GINJAL

*

FUNGSIPengaturan keseimbangan air & elektrolitPengaturan konsentrasi osmolaritas cairan tubuh & elektrolitPengaturan keseimbangan asam basaEkskresi hasil sisa metabolisme Pengaturan tekanan arteriSekresi hormonGlukoneogenesis

*

Excretion

The removal of organic waste products from body fluidsElimination

The discharge of waste products into the environmentHomeostatic regulation of blood plasma

Regulating blood volume and pressureRegulating plasma ion concentrationsStabilizing blood pHConserving nutrientsFunctions of the urinary system

*

ANATOMI FISIOLOGI GINJAL ANJING

*

ANATOMI FISIOLOGI GINJAL SAPI

*

Figure 26.3

Figure 26.3 The Urinary System in Gross Dissection

*

ANATOMI & FISOLOGI

*

Cortical nephrons

~85% of all nephronsLocated in the cortexJuxtamedullary nephrons

Closer to renal medullaLoops of Henle extend deep into renal pyramidsTwo types of nephron

*

Figure 26.7a

Figure 26.7 Cortical and Juxtamedullary Nephrons

*

Figure 26.7b, c

Figure 26.7 Cortical and Juxtamedullary Nephrons

*

*

Production of filtrateReabsorption of organic nutrientsReabsorption of water and ionsSecretion of waste products into tubular fluid

Nephron functions include:

*

Regulating blood volume and compositionExcreting waste products

UreaCreatinineUric acidUrine production maintains homeostasis

*

Filtration

Blood pressure Water and solutes across glomerular capillaries Reabsorption

The removal of water and solutes from the filtrateSecretion

Transport of solutes from the peritubular fluid into the tubular fluid Basic processes of urine formation

*

Figure 26.9 An Overview of Urine FormationFigure 26.9

*

Filtration in the kidneys modified by carrier mediated transport

Facilitated diffusionActive transportCotransportCountertransportCarrier proteins have a transport maximum (Tm)

Determines renal thresholdCarrier Mediated Transport

*

Accomplished via diffusion, osmosis, and carrier-mediated transportTm determines renal threshold for reabsorption of substances in tubular fluid

Reabsorption and secretion

*

Superficial outer cortex and inner medulla

The medulla consists of 6-18 renal pyramidsThe cortex is composed of roughly 1.25 million nephronsMajor and minor calyces along with the pelvis drain urine to the ureters

Sectional anatomy of the kidneys

*

NEPHRONMerupakan unit fungsionil terkecil ginjal 1 Juta / GinjalPanjang seluruh nephron = 45 65 mm

*

GLOMERULUSKapsula Bowman : pars visceralis & pars parietalisFilter glomerulus : 3 lapis

Endhotelium kapiler :100nmLamina basalis :8 nmEpithel Pars viceralis kapsula Bowman ( Podocyt) : 25 nmLuas area filtrasi 0,8 m2Ultra filtrat = plasma - protein

*

Figure 26.10 Glomerular FiltrationFigure 26.10

*

Figure 26.8 The Renal CorpuscleFigure 26.8a, b

*

Figure 26.8 The Renal CorpuscleFigure 26.8c, d

*

Figure 26.10 Glomerular FiltrationFigure 26.10a, b

*

Proximal convoluted tubule (PCT)

Actively reabsorbs nutrients, plasma proteins and ions from filtrateReleased into peritubular fluidLoop of Henle

Descending limbAscending limbEach limb has a thick and thin sectionFunctional anatomy of the nephronAnimation: Urinary System AnatomyPLAY

*

Glomerular filtration produces fluid similar to plasma without proteinsThe PCT reabsorbs 60-70% of the filtrate produced

Reabsorption of most organic nutrientsActive and passive reabsorption of sodium and other ionsReabsorption of waterSecretion also occurs in the PCT

Reabsorption and secretion at the PCTAnimation: Early Filtrate ProcessingPLAYAnimation: Glomerular filtrationPLAY

*

TUBULUS PROKSIMALISP = 15 mmTight junctionLateral intercellular spaceBrush borderReabsorbsi 65 %Zat yg direabsorbsi tidak disekresi kecuali K+Sekresi zat diikat oleh protein plasma

*

Figure 26.12 Transport Activities at the PCTAnimation: Proximal Convoluted TubulePLAYFigure 26.12

*

The loop of Henle and countercurrent multiplicationCountercurrent multiplication

Between ascending and descending limbs of loopCreates osmotic gradient in medullaFacilitates reabsorption of water and solutes before the DCT Permits passive reabsorption of water from tubular fluid

*

ANSA HENLEPars decendent : 2- 14 mmPars Ascendent : mithokondria >>, Sel Junxtaglomerular vas. Afferent mensekresi RENINANSA HENLE SEGMEN TIPIS : permeabilitas besar, metabolisme minimalANSA HENLE SEGMEN TEBAL : tidak permeabel thd H2O & Ureum, reabsorbsi aktif Cl- & Na+

*

Figure 26.13a

Figure 26.13 Countercurrent Multiplication and Concentration of Urine

*

Figure 26.13b

Figure 26.13 Countercurrent Multiplication and Concentration of Urine

*

Figure 26.13c

Figure 26.13 Countercurrent Multiplication and Concentration of Urine

*

Distal convoluted tubule (DCT)

Actively secretes ions, toxins, drugsReabsorbs sodium ions from tubular fluidFunctional anatomy of the nephronAnimation: Urinary System Dissection and FlythroughPLAY

