THE URINARY SYSTEM

dr. Sri Lestari Sulistyo Rini, M.Sc

The urinary system :

Ginjal terletak retroperitoneal

Sebuah ginjal 135-150 gr.
Ginjal menerima + 20% 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

How the Kidney Works

Filtrasi Glomerulus

Pgc

gc

Pt

Filtrasi glomerulus

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

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

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

LongTermEffectofOsmolarityonBP

antidiuretichormone(ADH).

DistalTubule

ADH

Aldosterone Release: the Renin-Angiotensin Pathway

Factors affecting the release of ADH.

Factors affecting release of Atrial Natriuretic Peptide.

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

p 921

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 kelamin,
derajat obesitas

Circulating Volume control

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