Ginjal Bilingual

8/17/2019 Ginjal Bilingual

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GINJAL/ KIDNEY

Tuty S. Richata, drg., MS., AIFM.

References :References :

Tortora : Principles of Anatomy & Physiology, 10Tortora : Principles of Anatomy & Physiology, 10thth

Edition, 2003Edition, 2003Gyton &!all : "isiologi #edo$teran, Edisi %, 1%%Gyton &!all : "isiologi #edo$teran, Edisi %, 1%%Ethel 'loane : Anatomi dan "isiologi, Edisi 1, 200(Ethel 'loane : Anatomi dan "isiologi, Edisi 1, 200()*" Ganong : "isiologi #edo$teran, Edisi 10, 1%+3)*" Ganong : "isiologi #edo$teran, Edisi 10, 1%+3


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GINJAL/ KIDNEY

MERUPAKAN BAGIAN TERPENTINGMERUPAKAN BAGIAN TERPENTING

DARI SISTEM URINARIADARI SISTEM URINARIA

SISTEM URINARIA TERDIRI DARISISTEM URINARIA TERDIRI DARI :: - 2 BUA GIN!A"- 2 BUA GIN!A"

- 2 BUA URETER- 2 BUA URETER

- # BUA KANDUNG KEMI- # BUA KANDUNG KEMI

- # BUA URETRA- # BUA URETRA

SISTEM INI MERUPAKAN SA"A SATUSISTEM INI MERUPAKAN SA"A SATUSISTEM UTAMA UNTUK MEMPERTAANKANSISTEM UTAMA UNTUK MEMPERTAANKAN

$ME$STATIS TUBU$ME$STATIS TUBU

AN IMP$RTANT PART $F URINAR%AN IMP$RTANT PART $F URINAR%S%STEMS%STEM

URINAR% S%STEM &$NSISTSURINAR% S%STEM &$NSISTS

$F:$F: 2 KIDNE%S2 KIDNE%S

2 URETERS2 URETERS

# B"ADDER# B"ADDER

# URETRA# URETRA

TIS S%STEM IS $NE $F TE MAINTIS S%STEM IS $NE $F TE MAIN

S%STEM T$ REGU"ATE B$D%'SS%STEM T$ REGU"ATE B$D%'S

$ME$STATI&$ME$STATI&


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GAMBAR SISTEM URINARIA

URINARY SYSTEM


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STRUKTUR GINJAL

THE STRUCTURE OF KIDNEY

"$KASI"$KASI

TER"ETAK RETR$PERIT$NEA"TER"ETAK RETR$PERIT$NEA"

SETINGGI (ERTEBRA T$RAKA" #2 -SETINGGI (ERTEBRA T$RAKA" #2 -

"UMBA" #"UMBA" #

STRUKTUR EKSTERNA" : BERBENTUK SEPERTI KA&ANG MERA

BERUKURAN #2,) * 2,) c+

MEMI"IKI BERAT SEKITAR #2) #) gr

PRIA/ DAN ##) #)) gr 0ANITA/ MEMI"IKI !ARINGAN IKAT

PEMBUNGKUS %ANG TERDIRI DARI

FASIA RENA"IS, "EMAK PERIRENA"

DAN KAPSU" FIBR$SA

LOCATION LOCATION IN RETROPERITONEAL ASIN RETROPERITONEAL AS

THORACIC 12- LUMBAR VERTEBRAETHORACIC 12- LUMBAR VERTEBRAE

11

EXTERNAL STRUCTURE RED BEAN LOOK ALIKE

ITS SIZE: 12,5X2,5 CM

ITS WEIGHT : ABOUT 125-175 GR (MALE

AND 115-155 GR (!EMALE

- IT IS COVERED B" CONNECTIVE

TISSUE WHICH CONSISTS O! RENAL

!ASCIA,PERIRENAL !AT, AND !IBROUS

CAPSULE


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STRUKTUR INTERNA" 1STRUKTUR INTERNA" 1 INTERNAL STRUCTURE INTERNAL STRUCTURE

I"US : PUSAT KE&EKUNGANTEPI MEDIA" GIN!A"

SINUS GIN!A" : R$NGGAUNTUK !A"AN MASUK URETER,

(ENA DAN ARTERI RENA"IS PE"(IS GIN!A" : MUARA DARI

KA"IKS MA%$R DAN KA"IKS

MIN$R

PARENKIM GIN!A" :

MEDU"A, TERSUSUN ATAS

PIRAMIDA DAN PAPI"A GIN!A"

K$RTEKS, TERSUSUN ATAS

NEFR$N

HILUS: THE CENTER O! KIDNE"MEDIAL ELLIPTICAL SIDE

KIDNE" SINUS: ENTR"VESTIBULE !OR URETHRA, VEIN

AND ARTER" RENAL

KIDNE" PELVIS: THE MIDPOINTMA"OR CAL"X AND MINOR

CAL"X

K#IDNE" PARENCH"M:MEDULLA, CONSIST O!

