SISTEMA URINARIA

Ginus Partadiredja Bagian Fisiologi FK UGM

SISTEMA URINARIA
Fungsi ginjal (ren) Anatomi ginjal Proses produksi urine
Filtrasi oleh glomerulus Reabsorbsi oleh tubulus Sekresi oleh tubulus

Evaluasi fungsi ginjal Transportasi, penyimpanan, dan ekskresi urine

Fungsi ginjal:
1.Regulasi komposisi ion darah 2.Regulasi pH darah 3.Regulasi volume darah 4.Regulasi tekanan darah 5.Pemeliharaan osmolaritas darah 6.Produksi hormon (calcitriol & erythropoetin) 7.Regulasi tingkat glukosa darah 8.Ekskresi sampah benda asing

Anatomi Ginjal
Anatomi eksternal:
Retroperitoneal
Renal fascia Adipose capsule Renal capsule

Renal hilum

http://images.google.co.id/imgres?imgurl=http://academic.kellogg.cc.mi.us/herbrandsonc/bio201_McKinley/f279a_urinary_bladder_c.jpg&imgrefurl=http://academic.kellogg.cc.mi.us/herbrandsonc/bio201_McKinley/Urinary%2520Syst em.htm&h=490&w=800&sz=135&hl=id&start=3&tbnid=PjiUmILb7BE7M:&tbnh=88&tbnw=143&prev=/images%3Fq%3Dmicturition%2Breflex%26svnum%3D10%26hl%3Did%26lr%3D% 26sa%3DG

http://www.netterimages.com/images/vtn/000/000/002/2122-150x150.jpg

Anatomi Ginjal
Anatomi internal
Cortex renalis Medulla renalis Pyramid renalis Papilla renalis Collumna renalis Ductus papillaris Calyx minor Calyx major Pelvis renalis Sinus renalis
http://images.google.co.id/imgres?imgurl=http://academic.kellogg.cc.mi.us/herbrandsonc/bio201_McKinley/f27-9a_urinary_bladder_c.jpg&imgrefurl=http://academic.kellogg.cc.mi.us/herbrandsonc/bio201_McKinley/Urinary%2520System.htm&h=490&w=800&sz=135&hl=id&s tart=3&tbnid=PjiUmILb7BE7M:&tbnh=88&tbnw=143&prev=/images%3Fq%3Dmicturition%2Breflex%26svnum%3D10%26hl%3Did%26lr%3D%26sa%3DG

http://kidney.niddk.nih.gov/kudiseases/pubs/solitarykidney/images/nephronkidA.gif

http://images.google.co.id/imgres?imgurl=http://academic.kellogg.cc.mi.us/herbrandsonc/bio201_McKinley/f279a_urinary_bladder_c.jpg&imgrefurl=http://academic.kellogg.cc.mi.us/herbrandsonc/bio201_McKinley/Urinary%2520System.htm&h=490&w=800&sz=135&hl=id&start=3&tbnid=PjiUmILb7BE7M:&tbnh=88&tbnw=143&prev=/images%3Fq%3Dmicturition%2Breflex%26svnum%3D10%26hl%3Did%26lr%3D%26sa%3DG

Nephron: 1. Renal corpuscle : a. Glomerulus b. Bowmans capsule 2. Renal tubule: a. Proximal convoluted tubule b. Loop of Henle c. Distal convoluted tubule Collecting duct Papillary duct
http://www.farmakologija.com/materia/images/nephron.gif

http://coe.fgcu.edu/faculty/greenep/kidney/glomer3.jpg

Vaskularisasi Ginjal
Renal artery Renal vein

Segmental arteries
Interlobar arteries Interlobar veins

Arcuate arteries
Interlobular arteries

Arcuate veins
Interlobular veins

Afferent arterioles
Glomerular capillaries

Peritubular capillaries
Efferent arterioles
http://www.geocities.com/biology_4e/cross_section_of_kidney.jpg

http://images.google.co.id/imgres?imgurl=http://academic.kellogg.cc.mi.us/herbrandsonc/bio201_McKinley/f279a_urinary_bladder_c.jpg&imgrefurl=http://academic.kellogg.cc.mi.us/herbrandsonc/bio201_McKinley/Urinary%2520System.htm&h=490&w=800&sz=135&hl=id&start=3&tbnid=PjiUmILb7BE7M:&tbnh=88&tbnw=143&prev=/images%3Fq%3Dmicturition%2Breflex%26svnum%3D10%26hl%3Did%26lr%3D%26sa%3DG

