GINJAL DAN

PENGATURAN AIR DAN

ION INORGANIK
Dr.YASWIR YASRIN
BAGIAN FISIOLOGI

Pembicaraan

:
1.Prinsip Dasar Fisiologi Ginjal
2,Pengaturan Keseimbangan air dan ion
inoganik.
3.Pengaturan Calsium
4.Pengaturan ion Hidrogen
5.Diuretik dan Beberapa Penyakit Ginjal

I.FUNGSI GINJAL :
1.Mengatur keseimbangan air dan ion
inorganik
2.Mengeluarkan end produc metabolisme
3.Mengeluarkan benda asing
4.Glukoneogenesis
5.Memproduksi hormon / Enzim :
-Erythopoetin
-Renin / Enzim angiotensin
- 1-25 Dihydroxi vitamin D

PRINSIP DASAR FISIOLOGI

GINJAL
II.Struktur Ginjal Dan Sistim urinarius
-Organ retrperitoneal
-Terdiri atas cortex dan Medula
-Ginjal terdiri atas 1 million Nefron
-1 nefron terdiri atas :
-Renal Corpuscle :
=glomerulus
=Capsul Bowman
-Tubulus proximal
- Ansa Henle
-Tubuli distal
-duktus koligen

FIGURE 162
Basic structure of a nephron. (a)
Anatomical organization. The
macula densa is not a distinct
segment but a plaque of cells in
the ascending loop of Henle where
the loop passes between the
arterioles supplying its renal
corpuscle of origin. The outer
area of the kidney is called the
cortex and the inner the medulla.
The black arrows indicate the
direction of urine flow.
(b) Consecutive segments of the
nephron. All segments in the
screened area are parts of the
renal tubule; the terms to the
right of the brackets are commonly
used for several consecutive
segments.

FIGURE 163
(a) Anatomy of the renal corpuscle. Brown lines in the capillary loops indicate space between
adjoining podocytes. (b) Cross
section of the three corpuscular membranescapillary endothelium, basement membrane, and
epithelium (podocytes) of
Bowmans capsule. For simplicity, glomerular mesangial cells are not shown in this figure.

FIGURE 164
Section of a human kidney. For clarity, the nephron illustrated
to show nephron orientation is not to scaleits outline would
not be clearly visible without a microscope. The outer kidney,
which contains all the renal corpuscles, is the cortex, and the
inner kidney is the medulla. Note that in the medulla, the loops
of Henle and the collecting ducts run parallel to each other.
The medullary collecting ducts drain into the renal pelvis.

FIGURE 165
Anatomy of the
juxtaglomerular apparatus.

III.Proses dasar pada Ginjal :

1.Glomerulu filtrasi
2.Reabsorbsi tubuli
3.Sekresi tubuli
Pembentukan urin hasil Filtrasi gromeruli,
Reabsorbsi dan Sekresi Tubuli :
-Pembentukan urin
=filtrasi
=Reabsorbsi
=Sekresi

FIGURE 166
The three basic components of renal function. This figure is
to illustrate only the directions of reabsorption and secretion,
not specific sites or order of occurrence. Depending on the
particular substance, reabsorption and secretion can occur at
various sites along the tubule.

Kecepatan ekresi urin

-GFR-Reabsorbsi+Sekresi

.Kecepatan ekresi urin

GFR Reabsorbsi + Sekresi
. FILTRASI :
-terjadi melalui memb.glomerulus
-Komposisi filtrat = plasma kecuali
tampa proten dan sel.

Kemampuan
Zat

Filtrasi zat oleh glomerulus

BM

Kecepatan filtrasi

H2O

18

Na

23

Glukosa

180

Inulin

55.000

Mioglobin

17.000

0,75

Albumin

69.000

0,005

IV.Reabsorbsi dan sekresi Tubuli Ginjal

Ekresi Urin = GF Reabsorbsi + Sekresi

Kecepatan
Zat

Filtrasi, Reabsorbsi, Sekresi

Jumlah
Fil

Reabs Ekresi %Filt yg

direabsorb

Glukosa gr/h 180

180

100

Bikarbonat
meg/h

4,320

4,320

99.9

Natrium
meq/h

25,560

25,410 150

99,4

Klorida
meq/h

19.40

19,260 180

991

Ureum

46.8

23.4

23,4

50

Kreatinin

1.8

1,8

.Mekanisme

Reabsorbsi :