P"RAMID AND KIDNE" PAPILLA

CORTEX, CONSIST O! NEPHRON


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7/39

FUNGSI GINJAL KIDNEY FUNCTION

FUNGSI UTAMAFUNGSI UTAMA #. MEMBUANG AT-AT SAMPA#. MEMBUANG AT-AT SAMPA

TUBU DARI ASI" PR$SESTUBU DARI ASI" PR$SES

PEN&ERNAAN DAN METAB$"ISMEPEN&ERNAAN DAN METAB$"ISME

2. PENGATURAN ($"UME DAN2. PENGATURAN ($"UME DAN

K$MP$SISI &AIRAN TUBUK$MP$SISI &AIRAN TUBU

TU!UANTU!UAN :: UNTUK MEME"IARA KESTABI"AN "INGKUNGANUNTUK MEME"IARA KESTABI"AN "INGKUNGAN

SE"-SE" %ANG DIPER"UKAN UNTUK ME"AKUKANSE"-SE" %ANG DIPER"UKAN UNTUK ME"AKUKANBERBAGAI MA&AM AKTI(ITASBERBAGAI MA&AM AKTI(ITAS

DENGAN &ARA

MEN%ARING P"ASMA MEMISAKAN AT-AT %ANGTIDAK DIBUTUKAN DARI FI"TRATMENGEKSKRESIKAN DA"AM URIN/ AT %ANG

DIBUTUKAN AKAN DIKEMBA"IKAN KE DA"AM DARA

MAIN UTILTIES :MAIN UTILTIES :

11$ TO REMOVE THE ORGANIC BOD"WASTE , EXCESS !ROM DIGESTION

AND METABOLISM PROCESS$ 2$ TO COMPOSE BOD"%S !LUID VOLUME

AND COMPOSITION

OB&ECTIVES:OB&ECTIVES:TO MAINTAIN THE ENVIRONMENTAL CELLSTO MAINTAIN THE ENVIRONMENTAL CELLS

STABILIT" WHICH ARE ESSENTIAL TO DOSTABILIT" WHICH ARE ESSENTIAL TO DO

VARIOUS ACTIVITIESVARIOUS ACTIVITIES

HOW IT WORKS:

PLASMA !ILTERING SEPARATING THE

UNNECESSAR" SUBSTANCES !ROM THE

!ILTRAT INITIATING URINAL EXCRETION

THE NECESSAR" SUBSTANCE WILL BE

RETURNED TO THE BLOOD !LOW


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BERBAGAI FUNGSI "AIN OTHER UTILITIES

PENGATURAN KESEIMBANGAN AIR DAN

E"EKTR$"IT

PENGATURAN K$NSENTRASI

$SM$"A"ITAS &AIRAN TUBU 3

K$NSENTRASI E"EKTR$"IT

PENGATURAN KESEIMBANGAN ASAM

BASA PENGATURAN TEKANAN DARA

PENGENDA"IAN TERBATAS TERADAP

K$NSENTRASI G"UK$SA DAN ASAM

AMIN$ DARA

BALANCING THE WATER AND

ELECTROLITES$

SETTING UP THE BOD" !LUIDS

OSMOLALIT" CONCENTRATION

ELECTROLITES CONCENTRATION

BALANCING ACID AND BASE LEVEL

SETTING UP THE BLOOD PRESSURE

LIMITED CONTROL TO GLUCOSE AND

AMINO ACID BLOOD

CONCENTRATION


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NEFRON / NEPHRON

UNIT STRUKTURA" DAN FUNGSI$NA" GIN!A"

!UM"AN%A : 4 # !UTA UNIT 1 GIN!A"

TERDIRI DARI : G"$MERU"US

TUBU"US PR$KSIMA" ANSA EN"E TUBU"US DISTA" DUKTUS K$"IGENTES 1PENGUMPU"

2 !ENIS NEFR$N :

NEFR$N K$RTIKA" NEFR$N !UKSTAMEDU"AR

KIDNE"%S STRUCTURAL AND !UNCTIONAL

UNITS

AMOUNT: : ' 1 MILLION UNITS KIDNE"

CONSISTS O!:

GLOMERULUS PROXIMAL TUBULES

LOOP O! HENLE

DISTAL TUBULE

COLIGENTESCOLLECTING

DUCT

2 T"PES NEPHRON

CORTICAL NEPHRON

&UXTAMEDULLAR NEPHRON


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11/39

GLOMERULUS

GU"UNGAN KAPI"ER 4 )5 KAPI"AR/ %ANG

DIKE"I"INGI KAPSU" EPITE" KAPSU"

B$0MAN/ MEMBENTUK K$RPUSKE" GIN!A"

K$RPUSKE" GIN!A" TERDIRI DARI :

"APISAN (IS&ERA" MENGANDUNG SE"-SE"

P$D$SIT, PEDIKE", DAN BARIER FI"TRASI

G"$MERU"US/ "APISAN PARIETA" ,TERDIRI DARI :

- KUTUB (ASKU"AR : TEMPAT

ARTERI$" AFEREN 3 EFEREN

KE"UAR MASUK G"$MERU"US

- KUTUB URINARIUS : TEMPAT

FI"TRASI G"$MERU"USMENU!U TUBU"US PR$KSIMA"

THE CAPILLAR" ROOLS (' 5) C*+#*.

