Sistem Urinaria Blok II

8/17/2019 Sistem Urinaria Blok II

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SISTEM URINARIA

Fisiologi Fakultas KedokteranUniversitas Muhammadiyah Purwokerto


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Organ Sistem Urinari

• Renal

• Ureter

• esi!a urinaria

• Urethra


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Kidney Fun!tion

• Regulate E"F #$lasma and interstitial%uid& through 'ormation o' urine(• Primary 'un!tion(

• Regulate volume o' )lood $lasma(

• *P(• Regulate +waste $rodu!ts, in the )lood(

• Regulate !on!entration o' ele!trolytes(• Na-. K -. "a/-. and 0"123 and other ions(

• Regulate $0(• Se!rete erythro$oietin

• Se!rete renin


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tructure of the Kidney

• 4uter!orte56• "ontains

many!a$illaries(

• Medulla6• Renal

$yramidsse$arated )yrenal

!olumns(• Pyramid

!ontainsminor !aly!eswhi!h uniteto 'orm a

ma7or !aly5(

Ma7or !aly!es 'orm renal $elvis( Renal $elvis !olle!ts urine( Trans$orts urine to ureters(


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Renal Blood Vessels


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Renal *lood essels

• A8erent arteriole6• 9elivers )lood into the

glomeruli(

• :lomeruli6• "a$illary network that

$rodu!es ;ltrate thatenters the urinarytu)ules(

• E8erent arteriole6• 9elivers )lood 'rom

glomeruli to $eritu)ular!a$illaries(

• Peritu)ular!a$illaries6• 9eliver )lood to vasa

re!ta(

Figure17.2


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fron

• nit fungsional ginjal ( ± 1,2 juta nefron 1 ginjal)


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Ne$hron

• Fun!tional unito' the kidney(

• "onsists o'6•

*lood vessels6• asa re!ta(

• Peritu)ular!a$illaries(

• Urinary tu)ules6

•

P"T(•


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Ty$e o' Ne$hrons

• "orti!alne$hron6• 4riginates in

outer /=2 o'

!orte5(• 4smolality o'

211 m4sm=l(

• Involved in soluterea)sor$tion(

•

>u5tamedullaryne$hron6• 4riginates in

inner ?=2 !orte5(• Im$ortant in the

a)ility to

$rodu!e a!on!entrated

Insert ;g( ?@(

Figure17.6


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:lomerular "a$sule

• *owmanBs!a$sule6• Surrounds the

glomerulus(• :lomerular

;ltration(

• Filtrate

$asses intothe urinarys$a!e intoP"T(

Insert ;g( ?@(

Figure17.6


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P"T and


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9"T and "9

• 9istal !onvoluted tu)ule6• Fun!tions6

• Se!retion(

• Rea)sor$tion(

•"olle!ting du!t6• Re!eives %uid 'rom the 9"T o' several

ne$hrons(

• Fun!tions6• Rea)sor$tion(

• 0/1 rea)sor$tion in%uen!ed )y A90(

• Se!retion(


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:lomerular Filtration Mem)rane

• Endothelial !a$illary $ores #'enestra&6• ?113C11 times more $ermea)le to $lasma. 0/1.

and dissolved solutes(• Pores are small enough to $revent R*"s.

$latelets. and D*"s 'rom $assing through the$ores(

•

*asement mem)rane6• Thin gly!o$rotein layer inhi)it $rotein• Negatively !harged(

• Podo!ytes6• Foot $edi!els 'orm small fltration slits(•

Passageway through whi!h ;ltered mole!ulesmust $ass(


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:lomerular Filtration Mem)rane #!ontinued&

Insert ;g( ?@(

Figure

17.8


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:lomerular Ultra;ltrate

• Fluid that enters glomerular !a$sule is!alled ultra;ltrate(• :lomerular ;ltration6

• Me!hanism o' $rodu!ing ultra;ltrate under

hydrostati! $ressure o' the )lood(• Pro!ess similar to the 'ormation o' tissue %uid )y

other !a$illary )eds(

• :lomerular ;ltration rate #:FR&6• olume o' ;ltrate $rodu!ed )y )oth kidneys

ea!h minute(• Averages ?? ml=min( in womenG ?/ ml=min( in

men(


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Regulation o' :FR

• aso!onstri!tion or dilation o' thea8erent arterioles a8e!ts the rate o')lood %ow to the glomerulus(• A8e!ts :FR(