 Ginjal = 0.5% total body mass 20-25% cardiac output istirahat via arteri renalis Renal blood flow = 1200 mL/ menit

PROSES PRODUKSI URINE 1.Filtrasi oleh glomerulus 2.Reabsorbsi oleh tubulus 3.Sekresi oleh tubulus

http://www.colorado.edu/eeb/web_resources/cartoons/nephr.gif

Filtrasi oleh Glomerulus

Filtrat glomerular = 150 l (F)/ 180 l (M); Fraksi filtrasi (1620%); 99% filtrat direabsorbsi (ekskresi 1-2 l) Net filtration pressure (NFP) Glomerular blood hydrostatic pressure (GBHP) = 55 mmHg Capsular hydrostatic pressure (CHP) = 15 mmHg Blood colloid osmotic pressure (BCOP) = 30 mmHg NFP = GBHP CHP BCOP = 10 mmHg

1. 2. 3.

 Glomerular Filtration Rate (GFR): jumlah filtrat terbentuk di dalam corpusculi renalis per menit = 125 ml/min (M) atau 105 ml/min (F) Regulasi GFR 1. Autoregulasi renal
1. Mekanisme myogenik 2. Umpan balik tubuloglomerular

2. Regulasi saraf simpatis 3. Regulasi hormonal 1. Angiotensin II 2. Atrial natriuretic peptide (ANP)

1. Autoregulasi renal
1. Mekanisme myogenik: BP RBF GFR regangan arteriola afferent kontraksi otot arteriola afferent lumen menyempit GFR ke tingkat semula 2. Umpan balik tubuloglomerular: BP GFR cairan lewat cepat di tubulus rebasorbsi Na, Cl, air di PCT & loop of Henle deteksi oleh macula densa inhibisi sekresi NO arteriola afferen konstriksi RBF GFR ke normal

http://images.google.co.id/imgres?imgurl=http://academic.kellogg.cc.mi.us/herbrandsonc/bio201_McKinley/f279a_urinary_bladder_c.jpg&imgrefurl=http://academic.kellogg.cc.mi.us/herbrandsonc/bio201_McKinley/Urinary%2520System.htm&h=490&w=800&sz=135&hl=id&start=3&tbnid=PjiU mIL-b7BE7M:&tbnh=88&tbnw=143&prev=/images%3Fq%3Dmicturition%2Breflex%26svnum%3D10%26hl%3Did%26lr%3D%26sa%3DG

2. Regulasi saraf simpatis norepinephrine

1. istirahat: stimulasi rendah arteriola a & e dilatasi autoregulasi renal & GFR 2. stimulasi moderat: arteriola a & e konstriksi restriksi aliran darah masuk & keluar GFR sedikit 3. stimulasi kuat: vasokonstriksi aretriola a > e RBF GFR urine aliran darah ke jaringan lain

Prinsip-prinsip Reabsorbsi & Sekresi Tubulus

Reabsorbsi: 99% air dikembalikan ke darah Tubulus proximalis berperan besar dalam reabsorbsi Reabsorbsi: Na+, K+, Ca2+, Cl- , HCO3- , HPO42Protein & peptida reabsorbsi pinositosis Tubulus distalis fine tuning reabsorbsi Sekresi: H+, K+, NH4+, kreatinin, obat-obatan (penisilin)
Sekresi H+ kontrol pH darah Sekresi substansi sampah

Rute reabsorbsi:
Paraseluler Transeluler

Mekanisme transport:
Transport aktif primer (hidrolisis ATP) Transport aktif sekunder (symporters & antiporters)

Rebasorbsi & Sekresi di Tubulus Proximalis

http://people.eku.edu/ritchisong/554images/proximal_tubule.jpg

Reabsorbsi ion (terutama Na+ dan air terbesar; 65%)

Reabsorbsi dng sistem Na+ symport: glukosa & asam amino (100%), asam laktat, ion-ion fosfat (HPO42-) dan sulfat (SO42-) Sistem Na+ /H+ antiport: Na+ dan HCO3- (80-90%) Osmosis air (tub. prox. & descending limb of Henle -> permeable) Difusi pasif: Cl- (50%), K+ (65%), Ca2+, Mg2+, HPO42+ Hepatosit: Ammonia (NH3) urea filtrasi & sekresi Deaminasi asam amino ammonia