CHICH ARE SUROUNDED B" EPITHELIAL

CAPSULES AND !ORMING KIDNE"

CORPUSCLE$

KIDNE" CORPUSCLE CONSIST O!

VISCERAL LA"ER (CONSISTING PODOSITCELLS, PEDICELLS, AND BARRIER

GLOMERULUS !ILTRATION

PARIETAL LA"ER CONSISTO! :

- VASCULAR POLE :THE PASSAGE ON

GLOMERULUS WHERE A!!ERENT

ARTERIOL AND E!!ERENT ARTERIOL GOES IN AND OUT

- URINARIUS POLE : THE PASSAGE

ON GLOMERULUS !ILTRATION

THROUGH TO PROXIMAL TUBULUS


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13/39

TUBULUS / TUBULES

TUBU"US PR$KSIMA",

PAN!ANGN%A #) ++ DAN BER"IKU

ANSA EN"E, TERDIRI DARITUNGKAI DESENDEN DAN ASENDEN

TUBU"US DISTA" SEPAN!ANG)++, TERDIRI DARI MA&U"ADENSA, SE"!UKSTAG"$MERU"AR, DAN SE"MESANGIUM

DUKTUS K$"IGENTESMENGA"IRKAN URINE KE DA"AMKA"IKS MIN$R

PROXIMAL TUBULE,

15 //-LONG *0 CURVE-SHAPED$

LOOP O! HENLE , CONSIST O!DESCENDENT AND ASCENDENT TAIL

DISTAL TUBULE, 5 //- LONG *0

CONSIST O! MACULA DENSA,

&UXTAGLOMERULAR CELLS AND

MESANGIUM CELLS

DUCTUS COLIGENTES !LOWS THEURINE INTO MINOR CAL"X


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VASKULARISASI GINJAL /

KIDNEY VASCULARISATION

ARTERI RENA"IS ARTERI INTER"$BARIS

ARTERI ARKUATA ARTERI INTER"$BU"ARIS

ARTERI$" AFEREN G"$MERU"USARTERI$" EFEREN KAPI"ER PERITUBU"AR

(ENA INTER"$BU"ARIS (ENA ARKUATA

(ENA INTER"$BARIS (ENA RENA"IS


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SISTEM SARAF GINJAL /

KIDNEY NERVES SYSTEM

PERSARAFAN PADA GIN!A"

BERASA" DARI GANG"I$N &E"IA&

%ANG MEMBENTUK P"EKSUS

RENA"IS DAN MASUK KE DA"AM

GIN!A" BERSAMA-SAMA DENGAN

ARTERI RENA"IS

BERASA" DARI SISTEM SARAF $T$N$M

%ANG BERSIFAT SIMPATIS

BERPERAN DA"AM REGU"ASI

A"IRAN DARA GIN!A" ME"A"UI

PR$SES (AS$K$NSTRIKSI DAN

(AS$DI"ATASI ARTERI$" GIN!A"

KIDNE" NERVES S"STEM COMES

!ROM CELIAC GANGLION WHICH

!ORMS PLEXUS RENALIS AND ENTER

THE KIDNE" ALONG WITH RENAL

ARTER"

COMES !ROM S"MPATHIZED

AUTONOMIC NERVE S"STEM

HAS A ROLE IN KIDNE"BLOODSTREAM REGULATIONTHROUGH VASOCONSTRICTION AND

VASODILATATION PROCESS O! THE

KIDNE" ARTERIOLE


17/39

SISTEM HORMONAL GINJAL

KIDNEY HORMONAL SYSTEM

ANTIDIURETI& $RM$NE AD/ :

BERFUNGSI UNTUK MENINGKATKANPERMEABI"ITAS TUBU"US DISTA" DANTUBU"US PENGUMPU" TERADAP AIR

DISINTESIS $"E BADAN SE" SARAF DIIP$TA"AMUS DAN DISIMPAN DA"AMSERABUT SARAF IP$FISIS P$STERI$R

$RM$N A"D$STER$N :

MERUPAKAN $RM$N STER$ID DISEKRESI $"E SE"-SE" K$RTEKS

KE"EN!AR ADRENA" BEKER!A PADA TUBU"US DISTA" DAN

PENGUMPU" UNTUK MENINGKATKANABS$RPSI AKTIF I$N NATRIUM DANSEKRESI AKTIF I$N KA"IUM

ANTIDIURETIC HORMONE (ADH : TO INCREASE DISTAL TUBULE DAN

COLLECTING TUBULE PERMEABILIT"

AGAINST WATER

S"NTHESIZED B" NERVES CELLS BOD" IN

H"POTHALAMUS AND RESTORED INSIDEPOSTERIOR H"POPH"SIS NERVES SET

ALDOSTERON HORMONE:

