DISKUSI PANEL

BLOK 1.6 2019

ASRI HENDRAWATI
Bag. Biokimia Fak. Kedokteran UII

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KEDOKTERAN
Kenapa urea malah di reabsorbsi kembali padahal kan
berbahaya?

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KEDOKTERAN
 FAKULTAS
KEDOKTERAN
 FAKULTAS
KEDOKTERAN
Kenapa NH4+ perlu direabsorbsi lagi lalu disekresi lagi?

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KEDOKTERAN
 FAKULTAS
KEDOKTERAN
• Schematic representation of ammonia recycling within
the renal medulla. Although NH4+ production occurs
primarily in the proximal tubule, most of the NH4+ is then
reabsorbed in the thick ascending limb, apparently by
substitution for K+ on the Na+-K+-2Cl- carrier in the
luminal membrane. Partial dissociation into NH3 and H+
then occurs in the less acid tubular cell. The NH3
diffuses into the medullary interstitium where it achieves
relatively high concentrations; it then diffuses back into
those segments that have the lowest pH and therefore
the favorable gradient: the S3 segment of the late
proximal tubule and, more importantly, the medullary
collecting tubule, where the secreted NH3 is trapped as
NH4+ and then excreted.
FAKULTAS
KEDOKTERAN
Apakah alkalosis metabolik dan respiratori dapat terjadi dalam waktu
yg bersamaan?

FAKULTAS
KEDOKTERAN
 Bagaimana peran hormon dalam keseimbangan pH?
• Increased Na+ reabsorption and H+ secretion directly stimulated by aldosterone
• Other hormones and receptors, including angiotensin II and the calcium-sensing
receptor, stimulate distal acidification. An important role for intrarenal endothelin
has also been found
• Parathormone (PTH) excess limits renal bicarbonate reabsorption

FAKULTAS
KEDOKTERAN
Ginjal akan mengurangi ekresi H+ dan reabsorpsi HCO3- ketika terjadi
alkalosis respiratorik. Bagaimana mekanisme menguranginya? (Apa
ada jaras2, hormon, dll?)

• Mechanism: Changes in the physicochemical equilibrium occur due to the

lowered pCO2 and this results in a slight decrease in HCO3-. There is
insufficient time for the kidneys to respond so this is the only change in an
acute respiratory alkalosis. The buffering is predominantly by protein and
occurs intracellularly; this alters the equilibrium position of the bicarbonate
system.
• There is a drop in HCO3- by 2 mmol/l for every 10mmHg decrease in pCO2
from the reference value of 40 mmHg.
• Mechanism: Renal loss of bicarbonate causes a further fall in plasma
bicarbonate (in addition to the acute drop due to the physicochemical effect
and protein buffering).
• Studies have shown an average 5 mmol/l decrease in [HCO3-] per
10mmHg decrease in pCO2 from the reference value of 40mmHg. This
maximal response takes 2 to 3 days to reach.

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KEDOKTERAN
Ketika beberapa buffer didalam tubuh terganggu kerjanya,apa yang
akan dilakukan oleh tubuh ketika terjadi kondisi alkalosis maupun
asidosis?

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KEDOKTERAN
 FAKULTAS
KEDOKTERAN
 Mengapa memakan sayuran membuat urin menjadi lebih
basa?

• A diet that increases your intake of foods that make the urine more alkaline,
including citrus fruits, vegetables and dairy products
• Vegetables contain high amounts of potassium and magnesium, and also
help to make the urine more alkaline
• A more alkaline diet (low PRAL), high fruit and vegetable intake and lower
consumption of meat was significantly associated with a more alkaline urine
pH
• Hepatic oxidation of amino acids, such as cysteine and methionine (found in
meats, fish, cereal and dairy foods), generates H+. This is balanced by
carbonate present as alkaline salts in fruits and vegetables, that also supply
large amounts of Mg and K in the diet.

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KEDOKTERAN
 Senyawa yang dapat menginhibisi karbonic anhidrase
untuk diuretik, hubungannya apa dengan membuat urin
menjadi lebih asam?

FAKULTAS
KEDOKTERAN
• The diuretic effect of acetazolamide is due to its action in
the kidney on the reversible reaction involving hydration
of carbon dioxide and dehydration of carbonic acid. The
result is renal loss of bicarbonate (HCO3 ion), which
carries out sodium, water, and potassium. Alkalinization
of the urine and promotion of diuresis are the end result.
• Alteration in ammonia metabolism occurs due to
increased reabsorption of ammonia by the renal tubules
as a result of urinary alkalinization.

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KEDOKTERAN
Selamat Belajar
Sukses selalu

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