THE URINARY SYSTEM

Pembentukan Urin dan Peran Ginjal Dalam

Keseimbangan Cairan Tubuh

dr. Sri Lestari Sulistyo Rini, M.Sc

The urinary system :
Ginjal terletak retroperitoneal
Sebuah ginjal 135-150 gr.
Ginjal  menerima 20-30% cardiac
output
Aliran darah ke ginjal  1-1,5 L / mnt
Darah yang difiltrasi  180 L / hr
 125 ml/mnt
 Renal Function
1. Elimination of Waste Products
2. Regulation of Fluid Balance
3. Regulation of Acid-Base Balance
4. Nutrient Balance : - electrolytes : Na+, K+, Cl-,
Ca++,Mg++
- amino acids, glucose, proteins
vitamin
5. Elimination, Detoxification of Drug and Toxins
6. Endocrine Function : - erytropoietin
- vitamin D metabolism
- renin
Nefron  Unit fungsional ginjal
- Sebuah ginjal terdiri dari + 1 juta nefron
- Nefron : - Glomerulus
- Tubulus
Struktur Nefron
The NEPHRON: The
Functional Renal Unit

Afferent
Arteriole
Efferent
Arteriole
 Urine formation
 Eliminasi produk sisa metabolik
 Urea, Kreatinin, Asam urat, Sulfat,
Nitrat, Phosphat, dll.

Proses :
1. Filtrasi  glomerulus
2. Reabsorpsi  tubulus
3. Sekresi  tubulus
4. Ekskresi

Ekskresi = Filtrat – reabsorpsi + sekresi

Steps in Urine
Formation

1) Glomerular Filtration

2) Tubular Reabsorption
& Secretion

3) Water Reabsorption
(Conservation)

p 904
Urine Formation Preview
How the Kidney Works
Filtrasi Glomerulus

Pgc pgc Pt
Filtrasi glomerulus
Filtration Membrane
• Fenestrated endothelium
• 70-90nm pores exclude blood
cells
• Basement membrane
• proteoglycan gel, negative
charge excludes molecules >
8nm
• blood plasma 7% protein,
glomerular filtrate 0.03%
• Filtration slits
• podocyte arms have pedicels
with negatively charged
filtration slits, allow particles
< 3nm to pass
Filtrasi Glomerulus
 Reabsorpsi dan Sekresi Tubulus
Proximal Tubulus
 Reabsorpsi 80% air dan garam
 Reabsorpsi semua glukosa, asam amino
 Reabsorpsi protein, urea, asam urat,
bicarbonat
 Sekresi ion Hidrogen, asam-basa organik

Reabsorpsi
 Aktif : glukosa, asam amino, natrium, dll
 Pasif : air dan urea

Transport maximum ( Tm)  maksimum substansi yang

di reabsorpsi per unit waktu
PCT Nutrient (glucose, amino acids)
reabsorption = Normally 100% returned via
cotransport with Na+
Transport maximum (Tm)

• Reabsorption will return solutes to the blood

• Binding sites for transport can become
saturated at high levels
• Solutes not reabsorped are lost in the urine
• Vitamin C is reabsorped unless plasma values
are so high that transporters can’t reabsorb
any more – then excess vitamin C lost in the
urine
Loop of Henle
• Descending limb  permeabel terhadap air
• Ascending limb  impermeabel terhadap air
 reabsorpsi Na dan Cl
Tubulus Distal
Reabsorpsi Na, Cl dan air
ADH mempengaruhi permeabilitas terhadap air
Reabsorpsi dan sekresi Kalium
Aldosteron mempengaruhi reabsorpsi Natrium
dan sekresi Kalium
Mekanisme Countercurrent
 Renal Regulation

