URINARY SYSTEM

dr. ARLENDS CHRIS, M.Si. Fakultas Kedokteran Universitas Tarumanagara Jakarta

Sistem ekskresi pada manusia dan vertebrata lainnya melibatkan organ paru-paru, kulit, ginjal, dan hati. Namun yang terpenting dari keempat organ tersebut adalah ginjal.

HOW THE KIDNEYS WORK The kidneys are two bean-shaped organs located toward the back of the body on either side of the spine near the waistline. They are about the size of a fist and are protected by other organs and two of the lower ribs. Normal functioning kidneys serve the body in several very important ways. They: Clean your blood and remove waste products Balance water and salt to control fluid in the body Control blood pressure Help make red blood cells and strong bones Control the amount of potassium, calcium, magnesium and phosphorus in the blood

Introduction
The

urinary system comprises

2 kidneys 2 ureters 1 bladder 1 urethra

This system contributes to the maintenance of homeostasis by complex process that involves, (nephron)
Filtration

of most small molecules from blood plasma to form an ultrafiltrate of plasma. Selective reabsorption of most of the water and some other molecule from ultrafiltrate, leaving behind excess and water material to be excreted. Secretion of some excretory products directly from blood into urine. Maintenance of the acid-base balance by selective of H+ ions into the urine.

The kidney also participates in other homeostatic mechanisms either by production or by modification of various hormones:
Renin,

is component of the reninangiotensin-aldosteron mechanism which control blood pressure. Erythropoietin, synthesised in the kidney, stimulated the production of erythrocytes in the bone marrow and thus regulated the oxygen-carrying capacity of the blood. Vitamin D, which regulated calcium balance, is converted to an active form in the kidney.

124 mL is absorbed in the organ The two kidney produce about 125 mL of filtrate per minute;

Only 1 mL is released into the ureter as urine

About 1500 mL of urine is formed every 24 h

Introduction
Urine kidney
retroperitoneal

ureter bladder
FOR MORE INFO...
anterior part of the pelvis

Urine is produced in the kidneys and flows down the ureters to the bladder where it is stored until voided via the urethra.

The kidney possess a convex and a concave border, the latter of which is known as the hilum.

The cortical region is subdevided into the cortical labyrinth and the medullary rays.

The medulla is composed of 10-18 renal pyramids, each of whose apex is perforated by 15-20 papillary duct (of Bellini) at the area cribrosa. Each renal pyramid is said to constitute a lobe of the kidney. The region of the medulla between neighboring renal pyramid is occupied by cortical-like material known as renal columns (of Bertin). Each medullary ray is an extension of the renal medulla into the cortex, where it forms the core of kidney lobule.

Cortical Labyrinth Medullary Rays

Medulla Zona Externa

Medulla Zona Interna

Cortical labyrinth cortex Medullary ray KIDNEY Zona eksterna medulla Zona interna
Histologic organization of the kidney

Corpus malphigi Tubulus contortus primus Tubulus contortus secundus Ductus colligentes pars arcuata

Tubulus rectus primus Tubulus rectus secundus Ductus colligentes pars rectus

Tubulus rectus primus Thin limb of Henles loop Tubulus rectus secundus Ductus colligentes pars rectus Thin limb of Henles loop Ductus colligentes pars rectus Ductus papillaris Bellini

Cortical Labyrinth Corpus Malpighi Tubulus Contortus Primus Tubulus Contortus Secundus Ductus Colligentes pars Arcuata

Medullary Rays Tubulus Rectus Primus Tubulus Rectus Secundus Ductus Colligentes pars Rectus

Medulla Zona Externa Tubulus Rectus Primus Ansa Henle Segmen Tipis Tubulus Rectus Secundus Ductus Colligentes pars Rectus Medulla Zona Interna Ansa Henle Segmen Tipis Ductus Colligentes pars Rectus Ductus Papillaris Bellini

Classification by the functions

Functional filtration unit (nefron) Corpus Malphigi (renal corpuscle) Ductus : TC I, TR I, thin limb of Henles loop,
TR II, TC II.