CLASSI!IED AS STEROID HORMONE

PRODUCED B" CORTEX CELLS ADRENAL

GLAND WORKS ON DISTAL AND COLLECTING

TUBULE TO INCREASE THE SODIUM IONS

ACTIVE ABSORPTION AND KALIUM ION

ACTIVE SECRETION$


18/39

EFEK ALDOSTERON TERHADAP

NATRIUM DARAH

PADA SAAT K$NSENTRASI NATRIUM DARATURUN

RESEPT$R GIN!A" MENDETEKSI

PENURUNAN INI

MERANGSANG APARATUS !U*TA-G"$MERU"AR ME"EPASKAN RENIN

%ANG KEMUDIAN DI DA"AM DARA DIUBAMEN!ADI ANGI$TENSIN

ANGI$TENSIN BEKER!A PADA K$RTEKSADRENA" DAN MENSEKRESI

A"D$STER$N

PENINGKATAN ABS$RPSI NATRIUM DITUBU"US KEDA"AM A"IRAN DARA

THE EFFECT OF ALDOSTERON TO

NATRIUM OF BLOOD

WHEN THE CONECENTRATION O! NATRIUM O!BLOOD DECREASED

KIDNE" RECEPTOR DETECTS THIS REDUCTION

STIMULATE THE &UXTAGLOMERULAR

APARATUS TO RELEASE RENIN

WHICH NEXT IN BLOOD WILL BE CHANGED TO

BE ANGIOTENSIN

ANGIONTENSIN WORKS IN ADRENAL CORTEX

AND SECRETE ALDOSTERON

INCREASING O! NATRIUM ABSORPTION IN

DISTAL TUBULE IN BLOOD STREAM


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PEMBENTUKAN URIN / URINE FORMING

TIGA PR$SES UTAMA PEMBENTUKAN

URIN, %AITU :

FI"TRASI G"$MERU"US

REABS$RPSI TUBU"US

SEKRESI TUBU"US

THREE MAIN PROCESSES TO !ORM

URINE:

!ILTRATION O! GLOMERULUS

REABSORPTION O! TUBULE

SECRETION O! TUBULE


20/39

FILTRASI GLOMERULUS GLOMERULUS FILTRATION

DEFINISI

PERP-./A!A. A-RA. /A. ATTERART /AR- #AP-ER

G45ER', /AA5 T-.G#ATA.

TE#A.A. TERTE.T #E /AA5#AP' 64)5A.

FAKT$R %ANG MEMBANTU :

5E56RA. #AP-ER

G45ER' "EBI PER5EA6E

TE#A.A. /ARA! /AA5 #AP-ER

G45ER' E6-! T-.GG-

DEFINITION

THE MOVEMENT OF FLUID ANDCOMPOUNDS FROM GLOMERULUS

CAPILLARY, ON CERTAIN GRADIENT

PRESSURE INTO THE BOWMANCAPSULE

FACTORS WHICH CONTRIBUTE:FACTORS WHICH CONTRIBUTE:

GLOMERULUS CAPILLARY GLOMERULUS CAPILLARY

MEMBRANE IS MORE PERMEABLE MEMBRANE IS MORE PERMEABLE

BLOOD PRESSURE INBLOOD PRESSURE IN

GLOMERULUS GLOMERULUS

CAPILLARY IS HIGHERCAPILLARY IS HIGHER


21/39

/MEKANISME

FILTRASI GLOMERULUS

TEKANAN IDR$STATIK DARA/

G"$MERU"US MEND$R$NG &AIRAN DANAT TER"ARUT KE RUANG KAPSU"B$0MAN

TEKANAN IDR$STATIK KAPSU"ARMEND$R$NG &AIRAN DARI KAPSU"MENU!U G"$MERU"US DAN TEKANAN

$SM$TIK K$"$ID G"$MERU"US MENARIK&AIRAN DARI KAPSU" B$0MAN MEMASUKIG"$MERUS

TEKANAN FI"TRASI EFEKTIF EFP/ 6TEKANAN IDR$STATIK G"$MERU"US TEKANAN KAPSU"AR 4 TEKANAN $SM$TIKK$"$ID G"$MERU"US/E!P 55 3 ( 15 ' 4) //H 1) //H

GLOMERULUS FILTRATION

MECHANISM

GLOMERULUS H"DROSTATIC (BLO)D PRESSURE

PUSHES THE !LUID AND COMPOUND INTO THE

BOWMAN CAPSULE CHAMBER

CAPSULLAR H"DROSTATIC PRESSURE PUSHES THE

!LUID !ROM CAPSULE INTO THE GLOMERULUS

AND OSMOTIC PRESSURE O! THE COLOID

GLOMERULUS EXTRACTING THE !LUID !ROMBOWMAN CAPSULE INTO ENTERING GLOMERULUS

E!!ECTIVE !ILTRATION PRESSURE 6EFPGLOMERULUS H"DROSTATIC PRESSURE 3

(CAPSULAR PRESSURE ' OSMOTICPRESSURE O! GLOMERULUS COLOID

E!P 55 3 ( 15 ' 4) //H 1) //H


22/39

"A!U FI"TRASI G"$MERU"US GLOMERULUS !ILTRATION RATE

G!R

DEFINISI !UM"A FI"TRAT %ANG TERBENTUK PERMENIT $"E SEMUA NEFR$N DARI

KEDUA GIN!A"

