URINARY SYSTEM

Urinary system rids the body of

waste materials and control the
volume and composition of
body fluids
Fungsi Ginjal

1.Ekskresi/Pembentukan Urine
 Mempertahankan homeostasis
 Mengatur osmolalitas ECF
 Mengatur volume ECF
 Mengatur pH ECF
2. Endokrin/Hormon (Non Ekskresi)
 Menghasilkan renin  mengatur TD
 Menghasilkan erythropoeitin  stimulasi
eritropoeisis oleh sumsum tulang
 Mengaktifkan vitamin D dengan
menghasilkan 1, 25-dihydroxycholecalciferol
absorbsi Ca dalam usus dipermudah
 Menghasilkan prostaglandin
 Menghasilkan Kinin
Internal structure of the kidney
Blood supply of the kidney:
21% of the cardiac output =
1200 ml/mnt
Nephron

 Merupakan unit fungsional ginjal

 1 ginjal terdapat ± 1,2 juta nephron
 Berdasarkan lokasi dibedakan atas 2 yi
cortical dan juxtamedullary nephron
 Struktur nephron terbagi atas :
Glomerulus dan,
 Tubulus renalis; tubulus proximal, loop of
Henle & tubulus distal serta collecting
duct
 Vascular supply to the nephron

Proximal convoluted
tubule
Efferent arteriole
Afferent arteriole
Glomerulus

Arcuate vein Distal convoluted tubule

Arcuate artery
Collecting duct

Vasa recta
Thick ascending limb
of the loop of Henlé

Descending limb
loop of Henlé
Thin ascending limb
of the loop of Henlé
Cortical & Juxtamedullary
nephron
Cortical Nephron
 Glomerulus terletak 2/3
bagian luar cortex
 85% dari seluruh
nephron
 Loop of henle pendek
 Dikelilingi oleh kapiler
peritubular berbentuk jala
 network
Juxtamedullary Nephron
 Terletak bagian dalam
cortex dekat medulla
 15% dari seluruh
nephron
 Loop of henle panjang,
lebih dalam masuk ke
medulla
 Dikelilingi kapiler
berbentuk U  vasa
recta
 Structure of the Bowman’s (glomerular) capsule

Parietal layer of
Afferent arteriole
glomerular capsule
Juxtaglomerular
cell

Capsule
space
Efferent arteriole
Proximal
convoluted
tubule

Endothelium
Podocyte of glomerulus
Pedicel
 Stellate cells called mesangial cells are
located between the basal lamina and
the endothelium. They are similar to cells
called pericytes, which are found in the
walls of capillaries elsewhere in the
body.
 Mesangial cells are especially common
between two neighboring capillaries, and
in these locations the basal membrane
forms a sheath shared by both
capillaries (Figure 38–2).
 The mesangial cells are
contractile and play a role in the
regulation of glomerular
filtration.
 Mesangial cells secrete the
extracellular matrix, take up
immune complexes, and are
involved in the progression of
glomerular disease.
Formation of Urine
Involves three main processes:
 1.Filtration
 2.Reabsorption
 3.Secretion
Filtration membrane

Is composed of three layers:

1. fenestrated glomerular endothelium
2.basement membrane
3.filtration slits are formed by the pedicels
of the podocytes

Substance are filtered are on the basis of

size and/or electrical properties
Glomerular Filtration Membrane

Insert fig. 17.8

Glomerular Filtration Membrane

 Endothelial capillary pores are large

fenestrae.
 100-400 times more permeable to
plasma, H20, and dissolved solutes than
capillaries of skeletal muscles.
 Pores are small enough to prevent
RBCs, platelets, and WBCs from
passing through the pores.
 Glomerular Filtration Membrane

 Filtrate must pass through the basement

membrane:
 Thin glycoprotein layer.
 Negatively charged.

 Podocytes:
 Foot pedicels form small filtration slits.
 Passageway through which filtered molecules must pass.
 The filtration barrier - podocytes

pedicel filtration
basal slit
lamina

fenestrated
endothelium

basal
lamina
podocyte

filtration
slit

fenestrated podocyte
endothelium
secondary primary cell body
process process
(pedicel)
 The filtration barrier - pedicels
Bowman’s
space

pedicel

filtration
slit

capillary
Common component of the glomerular
filtrate:
 Organic molecules: glucose,amino
acids
 Nitrogenous waste: urea, uric acid,
creatinine
 Ions: sodium, potassium, chloride
 Rumus tekanan filtrasi