Reabsorbsi di Loop of Henle

Akhir tubulus proximalis: osmolaritas = darah Loop of Henle:
Descending limb reabsorbsi 15% air Thick ascending limb impermeable thd. air Reabsorbsi HCO3- (10-20%)

Sistem Na+ -K+ -2Cl- symport:

Reabsorbsi Na+ & Cl- (35%) K+ kembali ke tubulus

Reabsorbsi kation: Na+, K+,Ca2+ (20-30%), Mg2+ Akhir loop of Henle: osmolaritas

http://www.mscd.edu/~biology/2320course/2320images/nephron.jpg

Reabsorbsi di Tubulus Distalis

Sistem Na+ -Cl- symport Hormon parathyroid reabsorbsi Ca2+ Reabsorbsi air 10-15% Akhir tubulus distalis: 90-95% ion & air terserap

http://www.varimed.hu/hypertension/pha/img/pha_577.gif

Reabsorbsi & Sekresi di Ductus Collectivus

Principal cells: reabsorbsi Na+ & sekresi K+ Intercalated cells: reabsorbsi K+ & HCO3- ; sekresi H+

http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/N/nephron.gif

Regulasi Reabsorbsi & Sekresi oleh Hormon

Sistem Renin Angiotensin Aldosteron

Vol darah sel juxtaglomerular renin angiotensin converting enzyme

angiotensinogen angiotensin I angiotensin II Angiotensin ll:

1. 2. 3. Vasokonstriksi arteriola afferent GFR Reabsorbsi Na+, Cl- , dan air di tubulus proximalis Stimulasi kortex adrenal aldosteron reabsorbsi Na+, Cl- dan sekresi K+ di ductus collectivus reabsorbsi air

 Hormon Antidiuretik (ADH)/ Vasopressin

Reabsorbsi air di bagian akhir tubulus distalis & ductus collectivus (urine = 400 500 mL) Osmolaritas plasma osmoreseptor hipothalamus hipophysis ADH tubulus distalis & ductus collectivus

Atrial Natriuretic Peptide (ANP) Volume darah ANP dari jantung 1. Inhibisi reabsorbsi Na & air di tubulus proximal & ductus collectivus 2. Inhibisi sekresi aldosteron & ADH

Diuresis
Memperlambat reabsorbsi air Terapi hipertensi Diuretik alami: kopi, teh, soda (inhibisi reabsorbsi Na+), alkohol (inhibisi ADH) Mekanisme kerja kebanyakan diuretik: inhibisi reabsorbsi Na+ Furosemide (Lasix) inhibisi Na+ K+ 2 Clsymporters di thick ascending limb of the loop of Henle Chlorthiazide (Diuril) tubulus distalis (inhibisi Na+ Cl- symporters)

Evaluasi Fungsi Ginjal

Urinalisis Tes darah
Blood Urea Nitrogen (BUN)
Katabolisme asam amino urea nitrogen GFR BUN

Kreatinin plasma
Katabolisme fosfat kreatinin dari otot skelet Fungsi ginjal Kreatinin darah

Renal plasma clearance: volume darah yang dibersihkan dari substansi tertentu per unit per waktu (mL/ menit) Renal plasma clearance substansi S = U X V P

Transportasi, Penyimpanan, dan Eliminasi Urine

Ureter Vesica Urinaria Refleks micturitio Urethra Inkontinesia urine

http://hcd2.bupa.co.uk/images/factsheets/kidney_stones.gif

http://academic.kellogg.cc.mi.us/herbrandsonc/bio201_McKinley/f27-9a_urinary_bladder_c.jpg

http://images.google.co.id/imgres?imgurl=http://clem.mscd.edu/~raoa/bio2320/uriphys/img038.jpg&imgrefurl=http://clem.mscd.edu /~raoa/bio2320/uriphys/sld038.htm&h=539&w=719&sz=43&hl=id&start=1&tbnid=RIxPxSlvLPYN0M:&tbnh=105&tbnw=140&prev=/images%3Fq%3Dmic turition%2Breflex%26svnum%3D10%26hl%3Did%26lr%3D%26sa%3DG

Rujukan
1. Tortora GJ & Derrickson B, 2006. Principles of Anatomy and Physiology, 11th ed, John Wiley & Sons, Inc, pp 992 - 1035