NI"AI N$RMA""AKI-"AKI #2) +71+89it #5 "12;


23/39

FAKT$R %ANG MEMPENGARUI

G!R IN!LUENCING G!R !ACTORS

K$NTRIKSI ARTERI$" AFEREN AKANMENURUNKAN A"IRAN DARASEINGGA GFR TURUN

K$NTRIKSI ARTERI$" EFEREN AKANK$NTRIKSI ARTERI$" EFEREN AKANMENINGKATKAN A"IRAN DARAMENINGKATKAN A"IRAN DARASEINGGA GFR NAIKSEINGGA GFR NAIK

STIMU"ASI SIMPATISSTIMU"ASI SIMPATISMEN%EBABKAN K$NTRIKSIMEN%EBABKAN K$NTRIKSIARTERI$" AFEREN SEINGGAARTERI$" AFEREN SEINGGAMENURUNKAN GFRMENURUNKAN GFR

$BSTRUKSI A"IRAN URINARIA AKANMENURUNKAN GFR

BERBAGAI PEN%AKIT GIN!A" AKANMENINGKATKAN PERMEABI"ITASKAPI"ER G"$MERU"AR SEINGGAMENINGKATKAN GFR

THE AFFERENT ARTERIOLE CONSTRICTION

WILL DECREASE THE FLOW OF BLOOD

STREAM UNTIL THE GFR DECREASED

THE EFFERENT ARTERIOLE CONSTRICTIONTHE EFFERENT ARTERIOLE CONSTRICTION

WILL INCREASE THE FLOW OF THE BLOODWILL INCREASE THE FLOW OF THE BLOOD

STREAM UNTIL THE GFR INCREASE STREAM UNTIL THE GFR INCREASE

SYMPATHETIC STIMULATIONSYMPATHETIC STIMULATION CAUSE THECAUSE THE

AFFERENT ARTERIOLE CONSTRICTION UNTIL AFFERENT ARTERIOLE CONSTRICTION UNTIL

GFR DECREASEDGFR DECREASED

THE OBSTRUCTION OF THE FLOW OF

URINARIA DECREASES GFR

VARIOUS DISORDERS OF KIDNEY WILL

INCREASE THE CAPILLARY PERMEABILITY OF

GLOMERULAR SO THAT CAN INCREASE GFR


24/39

REABS$RPSI TUBU"US 1 REABSORPTION O! TUBULE

SELEKTIF MELALUI PROSES :

DIFUSI PASIF GRADIEN KIMIA/LISTRIK

TRANSPORT AKTIF GRADIEN KIMIA/

LISTRIK

DIFUSI TERFASILITASI

REABSORPSI ION NATRIUM :

TRANSPORT PASIF DARI LUMEN

TUBULUS KE DALAM SEL EPITEL TUBULUS

TRANSPORT AKTIF DARI SEL EPITEL

TUBULUS KE INTERSTITIAL

REABSORPSI ION KLOR & ION

NEGATIF

BERDIFUSI PASIF KE DALAM SEL

EPITEL TUBULUS

BERGERAK PASIF MENGIKUTI

PERGERAKAN NATRIUM DARI SEL EPITEL

TUBULUS KE INTERSTITIAL

SELECTIVE THROUGH THE PROCESS OF:

PASSIVE DIFUSION OF CHEMICAL

OR ELECTRIC GRADIENT

ACTIVE TRANSPORT OF CHEMICAL/

ELECTRIC GRADIENT

FACILITATED DIFUSION

REABSORPTION OF THE ION OF

NATRIUM

PASSIVE TRANSPORT FROM THE LUMEN OF

TUBULE INTO THE EPITHELIUM CELL OF

TUBULE

ACTIVE TRANSPORT FROM EPITHELLIUM

CELL OF TUBULE TO THE INTERSTITIAL

REABSORPTION OF THE ION OF CHLOR

AND NEGATIVE ION

PASSIVELY DIFUSED INTO THE EPITHELIAL CELL

OF TUBULE

MOVE PASSIVELY FOLLOWING THE MOVEMENT

OF NATRIUM FROM EPTHELLIAL CELL OF

TUBULE TO THE INTERSTITIAL


25/39

REABS$RPSI G"UK$SA, FRUKT$SA 3 ASAMREABS$RPSI G"UK$SA, FRUKT$SA 3 ASAM

AMIN$AMIN$ CARIERCARIER -N%A BERUPA K$TRANSP$R-N%A BERUPA K$TRANSP$R

MAKSIMUM TRANSP$R TM/ G"UK$SA :MAKSIMUM TRANSP$R TM/ G"UK$SA :

