SISTEM URINARI

DISEDIAKAN OLEH: SUHAIMI BIN SAHAT

FUNGSI SISTEM URINARI FUNGSI SISTEM URINARI

 Tubuh kita akan menghasilkan bahan kumuhan yang mengandungi nitrogen iaitu urea dan uric acid Ianya terhasil ketika sel-sel tubuh memecahkan proteins dan nucliec acids. Sistem urinari berfungsi menghilangkan sisa nitrogen dari tubuh, dan menetapkan air, elektrolit, dan keseimbangan acid-base darah dan merembeskannya dalam bentuk urine. Sistem ini, sering disebut sistem ekskretori (system excretory), yang terdiri daripada ginjal, ureter, urinary bladder, dan urethra.

INFERIOR VENA CAVA GINJAL RENAL ARTERY RENAL VEIN URETER

URINARY BLADDER

URETHRA

GINJAL FUNGSI SISTEM URINARI

FUNGSI GINJAL

Menapis darah merembes bahan buangan mempertahankan kadar air, garam mineral, protein dan nutrisi dalam tubuh

Fungsi endokrin menetapkan tekanan darah menghasilkan renin, eritropoietin & prostaglandin menukarkan vitamin D bentuk aktif

Menghasilkan urine

STRUKTUR GINJAL
CAPSULE MEDULLA

CORTEX

Capsule Hilum ureter renal pelvis major and minor calyxes renal artery and vein segmental arteries interlobar arteries arcuate arteries interlobular arteries Medulla renal pyramids cortical/renal columns Cortex renal corpuscles cortical labryinth of tubules medullary rays

Renal Lobe = renal pyramid & overlying cortex

Renal Lobule = medullary ray & surrounding cortical labryinth

Cortex

Medulla

Papilla
Calyx

Renal Cortex
Bahagian terluar ginjal- antara renal capsule dan renal medulla Membentuk zon luar terus menerus halus dengan sejumlah unjuran (cortical columns) yang membentang di antara piramid.

Ini mengandungi renal corpuscles dan renal tubules

-kecuali untuk sebahagian daripada loop of Henle yang turun ke renal medulla.

Mengandungi vessels darah dan cortical collecting duct.

Merupakan sebahagian daripada ginjal di mana terjadi ultrafiltrasi

Renal Medulla
Lapisan paling dalam pada ginjal.
Terbahagi kepada beberapa bahagian, yang dikenali sebagai renal pyramids. Darah masuk ke dalam buah pinggang melalui renal artery, yang kemudian dibahagikan untuk membentuk arcuate arterioles. Arcuate arterioles berubah menjadi arteriol interlobular, yang akhirnya mencapai glomeruli. Pada glomerulus, darah mencapai kecerunan tekanan yang sangat tinggi dan kawasan pertukaran permukaan yang luas, yang memaksa bahagian serum darah keluar dari vessels ke dalam renal tubules.. Mengalir terus melalui tubul ginjal, termasuk tubul proksimal, Loop of Henle

Akhirnya meninggalkan buah pinggang melalui saluran mengumpul, mengarah ke renal ureter.

III. The Nephron NEPHRON

a) renal corpuscle (bahagian awal nephron) i) 1 - 4 million pada setiap ginjal ii) Berlaku penapisan darah iii) glomerulus:

-tuft of capillaries about 200 microns in diameter - capillaries are fenestrated without diaphragms - thick basal lamina produced by both endothelial cells of capillaries and podocytes that wrap around capillaries - 10 - 20 capillary loops - blood enters glomerulus at the afferent arteriole, passes through glomeruli capillaries then exits at the efferent arteriole

- both afferent and efferent arteriole are located at the vascular pole of the renal corpuscle

Nephron: Vascular System

Afferent arteriole Glomerulus Efferent arteriole Peritubular capillaries
Capillary beds reabsorb in cortex

Vasa recta
Capillary beds reabsorb in medulla

Nephron
Tubular system
Glomerular Capsule Proximal convoluted tubule Loop of Henle (nephron loop)
Descending limb Ascending limb

Distal convoluted tubule Collecting duct

Nephron

Nephron Loop

Jenis Nephrons
i) coritical
-biasanya pendek dilengkarkan nephrons -Sel darah di korteks luar, -loop Henle pendek -U-turn terjadi pada atau dekat pada ketebalan distal tubule lurus di dasar dari piramid ginjal (berhampiran cortex/medulla

Renal piramid
Renal pyramids (or malpighian pyramids) adalah tisu ginjal yang berbentuk kon. The renal medulla terdiri daripada 8 hingga 18 dari bahagian-bahagian kon. Dasar yang luas dari setiap piramid wajah korteks ginjal, dan puncaknya, atau papilla, mata dalaman. Piramid muncul bergaris kerana mereka dibentuk oleh segmen selari langsung dari nefron.

Renal Papila

Di ginjal, renal papilla berada di mana piramid medullary urin kosong ke renal pelvis. Histologi hal ini ditandai dengan saluran mengumpul meduler untuk menyalurkan cecair. Peralihan epitel mulai terlihat

Calyx (ces)
The minor calyx, in the kidney, surrounds the apex of the malpighian pyramids. Urine formed in the kidney passes through a papilla at the apex into the minor calyx then into the major calyx. Peristalsis of the smooth muscle originating in pacemaker cells originating in the walls of the calyces propels urine through the pelvis and ureters to the bladder.