 Kf, the glomerular ultrafiltration coefficient, is

the product of the glomerular capillary wall
hydraulic conductivity (ie, its permeability)
and the effective filtration surface area.
 PGC is the mean hydrostatic pressure in the
glomerular capillaries, PT the mean
hydrostatic pressure in the tubule
(Bowman’s space), πGC the oncotic pressure
of the plasma in the glomerular capillaries,
and πT the oncotic pressure of the filtrate in
the tubule (Bowman’s space).
Forces affecting filtration
 Glomerular hydrostatic pressure (blood
pressure) promotes filtration=55 mmHg
 Capsular hydrostatic pressure opposes
filtration=15 mmHg
 Glomerular osmotic pressure opposes
filtration=30 mmHg
 Net filtration pressure =
55 – (15+30) =10 mmHg
 GAYA FISIK YANG TERLIBAT DALAM FILTRASI
GLOMERULUS

1. Tekanan darah kapiler

PI PC
gomerulus (PGC) = 55 mmHg
2. Tekanan osmotik koloid PI PC
plasma (IIGS) = 30 mmHg
3. Tekanan hidrostatik kapsul
Bowman (PBC) = 15 mmHg
Aff. Art. Eff. Art.
Tekanan filtrasi netto :
= PGC – (IIGS – PBC) PGC PGS
= 55 - (30+15)
= 10 mmHg PBC
Glomerular filtration rate

The total amount of filtrate formed by the kidney

per minutes

 Sekitar 20% dari renal plasma flow

 Nilai GFR ditentukan oleh: (1) keseimbangan

antara tekanan hidrostatis dan osmotik (2)
filtration coefficient kapiler (Kf) yaitu
permeabilitas dan area permukaan filtrasi

 GFR normal 125 ml/min, atau 180 L/day.

 Autoregulation Mechanism
To counteract changes in GFR
Myogenic mechanism
 Increased systemic pressure: Autoregulation:
afferent arteriole diameter decreased (constricted)
to maintain the GFR
 Decreased systemic pressure: Autoregulation:
afferent arteriole diameter increased (dilated) to
maintain the GFR
Qualities of agents to measure GFR
 Inulin: (Polysaccharide from Dahalia plant)

 Freely filterable at glomerulus

 Does not bind to plasma proteins
 Biologically inert
 Non-toxic, neither synthesized nor metabolized in
kidney
 Neither absorbed nor secreted
 Does not alter renal function
 Can be accurately quantified
 Low concentrations are enough (10-20 mg/100 ml plasma)
 Creatinine:
 End product of muscle creatine metabolism
 Used in clinical setting to measure GFR but less
accurate than inulin method
 Small amount secrete from the tubule
 Para-aminohippurate (PAH):
 An organic anion not present in body
 Freely filtered, secreted but not reabsorbed by
nephron
 Non-toxic, neither synthesized nor metabolized
in kidney
 Low concentrations are enough (10 mg/100 ml plasma)
 RPF = ClearancePAH = UPAH.V / PPAH
 Solute Clearance:
Rate of removal from the Blood

Figure 19-16: Inulin clearance

 Concept of clearance
Qx extracted = Qx excreted

Px . Cx = Ux . V Where,
Cx = Clearance of substance X (mg/min)
Ux = Urine concentration of X (mg/ml)
Ux . V
GFR = Cx = Px = Plasma concentration of X (mg/ml)
Px V = Urine flow rate of X (ml/min)

Effective renal plasma flow =GFR

ERPF
Effective renal blood flow = ERBF = Cx = Hct=hematocrit
1 - Hct

ERBF
RBF =
Renal blood flow = Extraction ratio

APAH - VPAH APAH = arterial plasma PAH

Extraction ratio (0.9) =
APAH VPAH = vein plasma PAH
Early Filtrate Processing
 Gambaran seluler dari tubulus
renalis
 Tubulus proximal: simple cuboidal cells
(brush border cells ok terdapat microvilli)
 Thin loop of henle: simple squamous cell,
highly permeable to water not to solute
 Thick ascending loop of henle & early
distal tubule: cuboidal cells, highly
permeable to solutes, particularly NaCl but
not to water
 Late distal tubule and cortical collecting
duct: cuboidal cells has two distinct
function:
 1. principal cells; permeability to water
and solutes are regulated by hormones
and,
 2. intercalated cells; secretion of hydrogen
ion for acid/base balancing
 Medullary collecting duct; principal cells;
hormonally regulated permeability to
water and urea
 Tubular Reabsorption
 By passive diffusion
 By primary active transport: Sodium
 By secondary active transport: Sugars and
Amino Acids
 Endositosis ; small proteins and peptide
hormones
 Reabsorption Pathways
 There are two reabsorption pathways:

1. the transcellular pathway (>>)

2. the paracellular pathway

Reabsorpsi Filtrat
 Trancellular pathway : Through luminal
and basolateral membranes of the tubular
cells into the interstitial space and then
into the peritubular capillaries.
 Paracellular pathway : through the tight
junctions into the lateral intercellular
space.
 Water and certain ions use both
pathways, especially in the proximal
convoluted tubule.
 Diffusion of Water

 Water diffuses from the lumen through the

tight junctions into the interstitial space:
 1. Water will move from its higher
concentration in the tubule through the
tight junctions to its lower concentration in
the interstitium.
 2. Water will also move through the
plasma membranes of the cells that are
permeable to water
 Sodium Reabsorption
PUMP: Na/K ATPase

Sodium
Lumen
Cells
Potassium

Plasma
Chloride

Water

 Keluar dari sel ke

interstiital
 Tubular Secretion
 Protons (acid/base balance)
 Potassium
 Organic ions
 Zat-zat lain yg tidak normal ada dalam
darah spt obat-obatan dan bahan-bahan
toksik
 Transport Maximum (Tm)

For most actively reabsorbed solutes, the

amount reabsorbed in the PCT is limited only by
the number of available transport carriers for
that specific substance.
This limit is called the transport maximum, or Tm.
If the volume of a specific solute in the filtrate
exceeds the transport maximum, the excess
solute continues to pass unreabsorbed through
the tubules and is excreted in the urine.
Reabsorption: Receptors can Limit

Figure 19-15: Glucose handling by the nephron

 The final processing of filtrate in the
late distal convoluted tubule and
collecting ducts comes under direct
physiological control in response to
changing physiological conditions and
hormone levels.
 Membrane permeabilities and cellular
activities are altered in response to the
body's need to retain or excrete specific
substances.
 Distal Tubule & Collecting Duct
 The Late Distal Tubule & CCT are
composed of principal cells & intercalated
cells
 Intercalated cells secrete hydrogen ions
into filtrate
 Principals cells perform hormonally
regulated water & sodium reabsorption &
potassium secretion
 Role of Aldosteron
 Principal cells are more permeable to
sodium ions and water in the presence of
Aldosterone & ADH
 Low level of Aldosterone result in little
basolateral sodium/potassium ATPase ion
pump activity & few luminal sodium &
potassium channel
 Aldosteron increases the number of
basolateral Na/K pump and luminal Na
& K channels
 Since there are no basolateral K
channel, K ion are secreted into the
instead of returning to the interstitium
 Without an increase in water
permeability, the interstitial osmolarity
increases
 Role of ADH
 Principals cells are more permeable to
water on the presence of ADH
Reabsorption in Proximal Tubule
 Glucose and Amino Acids
 67% of Filtered Sodium
 Other Electrolytes
 65% of Filtered Water
 50% of Filtered Urea
 All Filtered Potassium
 Juxtaglomerular apparatus

 As the thick ascending loop of henle

transition into early distal tubule, the
tubule runs adjacent to the afferent and
efferent arteriole.
 Where these structure are contact they
form the monitoring structure called the
juxtaglomerular apparatus (JGA), which is
composed macula densa and JG cells
Figure 19-9: The juxtaglomerular apparatus
 TUBULOGLOMERULAR FEEDBACK &
GLOMERULOTUBULAR BALANCE
 Signals from the renal tubule in each nephron
feedback to affect filtration in its glomerulus. As the
rate of flow through the ascending limb of the loop
of Henle and first part of the distal tubule increases,
glomerular filtration in the same nephron decreases,
and, conversely, a decrease in flow increases the
GFR
 This process, which is called tubuloglomerular
feedback, tends to maintain the constancy of
the load delivered to the distal tubule.
 The sensor for this response is the macula densa.
 The amount of fluid entering the distal
tubule at the end of the thick ascending
limb of the loop of Henle depends on the
amount of Na+ and Cl– in it.
 The Na+ and Cl– enter the macula densa
cells via the Na–K–2Cl cotransporter in
their apical membranes.
 The increased Na+ causes increased Na, K
ATPase activity and the resultant
increased ATP hydrolysis causes more
adenosine to be formed.
 Presumably, adenosine is secreted from the
basal membrane of the cells. It acts via
adenosine A1 receptors on the macula densa
cells to increase their release of Ca2+ to the
vascular smooth muscle in the afferent
arterioles.
 This causes afferent vasoconstriction and a
resultant decrease in GFR.
 Presumably, a similar mechanism generates a
signal that decreases renin secretion by the
adjacent juxtaglomerular cells in the afferent
arteriole but this remains unsettled
 Conversely, an increase in GFR causes an
increase in the reabsorption of solutes,
and consequently of water, primarily in
the proximal tubule, so that in general the
percentage of the solute reabsorbed is
held constant.
 This process is called glomerulotubular
balance, and it is particularly
prominent for Na+.
 The change in Na+ reabsorption occurs within
seconds after a change in filtration, so it seems
unlikely that an extrarenal humoral factor is
involved.
 One factor is the oncotic pressure in the
peritubular capillaries.
 When the GFR is high, there is a relatively large
increase in the oncotic pressure of the plasma
leaving the glomeruli via the efferent arterioles and
hence in their capillary branches.
 This increases the reabsorption of Na+ from the
tubule. However, other as yet unidentified
intrarenal mechanisms are also involved.
 Sympathetic control