*

DCT performs final adjustment of urine

Active secretion or absorptionAbsorption

Tubular cells actively resorb Na+ and Cl- In exchange for potassium or hydrogen ions (secreted) Reassertion and secretion at the DCT

*

TUBULUS DISTALISP = 5 mmEphitel lebih pipih dari ephitel tubulus proksimalisBrush border ()Bagian proksimal = segmen tebal ansa henleBagian distal terjadi ion exchange K+ dg Na+ : Hormon Aldosteron

*

Figure 26.14

Figure 26.14 Tubular Secretion and Solute Reabsorption at the DCTAnimation: Distal Convoluted TubulePLAY

*

Figure 26.14c

Figure 26.14 Tubular Secretion and Solute Reabsorption at the DCT

*

Reabsorption and secretion along the collecting systemWater and solute loss is regulated by aldosterone and ADHReabsorption

Sodium ion, bicarbonate, and urea are resorbedSecretion

pH is controlled by secretion of hydrogen or bicarbonate ions

*

DUKTUS COLLIGENTESP = 20 mmMenampung beberapa tubulus distalisBer muara di papilla renalisBagian Cortex : tidak permeabel thd ureumBagian medulla ; permeabel thd ureumADH < : tidak permeabel thd H2O

*

Figure 26.6 A Representative NephronFigure 26.6

*

Figure 26.5 The Blood Supply to the KidneysFigure 26.5c, d

*

Figure 26.5 The Blood Supply to the KidneysFigure 26.5a, b

*

SUPLAI DARAH GINJAL

*

*

RENAL FRACTIONVasa afferent glomerulus membentuk vasa rectaRenal Blood Flow = 1200 ml/menitCardiac Out Put = 5000ml/ menitRenal Fraction = 1200/5000 X 100% = 24%

*

KECEPATAN ALIRAN DARAH TIAP 100 g JARINGAN

ORGANBLOOD FLOW (ml / min )

Otot SkeletOtakHatiOtot JantungGinjal3545884420

*

ALIRAN CAIRAN DLM TUBUH

JARINGANKecepatan (ml/min)Reabsorpsi ( %)Tubulus ProksimalAnsa HenleTubulus DistalisDuct. ColligentesUrine12545251216515109,30,7

*

REABSORPSI ELEKTROLIT( kation ) perlu dikendalikan, bila berubah : kegagalan faal ginjalK+ > : potensial membran < : paralisisK+ < : potensial membran > : paralisisNa+ : tetani

*

Amount of filtrate produced in the kidneys each minuteFactors that alter filtration pressure change GFR

Glomerular filtration rate (GFR)

*

GLOMERULAR FILTRATION RATE ( GFR)Jumlah filtrat yg disaring dr plasma dalam satu menitNormal : 125 ml / minLebih dr 99% direabsorpsiProduk urine : 1 L / hariZat yg digunakan untuk mengukur : Inulin, Manitol

*

A drop in filtration pressure stimulates Juxtaglomerular apparatus (JGA)

Releases renin and erythropoietinFactors controlling the GFR

*

FAKTOR YG MEMPENGARUHIPerubahan Tek. Darah

Tek. Darah umumStatus vasa afferent / efferentContoh : latihan jasmani : vasokontriksi vasa afferentCaffein : Vasodilatasi vasa afferent

*

Perubahan Tekanan Capsular : Obstruksi, Edema jaringanPerubahan Tek. Osmotik Koloid : Dehidrasi, HipoproteinPerubahan Permeabilitas : Peny. Ginjal, Keracunan ObatPerubahan Luas Area Filtrasi : Peny. Ginjal, Nephrotomy

*

FILTRASI GLOMELURUSEffective Filtration Pressure (EFP)Tek. Darah Tek Capsular Tek Koloid Osmotik = 70 20 32 = 18 mmHg

*

DIURETIKAZat yg dpt meningkatkan kec.pembentukan urineCara :

Meningkatkan GFRMengurangi reabsorpsi cairan dlm tubuhTerapi : Edema , HipertensiMekanisme kerja :

Meningkatkan GFRMeningkatkan muatan osmotik koloid tubuhMenghambat ADH

*

MENINGKATKAN GFRCara :

Tek darah >Vasodilatasi vasa afferentVasokonstriksi vasa efferentTek. Osmotik Koloid

BEBERAPA JENIS OBATEPINEPHRINE : Tek darah Tek Caps Bowman GFR Diuresis DIGITALIS : Decompensatio Cordis sirkulasi diperbaiki P Bowman GFR Diuresis THEOPHYLIN & CAFFEIN : Vasodilatasi Vasa Aff. P Bowman GFR Diuresis

*

MENINGKATKAN MUATAN OSMOTIK TUBULUSMempunyai efek terutama di tub. Proks: Ureum, Sukrosa, Manitol, GlukosaMenghambat Reabsopsi Na+Di Ansa Henle : Furosemide, Ethacrynil AcidDi Tub. Distal bgn Proksimal : thiazide, metalazoneDi tub. Distalis bgn Distal : spironolactone, amiloride

*

Menghambat ADHADH reabsorpsi H2O di Ductus colligentes diuresisAlkohol, narkotika, anastesi

*

Figure 26.11a

Figure 26.11 The Response to a Reduction in the GFR

*

Figure 26.11b

Figure 26.11 The Response to a Reduction in the GFR

*

Figure 26.16 A Summary of Renal FunctionFigure 26.16a

*

Figure 26.15

Figure 26.15 The Effects of ADH on the DCT and Collecting Ducts

*

Figure 26.15a, b

Figure 26.15 The Effects of ADH on the DCT and Collecting Ducts

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*