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Figure 15.1a
Copyright2003PearsonEducation,Inc.publishingasBenjaminCummings
GINJAL
1.
2.
3.
4.
Fungsi Ginjal :
Ekskresi produk sisa metabolik & bahan
kimia asing.
Pengaturan konsentrasi osmolalitas cairan
tubuh & konsentrasi elektrolit.
Pengaturan keseimbangan asam-basa
darah.
Pengaturan keseimbangan air & elektrolit.
5.
6.
1.
2.
Pelvic space
Renal artery
Renal vein
Pelvis
Ureter
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Outer cortex:
Contains many
capillaries.
Medulla:
Renal pyramids
separated by
renal columns.
Pyramid
contains minor
calyces which
unite to form a
major calyx.
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Afferent arteriole:
Glomeruli:
Efferent arteriole:
Peritubular capillaries:
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(continued)
Nefron
Unit
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Nephron
Functional unit
of the kidney.
Consists of:
Blood vessels:
Vasa recta.
Peritubular
capillaries.
Urinary
tubules:
PCT.
LH.
DCT.
CD.
The nephron
The nephron is the functional unit of the kidney
Each region is composed of cells that are suited to perform specific transport functions
Distal convoluted
tubule
Proximal
convoluted
tubule
Collecting duct
Ascending
thin limb of
loop of Henl
Efferent arteriole
Afferent arteriole
Distal convoluted tubule
Arcuate artery
Collecting duct
Vasa recta
Thick ascending limb
of the loop of Henl
Descending limb
loop of Henl
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Nephron Tubules
Glomerular
capsule.
Proximal
convoluted
tubule (PCT).
Descending and
ascending
limbs of Loop of
Henle (LH).
Distal
convoluted
tubule (DCT).
Collecting duct
(CD).
Glomerulus
Merupakan invaginasi
tumpukan kapiler ke
ujung buntu nefron
(capsula Bowman).
Glomerulus dan Capsula
bowman disebut sebagai
Renal corpuscle.
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Glomerular Capsule
Bowmans
capsule:
Surrounds the
glomerulus.
Location where
glomerular
filtration
occurs.
Filtrate passes
into the urinary
space into PCT.
Cortical nefron
Juxtamedular n.
Letak glomerulus di
luar cortex
Loop of henle
pendek
Di cortex renal,
sebelah dalam
dekat medulla.
Loop of henle
panjang
kapiler peritubuler
khusus vasa recta)
Capsule
PT
Gl
Cortex
DCT
TAL
Proximal
convoluted tubule
Distal convoluted
tubule
Glomerulus
DTL
ATL
Medulla
Descending Loop
thin limb
of
Henl
Ascending
thin limb
Collecting duct
Filtrasi
Reabsorpsi
Sekresi
Ekskresi
Glomerular Filtration
First step in urine formation called
primary urine.
180 liters/day filtered
Entire plasma volume filtered 65
times/day
Blood Ultrafiltration dimana sel-sel
darah dan molekul-molekul besar
protein tidak dapat melewati
membran filtrasi glomerulus.
GLOMERULAR FILTRATION
The glomerular filtration rate (GFR) is about 125 ml/min in a normal adult
The first step in the formation of urine is the production of a plasma ultrafiltrate.
The ultrafiltrate is cell and protein-free and the concentration of small solutes are
the same as in plasma.
The filtration barrier restricts movement of solutes on a basis of size and charge.
Molecules < 1.8 nm freely filtered; >3.6 nm not filtered
Cations are more readily filtered than anions for the same molecular radius.
Serum albumin has a radius if about 3.5 nm but its negative charge prevents its
filtration
In many disease processes the negative charge on the filtration barrier is lost
so that proteins are more readily filtered - a condition called proteinuria
2.
3.
Afferent arteriole
Juxtaglomerular
cell
Capsule
space
Efferent arteriole
Proximal
convoluted
tubule
Endothelium
of glomerulus
Podocyte
Pedicel
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basal
lamina
pedicel
filtration
slit
fenestrated
endothelium
basal
lamina
podocyte
filtration
slit
fenestrated
endothelium
secondary
process
(pedicel)
podocyte
primary cell body
process
Podocyte
process
Cap
Mesangial
cell
Mesangial
matrix
Cap
Cap
Basement
membrane
Bowmans
capsule
Fenestrations
Bowmans
space
Endoth
cell
nucleus
Podocyte
process
Capillary
Basement
membrane
F
BM
E
Basement
membrane
Capillary
Capillary
Fenestrations
Fenestrations
Endoth
cell
nucleus
filtration
slit
capillary
PI
PC
Aff.Art.
At the glomerulus
The filtrative force is:
PGC - PBC
Opposed by an absorptive force
GC
Eff.Art.