-Transfort aktif
-Difusi
-Pinositosis
-Osmosis

Transfort

Maksimum

Zat

Transfot maks

Glukosa

320 mg / menit

Fosfat

0,10 mOs / menit

Sulfat

0,06 mOsm / menit

Asam amino

1,5 mosm / menit

Garam as urat

1,5 mg / menit

Laktat

75 mg/menit

Protein

30 mgr/menit

Tubuli

distal :

Segmen tebal A/H kompleks---

juxtagromeruli mengontrol umpan balik
GFR/aliran darah.
Reabsorbsi ion Na, K dan klorida
Tidak permeabel terhadap air/ ureum
Tubuli distal bagian akhir/ tub koligen:
- membr tubuler impermeabel terhadap ureum
- Reabsorbsi Na,,sekresi K dan H
- Permeabilitas dikontrol oleh ADH

Duktus

koligen medula :

Permeabilitas dikontrol ADH

Permeabel terhadap ureum
V.Konsep Clearance Ginjal
-Kemampuan ginjal membersihkan plasma
darah dari suatu zat persatuan waktu
- Cs = Us x V
Ps

 Bahan

yang dipergunakan :
Inulin
PAH
Creatinin
Iotalamat radioaktif

FIGURE 167
Renal handling of three hypothetical substances X, Y, and Z. X is
filtered and secreted but not reabsorbed. Y is filtered, and a
fraction is then reabsorbed. Z is filtered and completely reabsorbed.

Kecepatan Clearance Beberapa Zat

Zat

Kecepatn Cl

Glukosa

Na

0,9

Clorida

1.3

Kalium

12

Pospat

25

Inulin
Kreatinin

125
140

FIGURE 168
Forces involved in glomerular filtration. The symbol
denotes the osmotic force due to the presence of protein in
glomerular capillary plasma.

FIGURE 169
Diagrammatic representation of tubular epithelium. In this
and subsequent figures illustrating transport in this chapter,
the basement membrane of the tubulea homogeneous
proteinaceous structure that plays no significant role in
transportwill not be shown. (Do not confuse the
basement membrane with the basolateral membrane of the
tubular cells, as illustrated in this and subsequent figures.)

FIGURE 1610
Example of renal handling of inulin, a substance that is
filtered by the renal corpuscles but is neither reabsorbed nor
secreted by the tubule. Therefore, the mass of inulin
excreted per unit time is equal to the mass filtered during
the same time period, and as explained in the text, the
clearance of inulin is equal to the glomerular filtration rate.

FIGURE 1611
Control of the bladder.

VI

Micturation
Pengisian VU :
Stimulasi SPS-- m Destrusor
Stimulasi kuat SS---IUS
Stimulasi somatik motor neuron

m.Detrusor relax

Miksi : peninggian P VU-- Strech refleks

Aferen :-Inhibisi SS IUS--- terbuka
-Inhibisi somatik neuron EUS Relaks
-Stimulasi SPS--Kont m Detrusor
-- fasilitasi pembukaan IUS

Stimulasi / Inhibisi
Batang Otak / Korteks sereberal

Inhibisi partial
Preventif-- menunggu waktu
Waktu tiba
Kontraksi Abdomen/ P VU meninggi
Stimulasi Reseptor
Refleks miksi--- Inhibisi EUS

Beberapa

Kelainan Klinik :
1.Incotinence
-tidk sadar miksi ( sosial/ hygine )
2.Stress Incontinence ( Sneezing.coughing,
Exercise )
3.Urge incontinence ditemukan pada wanita
Umur 60 thn.
.

Pengaturan Keseimbangan Na, air

dan potasium
1. Keseimbangan Na,air dan sodium
-intake :-produksi hasil metabolisme
-masuk bersama makanan 70%
-Water loss :
-skin
-respirasi
-TGI
-urin

2.Proses

dasar ginjal
-Cairan filtrat ( Na dan air ) -99 %
-2/3 bagian reabsorbsi tub prox.
Mekanisme reabsorbsi:
-Transfort aktif kecuali descen L/H
-Difusi
-bersamaan dengan Na

FIGURE 1612
Mechanism of sodium reabsorption in the cortical collecting
duct. Movement of the reabsorbed sodium from the
interstitial fluid into peritubular capillaries is shown in Figure
1613. The sizes of the letters for Na and K denote high
and low concentrations of these ions. The fate of the
potassium ions transported by the Na,K-ATPase pumps is
discussed in the later section dealing with renal potassium
handling.