ADA"A !UM"A MAKSIMUM G"UK$SA %ANGADA"A !UM"A MAKSIMUM G"UK$SA %ANGDAPAT DI TRANSP$R PER MENIT, %AITUDAPAT DI TRANSP$R PER MENIT, %AITU

SEKITAR 255 +g G"UK$SA ATAU #55 +7 P"ASMASEKITAR 255 +g G"UK$SA ATAU #55 +7 P"ASMA

BI"A KADAR G"UK$SA DARA %G ME"EBIIBI"A KADAR G"UK$SA DARA %G ME"EBIINI"AI TM ME"E0ATI AMBANG P"ASMANI"AI TM ME"E0ATI AMBANG P"ASMA

GIN!A"/ MAKA TER!ADI G"IK$SURIAGIN!A"/ MAKA TER!ADI G"IK$SURIA

REABS$RPSI AIR, UREA DAN I$N-I$N $RGANIK: AIR BERGERAK BERSAMA I$N NATRIUM

ME"A"UI $SM$SIS

UREA SE&ARA PASIF DIREABS$RPSI AKIBAT

GRADIEN %ANG TERBENTUK SAAT AIR

DIREABS$RPSI

I$N I$N $RGANIK KA"IUM, KA"SIUM,F$SFAT da9 SU"FAT/ DIREABS$RPSI ME"A"UI

TRANSP$R AKTIF

GLUCOSE REABSORPTION, !RUCTOSE, 9GLUCOSE REABSORPTION, !RUCTOSE, 9

AMINO ACID AMINO ACID ITS CARRIER IS CO-TRANSPORT ITS CARRIER IS CO-TRANSPORT

GLUCOSE MAXIMUM TRANSPORT :GLUCOSE MAXIMUM TRANSPORT :

IS MAXIMUM AMOUNT O! TRANSPORTABLEIS MAXIMUM AMOUNT O! TRANSPORTABLE

GLUCOSE PER-MINUTE WHICH AROUND 2)) /GLUCOSE PER-MINUTE WHICH AROUND 2)) /

GLUCOSE 1)) / PLASM GLUCOSE 1)) / PLASM

I! THE BLOOD GLUCOSE LEVEL EXCEED THEI! THE BLOOD GLUCOSE LEVEL EXCEED THE

TM LEVEL (PASSES THE KIDNE" PLASMTM LEVEL (PASSES THE KIDNE" PLASM

THRESHOLD,THE GLICOSURIA WILL OCCURTHRESHOLD,THE GLICOSURIA WILL OCCUR

WATER REABSORPTION, UREA, AND ORGANIC

IONS: WATER MOVES ALONG WITH NATRIUM IONS

THROUGH OSMOTIC PROCESS

UREA WILL BE PASSIVEL" REABSORPED DUE

TO EXISTING GRADENT DURING WATER RE- ABSORPTION

ORGANIC IONS (KALIUM, CALSIUM, PHOSPATE,

AND SUL!ATE RE-ABSORPED THROUGH

ACTIVE ION-TRANSPORT


26/39


27/39

SEKRESI TUBULUS / TUBULE SECRETION

MEKANISME SEKRESI TUBU"US ME"A"UI

PR$SES AKTIF %ANG MEMINDAKAN AT

KE"UAR DARI DA"AM KAPI"ER

PERITUBU"AR ME"E0ATI SE"-SE"

TUBU"US MENU!U &AIRAN TUBU"US

UNTUK DIKE"UARKAN DA"AM URINE

AT-AT %ANG DIKE"UARKAN ADA"A

I$N IDR$GEN, KA"IUM, AM$NIUM,

PR$DUK AKIR METAB$"IK KREATININ

DAN ASAM IPURAT, SERTA $BAT-$BAT

TERTENTU SEPERTI PENISI"IN

TUBULE SECRETION MECHANISM

THROUGH ACTIVE PROCESS WHICH

TRANS!ER SUBSTANCES OUT !ROM

PERITUBULAR CAPILLAR", PASSING

THROUGH TUBULE CELLS, HEADING TO

TUBULE ;S LI


28/39

ANSA HENLE

SISTEM ARUS B$"AK-BA"IK GANDASISTEM ARUS B$"AK-BA"IK GANDA

DA"AM ANSA EN"E :DA"AM ANSA EN"E :

6ER6E.T# T6A 'E!-.GGA -."4)6ER6E.T# T6A 'E!-.GGA -."4)

A#A. PARAE /E.GA. 4T 4)A#A. PARAE /E.GA. 4T 4)

T.G#A- /E'E./E. 'A.GAT PER5EA6ET.G#A- /E'E./E. 'A.GAT PER5EA6E

TER!A/AP A-R /A. -5PER5EA6ETER!A/AP A-R /A. -5PER5EA6E

TER!A/AP .aTER!A/AP .a

T.G#A- A'E./E. -5PER5EA6ET.G#A- A'E./E. -5PER5EA6E

TER!A/AP A-R .A5. PER5EA6ETER!A/AP A-R .A5. PER5EA6ETER!A/AP .aTER!A/AP .a

DOUBLED ALTERNATIVE CURRENTDOUBLED ALTERNATIVE CURRENT

S"STEM INSIDE ANSA HENLE:S"STEM INSIDE ANSA HENLE:

