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Sistem Urinaria
Sistem Urinaria
Sistem Urinaria
Fungsi ginjal:
1.Regulasi komposisi ion darah
2.Regulasi pH darah
3.Regulasi volume darah
4.Regulasi tekanan darah
5.Pemeliharaan osmolaritas darah (300
mOsm/l)
6.Produksi hormon (calcitriol &
erythropoetin)
7.Regulasi tingkat glukosa darah
8.Ekskresi sampah benda asing
ANATOMI GINJAL
Anatomi eksternal:
Retroperitoneal
Renal fascia
Adipose capsule
Renal capsule
Renal hilum
http://images.google.co.id/imgres?imgurl=http://academic.kellogg.cc.mi.us/herbrandsonc/bio201_McKinley/f279a_urinary_bladder_c.jpg&imgrefurl=http://academic.kellogg.cc.mi.us/herbrandsonc/bio201_McKinley/Urinary%2520Syst
em.htm&h=490&w=800&sz=135&hl=id&start=3&tbnid=PjiUmILb7BE7M:&tbnh=88&tbnw=143&prev=/images%3Fq%3Dmicturition%2Breflex%26svnum%3D10%26hl%3Did%26lr%3D%
26sa%3DG
http://www.netterimages.com/images/vtn/000/000/002/2122-150x150.jpg
ANATOMI GINJAL
Anatomi internal
Cortex renalis
Medulla renalis
Pyramid renalis
Papilla renalis
Collumna renalis
Ductus papillaris
Calyx minor
Calyx major
Pelvis renalis
Sinus renalis
http://images.google.co.id/imgres?imgurl=http://academic.kellogg.cc.mi.us/herbrandsonc/bio201_McKinley/f27-9a_urinary_bladder_c.jpg&imgrefurl=http://academic.kellogg.cc.mi.us/herbrandsonc/bio201_McKinley/Urinary%2520System.htm&h=490&w=800&sz=135&hl=id&s tart=3&tbnid=PjiUmILb7BE7M:&tbnh=88&tbnw=143&prev=/images%3Fq%3Dmicturition%2Breflex%26svnum%3D10%26hl%3Did%26lr%3D%26sa%3DG
http://kidney.niddk.nih.gov/kudiseases/pubs/solitarykidney/images/nephronkidA.gif
http://images.google.co.id/imgres?imgurl=http://academic.kellogg.cc.mi.us/herbrandsonc/bio201_McKinley/f279a_urinary_bladder_c.jpg&imgrefurl=http://academic.kellogg.cc.mi.us/herbrandsonc/bio201_McKinley/Urinary%2520System.htm&h=490&w=800&sz=135&hl=id&start=3&tbnid=PjiUmILb7BE7M:&tbnh=88&tbnw=143&prev=/images%3Fq%3Dmicturition%2Breflex%26svnum%3D10%26hl%3Did%26lr%3D%26sa%3DG
Nephron:
1. Renal corpuscle :
a. Glomerulus
b. Bowmans capsule
2. Renal tubule:
a. Proximal convoluted tubule
b. Loop of Henle
c. Distal convoluted tubule
Collecting duct
Papillary duct
http://www.farmakologija.com/materia/images/nephron.gif
http://coe.fgcu.edu/faculty/greenep/kidney/glomer3.jpg
VASKULARISASI GINJAL
Renal artery
Renal vein
Segmental arteries
Interlobar arteries
Interlobar veins
Arcuate arteries
Arcuate veins
Interlobular arteries
Interlobular veins
Peritubular venules
Afferent arterioles
Peritubular capillaries
Glomerular capillaries
Efferent arterioles
Vasa recta
http://www.geocities.com/biology_4e/cross_section_of_kidney.jpg
http://images.google.co.id/imgres?imgurl=http://academic.kellogg.cc.mi.us/herbrandsonc/bio201_McKinley/f279a_urinary_bladder_c.jpg&imgrefurl=http://academic.kellogg.cc.mi.us/herbrandsonc/bio201_McKinley/Urinary%2520System.htm&h=490&w=800&sz=135&hl=id&start=3&tbnid=PjiUmILb7BE7M:&tbnh=88&tbnw=143&prev=/images%3Fq%3Dmicturition%2Breflex%26svnum%3D10%26hl%3Did%26lr%3D%26sa%3DG
http://www.colorado.edu/eeb/web_resources/cartoons/nephr.gif
2.