3.Coupling

of Water Reabsorbtion to
Sodium Reabsorbtion;
-Na/gluk/aa dan HCO3 lumen C Inter
-Local Osmolarity tubu bagian bawah
osmosis
-net difusi kons air lumen-c Inter
-Air/Na/zat terlarut-- C Inter-kapiler
-Permeabilitas Tub-- ADH

-Water Diuresis
-Diabetes Insipidus / Central Diabetes Insi
-Nephrogenic Diabetes Insipidus
-Osmotic Diuresis

FIGURE 1613
Coupling of water and sodium reabsorption. See text for
explanation of numbers. The reabsorption of solutes other
than sodiumfor example, glucose, amino acids, and
bicarbonatealso contributes to the difference in osmolarity
between lumen and interstitial fluid, but the reabsorption of
all these substances is ultimately dependent on direct or
indirect cotransport and countertransport with sodium;
therefore, they are not shown in the figure.

Langkah

yang menyebabkan intertitial

medula hiperosmotik :
1.Ansa Henle = cairan prox tubulus300
2.Transfort aktif Ascenden L/H konsenrasi
naik 200 mOsm
3.Difus ion pada Tubuli untuk
mengimbangi Transfor aktif- 200 Mosm/l
4,Cairan tubuli descenden A/H/ intertitial

400 Mosm/l
5.Tambahan cairan dari Tub prox ke cairan
hiperosmotik mengalir kecab Ascenden
tekanan cairan intertitial hiperosmotik
500 Mosm/l
6.Cairan cab Desenden keseimbangan
dengan cairan intertitial--hiperosmotik
7.Penambahan zat terlarut >>> cairan
medula

Kesimpulan Reabsorbsi NaCl berulang pada

segmen tebal cab Ascenden A/H dan
penambahan NaCl baru terus menerus
dari tubuli prox ke A/H akan
meningkatkan tekanan Osm dari cairan
intertitial.
Ringkasan mekanisme pemekatan urin dan
perobahan osmolaritas pada berbagai
segmen tubuli :

-Tubuli Prox :
-65 % filtrat-- reabsobsi
-permebilitas H2o >> osmosis/difusi
-Osmolaritas 300 Mosm/l
-Cab decenden A/H :
-Air diabsorbsi medula
-pemeabilitas air /NaCl berkurang
hingga osmolaritas meningkat ADH

se

-ADH berkurang osmolaritas cairan

intertitial < 1200 Mosm/l dan ureum

dikit reabsorbsi
-Segmen tipis A/H :
-Impermeabel terhadap air
-> permeabel terhadap NaCl
- Ureum difusi ke cab Ascenden L/H

-Segmen tebal L/H :

-Impemeabel terhadap air
-Transfort aktif ke lumen tubulus(NaCl
dan K ke cabang Ascenden utrine
encer.
-Segmen awal Tubuli distal :
= dengan cab tebal Ascenden

-Cabang Akhir Tubuli distal /Duk Koligen:

-Osmolaritas tergantung konsentrasi
ADH
-Duk Kolligen medula
-Osmolaritas tergantung pada ADH
-osmolaritas cairan intertitial medula

-Gangguan pemekatan urin :

-Sekresi ADH
-Kerusakan arus balik
-Ketidak mampuan tub distal/duk
kolligen merespon ADH.

- Pengaturan sekresi ADH

Peningkatan

Penurunan

Osmolaritas plasma
Volume darah berkurang
BP menurun
Nausea
Hipoxia
morpin

alkohol

nikotine

klonidin

siklofosfamad

haloperidol

-Mekanisme Pengaturan Ekresi Na dan air:

-Normal---- ekresi ginjal diatur oleh
asupan
-Gangguan ringan--- kompensasi tbh
-ggn berat--- sistemik:BP/Hormon dan
inhibisi ss
-Diatur : -inhibisi GFR
-kecepatan reabsorbsi

Pengaturan kalium oleh ginjal

K

pada filtrat glomerulus-- reabsorbsi

tubuli proksimal / sekresi Duk Kolligen
.Kadar K ditentukan oleh :
-Diet
-Hormon aldosteron