Saraf simpatis  arteriol aferen & eferen

 vasokonstriksi, RBF (renal blood
flow) menurun
 GFR menurun

Hormonal  Renin-Angiotensin
 Aldosteron
 ADH
 Atrial Natriuretic Peptide
Renal Autoregulation of GFR
•  BP  constrict
afferent arteriole, dilate
efferent
•  BP  dilate afferent
arteriole, constrict
efferent
• Stable for BP range of
80 to 170 mmHg
(systolic)
• Cannot compensate for
extreme BP
 Glomerular Filtration Rate
(GFR)
• Renal autoregulation
– Regulation of NFP
– Macula densa
• Cells of DCT
• Slow filtrate flow, low
osmolality (low Na, Cl)
causes dilation of
afferent arterioles
• High flow, high
osmolality causes
contraction of JGA
cells, vasoconstriction
 Duktus kolegentes
 Reabsorpsi Na dan Cl
 dipengaruhi ADH
 Hormones
• Aldosterone
– Acts on distal convoluted tubule cells to
stimulate active transport of 3 molecules
of Na+ out of tubule (reabsorption) for
every 2 molecules of K + brought into
tubule (secretion)
– Water from tubule lumen follows Na+ by
osmosis into blood
• Antidiuretic hormone (ADH)
– Acts to increase the number of aquaporins
(water channels) in the collecting duct
membranes
– Collecting ducts travel through
hyperosmotic medulla
– Higher levels of ADH increase the
number of aquaporins allowing water to
leave the duct and urine volume decreases
Homeostatic
Control
involving
Aldosterone
 Formation of Water Pores:
Mechanism of Vasopressin Action
Aldosterone Release: the Renin-Angiotensin
Pathway
Factors affecting the release of ADH.
Factors affecting release of Atrial Natriuretic
Peptide.
 Urine Composition
• about 95% water

• usually contains urea, uric acid, and creatinine

(break down product from creatine phosphate used
up in muscles)

• may contain trace amounts of amino acids and

varying amounts of electrolytes

• volume varies with fluid intake, diuretics (caffeine &

alcohol) and environmental factors (heat, humidity)
Renal Function Test
Inulin Clearance
 MIKSI

Vesika urinaria terisi  reseptor regang

sensorik N pelvikus (aferen) 
Medula Spinalis parasimpatis (eferen)

Miksi  otot-otot perineum & sphincter

uretra externa relaksasi, otot detrusor
kontraksi urine melalui uretra
Conduction of Urine
Micturition Reflex

p 923
MIKSI
Menjaga keseimbangan cairan tubuh 
homeostasis

keseimbangan  -jumlah volume

-jumlah zat terlarut
-konsentrasinya

Asupan cairan : - larutan/air dalam makanan

- hasil metabolisme KH
( tiap individu berbeda,
tergantung kebiasaan, aktivitas, cuaca)
Pengeluaran cairan :
-insensible water loss tidak dapat diatur
dengan tepat, terjadi
menerus
 evaporasi lewat kulit,
paru-paru
 +700ml
-keringat  + 100ml, dipengaruhi aktivitas,
suhu
-feses  + 100ml, meningkat pada diare
-urin  dalam pembentukannya terdapat
mekanisme untuk menjaga
keseimbangan cairan dan elektrolit
KOMPARTEMEN-KOMPARTEMEN CAIRAN
TUBUH
 Cairan ekstraseluler : plasma,cairan
interstisial, transeluler
( cairan dalam
sinovial, peritonium,perikardium, intraokular,
serebrospinal)
 Cairan intraseluler

Prosentase cairan dipengaruhi umur, jenis

kelamin, derajat obesitas
Body Water Balance

• Drinking &
eating
provides
water
• Kidney
conserves
water so
output =
intake
Body Water Balance
Circulating Volume control
 Thirst

• Osmoreceptors detect changes  decreases in

blood volume and increases in blood solute levels

• They activate the thirst center in hypothalamus and

ADH-secreting cells

• Angiotensin II
– formed from the interaction of renin (produced by
the kidneys) with circulating angiotensinogen in the
plasma
– also acts on brain to promote thirst and ADH
secretion
Normal Urine & Blood
Urine pH ~ 6.0
Blood pH = 7.4
Blood [HCO3-] = 24 mM
Blood PCO2 = 40 mmHg
Plasma osmolality = 285 mOsm/kg water
Urine osmolality (depends upon
hydration status) = 600 mOsm/kg water
(note that this can vary between 50-1200
depending on water intake etc.)
Buffer System
Integration Renal – Cardiovascular –
Respiratory System
RENAL SYSTEM

Effective circulating Acid-base

volume control, balance
ECF osmolality,
blood pressure
All of these are
constantly changing,
trying to maintain
HOMEOSTASIS!

CARDIOVASCULAR RESPIRATORY
SYSTEM SYSTEM
Gas exchange, ACE
TERIMA KASIH