Excretion unit ( nefron) Collecting tubules : D. Colligentes pars arcuata, D. Colligentes pars rectus, D. Papillaris Bellini.

The Human Kidney contains approximately one-four million nephrons.

Classification of the nephrons: According to location of Corpus Malphigi Nephron Juxtamedullar ( 1/7 nephrons) this nephron have loop of long henle. Nephron Capsuler/superficial Parts of The loop of Henle Long nephron Short nephron

CORPUS MALPHIGI
Glomerulus

Capsula Bowman Pars Parietal Pars Visceral Vascular Pole Urinary Pole

GLOMERULUS
Pars Visceralis cell Bowman Capsula. Podocytes cell Capillary endothelium Intraglomerular mesangial cell (fagositosis)

APPARATUS JUXTAGLOMERULUS (VASCULER POLE)

1. Juxtaglomerular cells are specialised smooth cells of the wall of the afferent arteriol modifications as granuler mioepiteloid cell cytoplasm contains immature and mature membran-bound granules of the enzyme renin. 2. Macula densa between afferent and efferent arteriole, the cell of macula densa are taller and have larger more prominent nuclei which are situated towards the luminal surface. 3. Lacis cells/extraglomerular mesangial cell agranuler juxtaglomerular cell.

Juxtaglomerular apparatus

Juxtaglomerular apparatus Blood pressure control system

Ciri-ciri mikroskopik saluran:

TUBULUS CONTORTUS PRIMUS
- Berkelok-kelok

- Epitel Selapis kubis - Aspek sangat asidofil - Batas sel tak jelas - Letak inti berjauhan - Brush Border - Mitokhodria

TUBULUS RECTUS PRIMUS - Hampir sama Tubulus Contortus I - Tidak berkelok-kelok - Epitel Selapis kubis - Aspek asidofil - Batas sel tak jelas - Letak inti berjauhan - Brush Border - Mitokhodria

ANSA HENLE SEGMEN TIPIS

-Epitel Selapis Gepeng

-Inti menonjol ke lumen -Bentuk lebih tebal dari endotel -Sedikit brush border -Sitoplasma kurang asidofil -Lumennya lebar

TUBULUS RECTUS SECUNDUS - Tidak berkelok-kelok - Epitel selapis kubis - Inti berdekatan - Sitoplasma sedikit asidofil - Tak ada brush border - Mitokhondria

TUBULUS CONTORTUS SECUNDUS - Kurang berkelok - Epitel selapis kubis - Inti banyak berdekatan - Batas sel tdk jelas - Sitoplasma bergranuler - Kurang asidofil - Brush border - Sedikit mitokhondria

DUCTUS COLLIGENTES - Epitel selapis kubistorak tinggi - Sitoplasma bening - Apical sel terdapat cuticula - Batas sel jelas

TCP TRP PI (Tubulus Contortus (Tubulus (Pars Intermedia) Primus) Rectus Primus) Epitel Selapis torak rendah/kubus Selapis kubus Selapis gepeng

TRS (Tubulus Tectus Secundus) Epitel selapis kubus (inti berdekatan)

TCS (Tubulus Contortus Secundus) Epitel selapis kubus (inti berdekatan)

DC (Ductus Colligentes)

Epitel selapis kubus-torak

Sitoplasma

Bergranuler, sangat asidofil

Bergranuler, Kurang asidofil, asidofil sedikit

Sedikit asidofil

Kurang asidofil

Bening, kurang sekali asidofil

Batas sel

Tidak jelas

Tidak jelas

Tidak jelas

Tidak jelas

Tidak jelas

Jelas

Brushborder

(+)

(+)

(-) MC tapi (+) Sedikit pd ME (Bailey, 17Th Ed)

(-)

(-)

(-), tapi terdapat kutikula

Basal striation

(+)

(+) Sedikit

(+) Paling sedikit

(+) Sedikit

(+) Sedikit

(-)

Bentuk sayatan

Berkelok

Tidak berkelok Tidak berkelok

Tidak berkelok

Berkelok

Tidak berkelok, kecuali pd pars arcuata

Saluran apakah ini? Sebutkan ciri-cirinya?