3.
1. Autoregulasi renal
1. Mekanisme myogenik:
BP RBF GFR regangan arteriola afferent
kontraksi otot arteriola afferent lumen menyempit
GFR ke tingkat semula
2. Umpan balik tubuloglomerular:
BP GFR cairan lewat cepat di tubulus
rebasorbsi Na, Cl, air di PCT & loop of Henle
deteksi oleh macula densa inhibisi sekresi NO
arteriola afferen konstriksi RBF GFR ke normal
http://images.google.co.id/imgres?imgurl=http://academic.kellogg.cc.mi.us/herbrandsonc/bio201_McKinley/f279a_urinary_bladder_c.jpg&imgrefurl=http://academic.kellogg.cc.mi.us/herbrandsonc/bio201_McKinley/Urinary%2520System.htm&h=490&w=800&sz=135&hl=id&start=3&tbnid=PjiU
mIL-b7BE7M:&tbnh=88&tbnw=143&prev=/images%3Fq%3Dmicturition%2Breflex%26svnum%3D10%26hl%3Did%26lr%3D%26sa%3DG
Reabsorbsi: Na+, K+, Ca2+, Cl- , HCO3- , HPO42Protein & peptida reabsorbsi pinositosis
Tubulus distalis fine tuning reabsorbsi
Rute reabsorbsi:
Paraseluler & Transeluler
Mekanisme transport:
Transport aktif primer (hidrolisis ATP)
Transport aktif sekunder (symporters & antiporters)
Transport maksimum (mg/min) glukosa darah > 200 mg/ml
Susbtansi
Air
Protein
Na+
ClHCO3Glukosa
Urea
K+
Asam urat
Kreatinin
Terfiltrasi*
180 L
Reabsorpsi
178 179 L
Urine
12L
2,0 g
579 g
640 g
275 g
162 g
54 g
29,6 g
8,5 g
1,6 g
1,9 g
575 g
633,7 g
274,97 g
162 g
24 g
29,6 g
7,7 g
0g
0.1 g
4g
6,3 g
0,03 g
0g
30 g**
2,0 g***
0,8 g
1,6 g
* Dengan asumsi GFR = 180 l/ hari; **Selain difiltrasi & direabsorpsi, urea
disekresi; ***K+ difiltrasi & semua direabsorpsi oleh tubulus kontortus & ansa Henle,
& disekresi oleh sel principal duktus kolektivus
http://www.mscd.edu/~biology/2320course/2320images/nephron.jpg
http://www.varimed.hu/hypertension/pha/img/pha_577.gif
http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/N/nephron.gif
angiotensin
converting enzyme
angiotensinogen angiotensin I angiotensin II
Angiotensin ll:
1.
2.
3.
DIURESIS
Memperlambat reabsorbsi air
Terapi hipertensi
Diuretik alami: kopi, teh, soda (inhibisi reabsorbsi
Na+), alkohol (inhibisi ADH)
Mekanisme kerja kebanyakan diuretik: inhibisi
reabsorbsi Na+
Furosemide (Lasix) inhibisi Na+ K+ 2 Cl- symporters
di thick ascending limb of the loop of Henle
Chlorthiazide (Diuril) tubulus distalis (inhibisi Na+
Cl- symporters)
Kreatinin plasma
Katabolisme fosfat kreatinin dari otot skelet
Fungsi ginjal Kreatinin darah
Inervasi:
http://academic.kellogg.cc.mi.us/herbrandsonc/bio201_McKinley/f27-9a_urinary_bladder_c.jpg
Abnormalitas mikturisio
osmolaritas
cairan tubuler
2. Symporters Na+, K+, Cl- pada thick ascending
limb dari loop of Henle
3. Thick ascending limb tak permeable terhadap air
150 mOsm/l di akhir loop of Henle
4. Tubulus kontortus distalis tak terlalu permeable
terhadap air & tak diregulasi oleh ADH
Countercurrent Mechanism
Osmolaritas cairan interstisial meningkat dari 300
mOsm/l (korteks renalis) 1200 mOsm/l (medula
renalis)
Arah aliran descending limb >< ascending limb of
Henle
Descending limb: Air keluar via osmosis; tak
permeable terhadap zat terlarut kecuali urea
osmolaritas tubular (1200 mOsm/l)
Vasa recta
Osmolaritas
RUJUKAN
1.
2.