In extreme stress or blood loss,

sympathetic stimulation overrides the
autoregulation

 Increased sympathetic discharge cause

intense constriction of renal blood vessel
 Blood is shunted to other vital organs
 GFR reduction causes minimal fluid loss
from blood
 Reduction filtration can not go indefinitely,
a waste product build up & metabolic
imbalances increase in blood
 IV fluid increases blood volume  restores
blood pressure to resting levels  reduced
sympathetic stimulation allows for normal
arteriole diameter  GFR & filtrate flow is
normalized
Sympathetic Regulation of GFR

Insert fig. 17.11

 COUNTERCURRENT MECHANISM

 The concentrating mechanism depends

upon the maintenance of a gradient of
increasing osmolality along the
medullary pyramids.
 This gradient is produced by the operation
of the loops of Henle as countercurrent
multipliers and maintained by the
operation of the vasa recta as
countercurrent exchangers.
 The operation of each loop of Henle as a
countercurrent multiplier depends on the
high permeability of the thin descending
limb to water (via aquaporin-1), the active
transport of Na+ and Cl– out of the thick
ascending limb, and the inflow of tubular
fluid from the proximal tubule, with
outflow into the distal tubule.
DIFFERENCES IN THE NEPHRON LOOP
The descending
limb:-
1. Highly permeable
to water
2. Relatively
impermeable to
sodium

The ascending limb:-

1. Impermeable
to water
2. Actively transports
sodium out of the
filtrate
 ROLE OF UREA
 Urea contributes to the establishment of the
osmotic gradient in the medullary pyramids and
to the ability to form a concentrated urine in
the collecting ducts.
 Urea transport is mediated by urea
transporters, presumably by facilitated
diffusion.
 The amount of urea in the medullary
interstitium and, consequently, in the urine
varies with the amount of urea filtered, and this
in turn varies with the dietary intake of protein.
 OSMOTIC DIURESIS
 The presence of large quantities of
unreabsorbed solutes in the renal tubules
causes an increase in urine volume called
osmotic diuresis.
 Osmotic diuresis is produced by the
administration of compounds such as mannitol
and related polysaccharides that are filtered but
not reabsorbed. It is also produced by naturally
occurring substances when they are present in
amounts exceeding the capacity of the tubules
to reabsorb them. For example, in diabetes
mellitus
 It is important to recognize the difference
between osmotic diuresis and water diuresis.
 In water diuresis, the amount of water
reabsorbed in the proximal portions of the
nephron is normal, and the maximal urine
flow that can be produced is about 16
mL/min.
 In osmotic diuresis, increased urine flow is
due to decreased water reabsorption in the
proximal tubules and loops and very large
urine flows can be produced.
 The water diuresis produced by
drinking large amounts of hypotonic fluid
begins about 15 min after ingestion of a
water load and reaches its maximum in
about 40 min.
 The act of drinking produces a small
decrease in vasopressin secretion before
the water is absorbed, but most of the
inhibition is produced by the decrease in
plasma osmolality after the water is
absorbed.
 Ureter
 Merupakan saluran yang menghubungkan
ginjal ke kandung kemih, yang
merupakan lanjutan renal pelvis.
 Panjang 10-12 inchi.
 Ureter memasuki kandung kemih melalui
bagian posterior dengan cara menembus
otot detrusor di daerah trigonum kandung
kemih
 Dinding ureter terdiri dari otot polos &
dipersarafi oleh saraf simpatis &
parasimpatis.
 Kontraksi peristaltik pada ureter
ditingkatkan oleh perangsangan
parasimpatis & dihambat oleh
perangsangan simpatis.
 Peristalsis dibantu gaya gravitasi akan
memindahkan urine dari ureter ke
kandung kemih.
 BLADDER
 FILLING
 The walls of the ureters contain smooth
muscle arranged in spiral, longitudinal, and
circular bundles, but distinct layers of
muscle are not seen.
 Regular peristaltic contractions occurring
one to five times per minute move the urine
from the renal pelvis to the bladder, where it
enters in spurts synchronous with each
peristaltic wave.
 The ureters pass obliquely through the
bladder wall and, although there are no
ureteral sphincters as such, the oblique
passage tends to keep the ureters closed
except during peristaltic waves, preventing
reflux of urine from the bladder.
 EMPTYING
 The smooth muscle of the bladder, like
that of the ureters, is arranged in spiral,
longitudinal, and circular bundles.
 Contraction of the circular muscle, which
is called the detrusor muscle, is mainly
responsible for emptying the bladder
during urination (micturition).
 Muscle bundles pass on either side of the
urethra, and these fibers are sometimes
called the internal urethral sphincter,
although they do not encircle the
urethra.
 Farther along the urethra is a sphincter of
skeletal muscle, the sphincter of the
membranous urethra (external urethral
sphincter).
 Micturition is
fundamentally a
spinal reflex
facilitated and
inhibited by higher
brain centers and,
like defecation,
subject to
voluntary
facilitation and
inhibition.
 The first urge to void is felt at a bladder volume
of about 150 mL, and a marked sense of
 During micturition, the perineal muscles
and external urethral sphincter are
relaxed, the detrusor muscle contracts,
and urine passes out through the urethra.
 The bands of smooth muscle on either
side of the urethra apparently play no role
in micturition, and their main function in
males is believed to be the prevention of
reflux of semen into the bladder during
ejaculation
 Kandung Kemih
(Vesica Urinaria)
 Berfungsi menampung/menyimpan urine
sementara.
 Terdiri atas :
1. Badan (corpus) = bagian utama kandung
kemih dimana urine terkumpul.
2. Leher (kollum) = lanjutan dari badan
yang berbentk corong, berjalan secara
inferior dan anterior ke dalam daerah
segitiga urogenital & berhubungan
dengan urethra.
Dinding kandung kemih :
 3 lapisan otot polos (detrusor
muscle)
 Mucosa : ‘transitional epithellium’
 Dinding : tebal &
berlipat saat
kandung kemih kosong.
Trigone – tiga pembukaan :
Dua dari ureter dan Satu ke
urethra
 Persarafan

 N. pelvikus yang berhubungan dengan

medulla spinalis melalui pleksus sakralis
(S2 dan S3).
 Saraf sensorik = regangan dinding
kandung kemih → refleks berkemih.
 Saraf motorik = parasimpatis →
berakhir pada sel ganglion yang
terletak dalam dinding kandung kemih
untuk mensarafi otot detrusor.
 Urethra
 Saluran berdinding tipis yang
memindahkan urine dari kandung kemih
ke luar tubuh degan gerak peristalsis.
 Panjang : pria=8 inchi, wanita=1½ inchi.
 Pengeluaran urine diatur oleh dua katup
(sphincters)
– Internal urethral sphincter (tanpa
sadari/involuntary)
 External urethral sphincter
(disadari/voluntary)
 Berkemih (Micturition/Voiding)
 Kedua katup (sphincter) otot harus terbuka
agar dapat berkemih
 Internal urethral sphincter : direlakskan
setelah peregangan kandung kemih
 Pengkatifan ini berasal dari impulse
dikirim ke spinal cord dan kemudian
balik melalui saraf pelvic splanchnic
 External urethral sphincter : harus
direlakskan secara sadar
Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings
 Neuroanatomy of
Lower Urinary Tract
 MICTURITION REFLEX
Bladder fills

+
Stretch receptors

Spinal Cord
+
Parasympathetic
nerve

Internal urethral
Bladder contracts
sphincter opens

Only the external urethral sphincter is controlled voluntarily

Figure 26.21
 Urination: Micturation reflex
Rugae folds

Detrusor
a-Adrenergic
receptors

Hypogastic nerves (L1, L2, L3)

Sympathetic

Pelvic nerve
Visceral afferent pathway

Fundus

Sacral
Parasympathetic

(S1, S2, S3)

Sacral
Pudential nerves
Skeletal muscle
Figure 19-18: The micturition reflex
THANK YOU