Proximal tubule

Distal tubule

A small number of dark intercalated cells (with microvilous)

Supporting tissue

Azan x 750

Ductus Papillaris Bellini (The largest of the collecting ducts) Calyx Minor Transitional Epithelium Smooth Muscle

Comparison of epithelial structure in different parts of the renal tubule

Summary diagram of activities of different parts of the tubule

Vaskularisasi ginjal. A. Renalis A. Interlobaris A. Arcuata A. Interlobularis A. Intralobularis Vasa Afferent

Vasa Afferrent Glomerulus Vasa Efferent Bercabang menjadi Plexus Peritubular dan plexus kapiler di medulla Plexus Peritubuler Venae V. Stellata V. Interlobularis V. Arcuata V. Interlobaris V. Renalis

SISTEM LIMFATIK GINJAL Sistem superficial (dimana cabang kapiler limfe terdapat pd kapsul ginjal dan berhubungan dengan pembuluh ginjal) Sistem Profunda Terletak pada jaringan kelenjar.
Dalam glomerulus tidak ada pembuluh limfe

PERSARAFAN GINJAL
Saraf tak bermielin Berasal dari Plexus Celiaca, Nervus Th X XII & LI mengikuti pembuluh darah dan berakhir pd arteriole glomerulus. Serat saraf sensoris bermielin berjalan menuju kapsul, otot polos pelvis dan Tunika adventisia dari pembuluh darah ginjal. Saraf memasuki ginjal melalui Hilus.

URETER Tn. Mukosa - Epitel - Lm. Propria - Tn. Musk. Muk. Tn. Sub Mukosa Tn. Musc Transisional, sel payung, krusta Jaringan ikat tipis Tidak jelas 2/3 proksimal: long, sirk. 1/3 distal: long,sir,long Tn. Adv Fibroelastika. Pembuluh drh ++

VESIKA URINARIA Transisional, sel payung, krusta + (tipis) Tidak jelas Dlm: Long. Tengah: Sirk. Luar: long.

Fibroelastika Bg. Dorsal: tn serosa

bladder

ureter

URETHRA PRIA : + 15-20 CM P. Prostatica Tn. Mucosa Epitel M. Basalis Lm. Propria Tn. Musc.muc Tn. submucosa 3-4 cm Transisional Tipis P. Membranacea 1 cm Berlapis bertingkat torak + P. Cavernosa 15 cm Berlps torakbertingkat + JI Jarang Lapisan otot<< Lacunae venae, fibroelastik, o. polos long & sirk Lacunae venae, long & sirkuler. JI fibrosa = Tn. albuginea Berlapis gepeng + JI Jarang P. Navicularis

JI jarang & p.d. JI Jarang

Tn. Musc.

Fibromusculer

Fibromusculer m. Sph Urethrae (otot lurik)

Tn. Adv

Ductus Ejaculatorius Urethra Pars Prostatica Kelenjar Prostat

Urethra Pars Membranacea

URETHRA PARS MEMBRANACEA

Urethra pars cavernosa

URETHRA WANITA : + 4 CM Tn Mucosa: - Epitel transisional (dekat VU), berlapis torak bertingkat torak berlapis gepeng (distal). - Lm. Propria : JI. Jarang, plexus venae - Tn. Musc. Mucosa : Tn submucosa: Tn Muscularis: Longitudinal, sirculer otot sphingster urethrae Tn. Adventitia: -

Who keeps learning all his life is like wine; the ripening experience during the years increases the quality.