PGC
GS
PBC
mm Hg
40
PGC-PBC
30
20
10
0
Glomerular hydrostatic
pressure, PGC, is high and
relatively constant
45 mmHg.
This is offset by a pressure
in Bowmans capsule PBC
10 mm Hg
Net filtrative force is:
35 mm Hg
aff. art
eff. art.
mm Hg
40
PGC-PBC
GS
30
20
10
0
Net filtration
force
aff. art
FILTRATIONFRACTION
Filtration fraction is an important expression of the extent of
glomerular filtration.
Glomerular filtration rate
It is the ratio: Filtration fraction =
Renal plasma flow
Renal blood flow
1250 ml/min
glomerulus
RPF
750 ml/min
Efferent
Arteriole
625 ml/min
GFR
125 ml/min
renal
vein
tubule
124 ml/min
Urine 1 ml/min
It is the fraction of
renal plasma flow
that is filtered at
the glomerulus
FILTRATIONFRACTION
anexample
Glomerular filtration rate (GFR)
is about:
125 ml/min
Renal blood flow
is about:
1250 ml/min
Renal plasma flow (RPF)
is about:
750 ml/min
125
Thus, in this example filtration fraction is:
750
0.17
Flow, l/min
1.5
1.0
0.5
GFR
0
0
100
200
Arterial blood pressure, mm Hg
Flow
arterial pressure
increases
Remember:
Flow14
r
Flow
arterial pressure
increases
Flow
returns to
normal
4. Ra
GFR
GFR
2. filtrate
3.signal from
JGA
GFR normal
= 125 ml/mnt
= 7,5 l/ jam
= 180 liter/hari
Tubular Reabsorption
By passive diffusion
By primary active transport: Sodium
By secondary active transport:
Sugars and Amino Acids
Reabsorpsi Tubulus
Kapiler peritubuler menyerap ;
Air
Glukosa
Asam amino
Ion-ion
Penyerapan sebagian besar terjadi
pada proximal convulated tubule.
1.
2.
3.
Reabsorption
125 ml
65%
15%
10%
9.3%
Urine 1ml/125 ml
Proximal Tubule
Most glucose, amino acids, water, and
Loop of Henle
Thin descending loop
Thin endothelial cell layer
Highly permeable to water
20% of water reabsorbed here
Distal Tubule
Juxtaglomerular apparatus
1st segment is diluting segment
impermeable to water but not to ions
2nd segment is similar to collecting duct
Principal cells
Intercalated cells
Impermeable to urea
Sekresi (secretion)
=Kebalikan Reabsorpsi
Beberapa
Urine Formation
1-filtration
movement fluid
across the
filtration
membrane as a
result of pressure.
Urine Formation
2-Reabsorption
movement of
substances from the
filtrate back into the
blood
Urine Formation
3- Secretion
active
transport of
solutes into the
neprhon.
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Measurement of GFR
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1.
2.
Ureter
Kandung Kemih
(Vesica Urinaria)
1.
2.
Persarafan
Urethra
Berkemih (Micturition/Voiding)
Kedua katup (sphincter) otot harus
terbuka agar dapat berkemih
Internal urethral sphincter : direlakskan
setelah peregangan kandung kemih
Pengkatifan ini berasal dari impulse
dikirim ke spinal cord dan kemudian
balik melalui saraf pelvic splanchnic
External urethral sphincter : harus
direlakskan secara sadar
Copyright2003PearsonEducation,Inc.publishingasBenjaminCummings
Neuroanatomy of Micturition
Storage Stability and good
compliance of Bladder
Empty Contraction of detrusor and
opening of Urethra
Parasympathetic - Pelvic nerve
Sympathetic - Hypogastric nerve
Somatic nerves- Pudendal nerve
Neuroanatomy of Micturition
Micturition reflex center sacral
cords 2-4
Micturition control center pons
Sensory motor center frontal lobe
Limbic system
Cerebellum, Basal ganglia
2934
MICTURITION REFLEX
Bladder fills
+
Stretch receptors
Spinal Cord
Parasympathetic
nerve
Bladder contracts
Internal urethral
sphincter opens
Figure 26.21
Hipotonis :
Banyak minum Vol. ECF
Sekresi ADH Reabsorbsi air
Diuresis.
Hipertonis
Sedikit minum Vol. ECF
Sekresi ADH Reabsorbsi air
Urine Hipertonis (Pekat).
Figure 26.19a
Figure 26.19b
Urinalisa
Makroskopik :
Bau
Mikroskopik
Leukosit
:Eritrosit : Silinder :
Kristal :
: Amoniak
Warna : Kuning jernih
Kimiawi
pH : 4,5 - 8
Berat jenis :
1,003 1,035
Proteinuria : Glukosauria : -
Radiologi :
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Kidney Diseases
Glomerulonephritis:
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Kidney Diseases
Renal insufficiency:
(continued)
Dialysis: