THE URINARY SYSTEM

dr. Sri Lestari Sulistyo Rini

 The urinary system :

– -Ginjal
– -Ureter
– -Kandung kemih
– -Uretra

Ginjal  menerima 20-30% cardiac

output
Aliran darah ke ginjal  1-1,5 L / mnt
Darah yang difiltrasi  180 L / hr
 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

How the Kidney Works
Filtrasi Glomerulus

Pgc pgc 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
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
Summary of tubular solute transport
 Duktus kolegentes
 Reabsorpsi Na dan Cl
 dipengaruhi ADH
Mekanisme Countercurrent
 Renal Regulation

Saraf simpatis  arteriol aferen & eferen

 vasokonstriksi, RBF menurun
 GFR menurun

Hormonal  Renin-Angiotensin
 Aldosteron
 ADH
 Atrial Natriuretic Peptide
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 & sfinter

uretra externa relaksasi, otot detrusor
kontraksi urine melalui uretra
MIKSI
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 Acid-base

volume control, balance
ECF osmolality,
blood pressure
All of these are
constantly changing,
trying to maintain
HOMEOSTASIS!

CARDIOVASCULAR RESPIRATORY
SYSTEM SYSTEM
Gas exchange, ACE
TERIMA KASIH