TUBE SHAPE ITS INFLOW WILL BETUBE SHAPE ITS INFLOW WILL BE

PARALLEL WITH THE OUTFLOW PARALLEL WITH THE OUTFLOW

DESCENDENT TAIL IS PERMEABLE TODESCENDENT TAIL IS PERMEABLE TO

WATER AND IMPERMEABLE TO Na CLWATER AND IMPERMEABLE TO Na CL

ASCENDENT TAIL IS IMPERMEABLE TO ASCENDENT TAIL IS IMPERMEABLE TO

WATER BUT IT IS PERMEABLE TO NaCLWATER BUT IT IS PERMEABLE TO NaCL


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PEMBENTUKAN URIN PEKAT FORMATION OF CONDENSED

URINE

INSUFISIENSI MASUKAN AIR

PENURUNAN ($".DARA PENINGKATAN

TEK.$SM$TIK DR

MERANGSANG SEKRESI AD $"E IP$TA"AMUS

AD DIBA0A KE GIN!A"

TUB.DISTA" SEMIPERMEABE",

DUKT.K$"IGENTES PERMEABE"

TERADAP AIR

AIR MASUK KEMBA"I KE DA"AM (ASKU"ARURIN SEDIKIT MENGANDUNG AIR

TERBENTUK URINE PEKAT

INSU!!ICIENT WATER INTAKE

DECREASING O! INCREASING O! OSMOTIC

BLOOD VOLUME BLOOD PRESSURE

STIMULATE ADH SECRETION B" H"POTHALAMUS

ADH BROUGHT TO THE KIDNE"

DISTALTUBULE

SEMIPERMEABLE,COLIGENTES

DUCT

PERMEABLE TO WATER

WATER GOES BACK TO THE VASCULAR

URINE

CONTAINS LESS WATER !ORMING URINE


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PEMBENTUKAN URIN FORMATION OF THIN URINE

ENCER

MASUKAN AIR %ANG BER"EBIAN

PENINGKATAN ($".DARA PENURUNAN

TEKANAN $SM$TIK DR

MENGAMBAT SEKRESI AD $"E IP$TA"AMUS

RESP$N GIN!A" TERADAP PENURUNAN AD

TUB.DISTA" MENAAN AIR, DUKT. K$"IGENTES

PERMEABE" TERADAP AIR, SEINGGA AIR

MASUK KE DA"AM DUKT. K$"IGENTES

URIN BAN%AK MENGANDUNG AIR TERBENTUK

URINE EN&ER

THE OVER INCOME WATER

INCREASING O! BLOOD DECREASING O! OSMOTIC

VOLUME BLOOD PRESSURE

INHIBIT ADH SECRETION B" H"POTHALAMUS

KIDNE" GIVE THE RESPONSE O! THE DECREASING

ADH

DISTAL TUBULE HOLD THE WATER, COLIGENTES

DUCT$ PERMEABLE TO WATER ,SO WATERENTER TO THE COLIGENTES DUCT

URINE CONTAINS A LOT O! WATER !ORMING

URINE


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KARAKTERISTIK URINE CHARACTERISITIC OF

URINE

KOMPOSISI URINE :95% AIR DAN 5% ZAT TERLARUT :

ZAT BUANGAN NITROGEN (UREA,

ASAM URAT DAN KREATININ)ASAM HIPURATBADAN KETONELEKTROLIT

HORMON / KATABOLIT HORMON TOKSIN/ZAT KIMIA ASING, VITAMIN,

ENZIMKONSTITUEN ABNORMAL (ALBUMIN,

GLUKOSA, SEL DARAH MERAH, ZATKAPUR, BATU GINJAL

VOLUME URINE PER HARI : 600 !500 "#

($ ! &&/ 'BB/*")

SI+AT +ISIK :ARNA KUNING PU-AT DAN JERNIHBAU KHAS URINE ADALAH BAU AMONIAPH URINE BERKISAR ANTARA ., ,5BERAT JENIS URINE BERKISAR ANTARA

$,00$ $,015

COMPOSITION OF URINE

95% WATER AND 5% SOLUTION

WASTED NITROGEN (UREA, URIC ACID,

CREATININ) HIPURIC ACIDKETON BODIESELECTROLITEHORMONE/ CATABOLITE HORMONE

TOXIN/ UNIDENTIFIEDCHEMICALS,VITAMIN,EN!ME)

ABNORMAL CONSTITUENT (ALBUMIN,

GLUCOSE, RED BLOOD CELL, KIDNE! STONES)

URINE VOLUME EACH DA!" #$$&5$$ '