The major calyx, in the kidney, surrounds the apex of the malpighian pyramids. Urine formed in the kidney passes through a papilla at the apex into a minor calyx then into major calyx before passing through the renal pelvis into the ureter.

Renal Pelvis
The renal pelvis is the funnel-like dilated proximal part of the ureter in the kidney. It is the point of convergence of two or three major calyces. Each renal papilla is surrounded by a branch of the renal pelvis called a calyx. The major function of the renal pelvis is to act as a funnel for urine flowing to the ureter.

juxtamedullary - typically long-looped nephrons -corpuscle at the base of the renal pyramid (near the cortex/medulla junction), long loops of Henle with the Uturn in the thin, straight, proximal tubule deep in the medulla (near the tip of the renal pyramid) intermediate - in between the above 2 types

Renal Corpuscle

Urinary / Bowmans space

parietal layer Bowmans capsule visceral layer

Glomerulus

Bowmans capsule:
double-walled epithelial capsule around glomerulus inner (capillary) layer called visceral layer: -cells include mesangial cells and podocytes mesangial cells have phagocyte function and are found within the basal lamina and clean the basement membrane of debris

podocytes have processes called pedicels that wrap around capillaries and that are in direct contact with the basal lamina:
- pedicels arise from primary processes of podocytes - pedicels processes are separated by 25 nm slits called filtration slits - this plus basal lamina and net negative charge of basal lamina limit permeability of capillary to < 70,000 - allows ions and small proteins to pass into urinary system, retains most plasma proteins in blood

Juxtaglomerular apparatus macula densa pada distal tubule JG cells in afferent arteriole extraglomerular mesangial cells

Glomerulus fenestrated capillaries podocytes intraglomerular mesangial cells

outer layer called parietal layer: -delimits corpuscle - simple squamous epithelium with tight junctions space between inner and outer layer called urinary space: -blood ultra-filtrate resides here -parietal layer fuses with proximal convoluted tubule: - location called urinary pole of corpuscle

Podocytes

Urinary Membrane

Proximal tubule proximal convoluted tubule thick descending limb Henles loop Henles loop thin descending & ascending limbs Distal tubule thick ascending limb Henles loop distal convoluted tubule macula densa in DCT Collecting tubule & duct

Proximal Convoluted Tubule

Cuboidal (low to high) cells Eosinophilic granular cytoplasm Basal nuclei Elaborate brush/striated border Lateral interdigitations

Resorbs 100% protein, amino acids, glucose, creatinine, and bicarbonate ions Resorbs 70-80% of Na+, Cl-, and water Na+/K+ pumps in basolateral membrane Na+ pumped into interstitium Cl- and water follow Secretes waste products into lumen

Henles Loop (thin segments)

Squamous cells slightly thicker than endothelial cells Few short microvilli Lateral interdigitations

Descending limb highly permeable to water, salt and urea Ascending limb impermeable to water permeable to salt which enters interstitium

Distal Tubule (DCT & thick ascending limb of Henles loop)

Low cuboidal cells Clear pale cytoplasm Apical nuclei (DCT) Central nuclei (Henles loop) Numerous mitochondria Absent (or few short) microvilli Basal interdigitations Numerous zonula occludens Not permeable to water or urea Active Na+/K+ pumps (DCT) aldosterone stimulates salt resorption H+ and K+ transported into lumen Active Cl- pumps (Henles thick) Cl- enters interstitium (Na+ follows)

collecting tubules and ducts

i) the convoluted distal tubule connects to a collecting tubule (normal or arched) in the cortical labyrinth in the cortex

ii) the collecting tubule continues towards the medullary ray and connects to straight collecting tubules iii) straight collecting tubules merge in the medullary ray (thus straight) within the cortex forming the cortical collecting ducts iv) cortical collecting ducts merge and progress towards medullary pyramid forming the papillary ducts of Bellini v) papillary ducts of Bellini empty final urine (old fart urine) into the minor calyx at the tip of the renal pyramid (papilla) at the area cribrosa

Collecting duct

vi) epithelia of collecting tubules and ducts: -collecting tubule/duct lumen lined by simple cuboidal epithelia -central nucleus -poor staining cytoplasm -no lateral or basal interdigitations -cell margins very obvious - have a single cilium and sparse, short microvilli on the apex (lumenal side) - as the duct progresses towards the area cribrosa, the epithelia becomes taller and stratified

juxtaglomerular apparatus (jga)

i) adjacent to the renal corpuscle ii) located at the vascular pole of Bowmans capsule iii) includes the macula densa of convoluted, distal tubule, juxtaglomerular cells of the afferent arteriole, and extraglomerular mesangial cells which are all in close proximity at the jga iv) smooth muscle cells of afferent arteriole have secretory granules containing renin and are called juxtaglomerular cells - renin secretion from these smooth muscle cells is stimulated by paracrine activity from the macula densa of the convoluted, distal tubule - renin is a protease that cleaves plasma angiotensinogen into angiotensin I - angiotensin I converted to angiotensin II in the lung - angiotensin II promotes vascular smooth muscle contraction and release of aldosterone from the adrenal cortex - aldosterone stimulates absorption of NaCl and water in the distal convoluted tubule thus increasing blood volume - net result is to increase blood pressure

Macula densa in distal tubule

monitor Na+ content and volume in DT low Na+: stimulates JG cells to secrete renin stimulates JG cells to dilate afferent arteriole tall, narrow columnar cells numerous microvilli

JG cells
secrete renin into circulation renin converts angiotensinogen angiotensin I contain angiotensin converting enzyme (ACE) lung is principal site of ACE activity ACE converts angiotensin I II contain angiotensin I & II angiotensin II constricts vasculature and stimulates secretion of aldosterone and ADH primarily in afferent arteriole specialized smooth muscle cells no basal lamina between JG cells & macula densa

Mesangial cell JG cell

Extraglomerular mesangial cells

Macula densa
also known as Polkissen or lacis cells

Ureter ialah tiub yang keluar dari tiap-tiap buah pinggang.

Membawa air kencing ke dalam pundi-pundi kencing.

Salur ini dibahagiakan kepada dua bahagian: - corong atau pelvis buah pinggang. Ini ialah bahagian atas yang kembang. Ia bermula sebagai alat berbentuk mangkuk, yang dikenali sebagai kaliks. -Salur buah pinggang benar. Ukurannya sepuluh inci panjangnya. Bahagian atasnya terletak di hadapan otot belakang abdomen, bahagian bawah masuk ke dalam ruang pelvis dan berakhir di permukaan belakang pundi-pundi kencing. -Tiap-tiap salur buah pinggang terbina daripada tisu berfiber,tisu otot bebas,tisu epitelium peralihan.

 Pundi kencing merupakan organ penakung air kencing dan ianya terletak di dalam ruang pelvis benar. Bagi lelaki ,usus hujung terletak di belakangnya dan sendi ari-ari terdapat di hadapannya. Bagi wanita sendi ari-ari terdapat di hadapannya,tetapi rahim dan liang faraj terletak di belakangnya.

Ruang di dalam pundi-pundi kencing menunjukkan satu bahagian segitiga yang dipanggil trigone
Dasar segitiga berarah ke atas dan puncak ke bawah. Kedua-dua salur buah pinggang membuka di bahagian atau trigone manakala salur kencing bermula dari puncaknya.

Fisiologi pembentukan air kencing boleh dibahagikan kepada tiga peringkat :

Penapisan oleh gumpalan rerambut.

Penyerapan semula oleh salur halus kencing.

Rembesan dari salur halus kencing

PENAPISAN
Penapisan ialah peringkat pertama dalam pembentukan air kencing. Ia berlaku antara gumpulan rerambut dan kapsula Browman. Kandungan darah di dalam rerambut yang membina gumpalan rerambut tertapis keluar secara mekanikal ke dalam kapsula Browman.

Proses tapisan berlaku dengan mudah kerana:

1. Tekanan darah di dalam salur nadi buah pinggang dan cabangnya adalah tinggi. 2. Salur di dalam salur nadi halus penghantar adalah lebih besar daripada salung di dalam salur nadi halus pengeluar. 3. Rerambut atau kapilari darah yang membina gumpalan rerambut mempunyai liang-liang halus yang banyak.

 Air bahan-bahan habluran(bahan yang mudah larut) ditapis keluar dari gumpalan rerambut ke dalam kapsual Browman.
Bahan-bahan koloid (bahan yang mempunyai molekul yang besar) seperti protein darah, tidak tertapis keluar.

PENYERAPAN SEMULA Berlaku di dalam salur halus kencing. Bahan-bahan yang tertapis keluar dari gumpalan rerambut iaitu bahan-bahan yang diperlukan tubuh, diserap balik ke dalam rerambut (kapilari) darah yang mengelilingi salur halus kencing. Tugas penyerapan adalah tanggungjawab selsel yang membina dinding salur halus kencing.

 Bahan- bahan yang perlu sahaja seperti glukosa, asid amino, vitamin, dan beberapa garam galian untuk penyerapan. Bahan yang tidak diperlukan dibiar keluar di dalam air kencing. Beberapa hormon menggalakkan sel-sel salur halus kencing dalam proses penyerapan iaitu pitresin dan aldosteron.

PEREMBESAN ATAU PENGELUARAN Suatu proses perembesan atau pengeluaran air kencing. Bahan-bahan yang diperlukan oleh tubuh diserap masuk ke dalam rerambut darah melalui salur halus kencing. Bahan yang tidak diperlukan seperti urea,racun,pigmen dan dadah dibiar keluar melalui air kencing.

 Salur halus kencing juga merembeskan ammonia yang tercampur di dalam air kencing. Proses penyerapan dan perembesan berlaku secara resapan, omosis serta mekanisma pengangkutan aktif.

RUJUKAN
http://kidney.niddk.nih.gov/kudiseases/pubs/ yoururinary/