arterioles
High flow, high
osmolality causes
contraction of JGA
cells, vasoconstriction

Duktus kolegentes
Reabsorpsi Na
dan Cl
dipengaruhi ADH

Hormones
Aldosterone
Acts 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 membranes
Collecting ducts travel through
hyperosmotic medulla
Higher levels of ADH increase the
number of aquaporins allowing
water to leave the duct and urine
volume decreases

Homeostatic
Control
involving
Aldosterone

Formation of Water Pores:

Mechanism of Vasopressin Action

Aldosterone Release: the Renin-Angiotensin

Pathway

Factors affecting the release of ADH.

Factors affecting release of Atrial Natriuretic

Peptide.

Urine Composition
about 95% water
usually contains urea, uric acid, and creatinine
(break down product from creatine phosphate used
up in muscles)
may contain trace amounts of amino acids and
varying amounts of electrolytes
volume varies with fluid intake, diuretics (caffeine &
alcohol) and environmental factors (heat, humidity)

Renal Function Test

Inulin
Clearance

MIKSI
Vesika 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

Conduction of Urine

Micturition Reflex

p 923

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

Body Water Balance

Drinking &
eating
provides
water
Kidney
conserves
water so
output =
intake

Body Water Balance

Circulating Volume control

Thirst
Osmoreceptors detect changes decreases in
blood volume and increases in blood solute levels
They activate the thirst center in hypothalamus and
ADH-secreting cells
Angiotensin II
formed from the interaction of renin (produced by
the kidneys) with circulating angiotensinogen in the
plasma
also acts on brain to promote thirst and ADH
secretion

Normal Urine & Blood

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

Buffer System

Integration Renal Cardiovascular

Respiratory System
RENAL SYSTEM
Effective circulating
volume control,
ECF osmolality,
blood pressure

Acid-base
balance
All of these are
constantly changing,
trying to maintain
HOMEOSTASIS!

CARDIOVASCULAR
SYSTEM

RESPIRATORY
SYSTEM

Gas exchange, ACE

TERIMA KASIH