PH!SICAL CHARACTERISTIC

PALE !ELLOWISH AND CLEARSMELLED AS AMONIAURINE ACIDIT! ABOUT P *,+ ,5THE MASS INTENSIT! OF URINE

BETWEEN -,$$--,$.5


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GANGGUAN GINJAL / THE DEFECT OF KIDNEY

GLOMERULONE+RITISINF"AMASI G"$MERU"US AKIBAT

INFEKSI :

AKUT : AKIBAT RESP$N IMUNTERADAP T$KSIN BAKTERI

TERTENTU STREPT$K$KUS BETA A/

KR$NIK : AKIBAT INFEKSI

STREPT$K$KUS PADA

G"$MERU"$NEFRITIS AKUT atau

AKIBAT INFEKSI SEKUNDER

SISTEMIK "AIN

MERUSAK G"$MERU"US da9

TUBU"US

GLOMERULONEPHRITIS GLOMERULUS IN!LAMATION CAUSED B"

IN!ECTION

ACUTE: CAUSED B" IMUNIT" RESPONSE

O! THE CERTAIN BACTERIAL TOXIN

(STREPTOCOCCUS BETA A CHRONIC: CAUSED B" STREPTOCOCCUS

IN!ECTION ON ACUTE

GLOMERULUSNEPHRITIS OR CAUSED B"

ANOTHER SECONDAR" S"STEMIC

IN!ECTION

DAMAGING GLOMERULUS ANDTUBULE


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PIELONE+RITISIN+LAMASI GINJAL DAN

PELVIS GINJAL AKIBAT IN+EKSI*2*3 OBSTRUKSI TRAKTUS

URINARIUS

BATU GINJAL PENGENDAPAN GARAM

KALSIUM, MAGNESIUM,

ASAM URAT ATAU SISTIN GAGAL GINJAL : HILANGN4A

+UNGSI GINJAL

PIELONEFRITISINFLAMATION OF KIDNE!

AND KIDNE!S PELVIS

CAUSED B! THE INFECTIONOR THE OBSTRUCTIVEURINAR! TRACT

KIDNE! STONES

SEDIMENTATION OF CALCIUM,MAGNESIUM, URIC ACID OR

CISTIN

KIDNE!S FAILURE THE LOSS OF KIDNE!S FUNCTION


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GAGAL GINJAL KIDNEY FAILURE

#. GAGA" GIN!A" AKUT#. GAGA" GIN!A" AKUT AMPIR SE"URU KER!A GIN!A" TIBA-AMPIR SE"URU KER!A GIN!A" TIBA-

TIBA BERENTI TETAPI KEMUDIANTIBA BERENTI TETAPI KEMUDIAN

MEMBAIK MENDEKATI FUNGSI N$RMA"MEMBAIK MENDEKATI FUNGSI N$RMA"

PEN%EBAB UTAMAPEN%EBAB UTAMA

PRERENA" :PRERENA" : AKIBAT PENURUNAN A"IRANAKIBAT PENURUNAN A"IRANDARA KE GIN!A" SE&ARA TIBA-TIBA,DARA KE GIN!A" SE&ARA TIBA-TIBA,

DITANDAI $"E $"IGURIA MENDADAKDITANDAI $"E $"IGURIA MENDADAK

SAMPAI ANURISAMPAI ANURIAA

INTRARENA"INTRARENA" : TER!ADI AKIBAT: TER!ADI AKIBAT

KE"AINAN DIDA"AM GIN!A"KE"AINAN DIDA"AM GIN!A"

P$STRENA"P$STRENA" : TER!ADI AKIBAT ADAN%A: TER!ADI AKIBAT ADAN%ASUMBATAN PADA SISTEM PENGUMPU"SUMBATAN PADA SISTEM PENGUMPU"

URINURIN

1$ ACUTE KIDNE"%S !AILURE 1$ ACUTE KIDNE"%S !AILURE MOST O! THE WORKING KIDNE"MOST O! THE WORKING KIDNE"

SUDDENL" STOPPED BUT THEN IT%SSUDDENL" STOPPED BUT THEN IT%S

GETTING BETTER AND CLOSER TO THEGETTING BETTER AND CLOSER TO THE

NORMAL !UNCTION NORMAL !UNCTION

MAIN CAUSESMAIN CAUSES

PRERENAL : IN RESULT O! THE DECREASINGPRERENAL : IN RESULT O! THE DECREASINGBLOOD STREAM TO THE KIDNE" AT THEBLOOD STREAM TO THE KIDNE" AT THE

SUDDEN , CHARACTERIZED B" ACUTESUDDEN , CHARACTERIZED B" ACUTE

OLIGURIA AND MIGHT BE ANURIAOLIGURIA AND MIGHT BE ANURIA

INTRARENAL :OCCUR B" THE DE!ECT INSIDEINTRARENAL :OCCUR B" THE DE!ECT INSIDE

THE KIDNE" THE KIDNE"

POSTRENAL: OCCUR B" THE PLUG IN THEPOSTRENAL: OCCUR B" THE PLUG IN THE

S"STEM O! URINE COLLECTORS"STEM O! URINE COLLECTOR


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