• Me!hanisms to regulate :FR6• Sym$atheti! nervous system(

• Autoregulation(

•

"hanges in diameter result 'rome5trinsi! and intrinsi! me!hanisms(


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Sym$atheti! Regulation o' :FR

• Stimulatesvaso!onstri!tion o'a8erent arterioles(• Preserves )lood

volume to mus!les andheart(

• "ardiovas!ular

sho!k6• 9e!reases glomerular

!a$illary hydrostati!$ressure(

• 9e!reases urine out$ut

#U4&(

Insert ;g( ?@(??

Figure 17.11


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Renal Autoregulation o' :FR

• A)ility o' kidney to maintain a !onstant :FRunder systemi! !hanges(• A!hieved through e8e!ts o' lo!ally $rodu!ed

!hemi!als on the a8erent arterioles(

•

Dhen MAP dro$s to @1 mm 0g. a8erentarteriole dilates(

• Dhen MAP in!reases. vaso!onstri!t a8erentarterioles(

• Tu)uloglomerular 'eed)a!k6• In!reased %ow o' ;ltrate sensed )y ma!ula densa

!ells in thi!k as!ending


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• :FR J K' Net ;ltration $ressure atau

• :FR J K' #P: L P* L $: - $*&


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Rea)sor$tion o' Salt and 0/1

• Return o' most o' the mole!ules and 0/1

'rom the urine ;ltrate )a!k into the$eritu)ular !a$illaries(• A)out ?1


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Insert ;g( ?@(?2

Rea)sor$tion in Pro5imal Tu)ule

Figure 17.14


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P"T

• Total +solute, is J 211 m4sm=


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Salt and Dater Rea)sor$tion inPro5imal Tu)ule

Insert ;g( ?@(?C

Figure 17.15


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Signi;!an!e o' P"TRea)sor$tion

• H Na-. "l3. and 0/1 rea)sor)ed

a!ross the P"T into the vas!ularsystem(

• 1H K - rea)sor)ed(• Rea)sor$tion o!!urs !onstantly

regardless o' hydration state(• Not su)7e!t to hormonal regulation(

• Energy e5$enditure is H o' !alories!onsumed at rest(


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"ounter!urrent Multi$lier

• In order 'or 0/1 to )e rea)sor)ed. interstitial %uidmust )e hy$ertoni!(

• 4smoti! $ressure o' the interstitial tissue %uid is C 5that o' $lasma(• Results $artly 'rom the 'a!t that the tu)ule )ends

$ermitting intera!tion )etween the des!ending andas!ending lim)s(


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As!ending


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9es!ending


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"ounter!urrent Multi$lier System

• Multi$lies the+interstitial %uid,and +des!ending

lim) %uid,(• Flow in o$$osite

dire!tions in theas!ending anddes!ending lim)s(

• "lose $ro5imity o'the / lim)s6• Allows intera!tion(

Insert ;g( ?@(?

Figure 17.17


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asa Re!ta

• "ounter!urrente5!hange(

• Re!y!les Na"l inmedulla(

• Trans$orts 0/1 'rominterstitial %uid(

• 9es!ending lim)6• Urea trans$orters(

•

Aua$orin $roteins#0/1 !hannels&(

• As!ending lim)6• Fenestrated

!a$illaries(

Insert ;g( ?@(?@

Figure 17.18


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asa Re!ta #!ontinued&• asa re!ta maintains hy$ertoni!ity )y

!ounter!urrent e5!hange(

• Na"l and urea di8use into des!ending lim)and di8use )a!k into medullary tissue%uid(

• At ea!h level o' the medulla. +solute, ishigher in the as!ending lim) than in theinterstitial %uidG and higher in theinterstitial %uid than in des!endingvessels(

• Dalls are $ermea)le to 0/1. Na"l and urea(

• "olloid osmoti! $ressure in vasa re!ta O

interstitial %uid(


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4smolality o' 9i8erent Regionso' the Kidney

Insert ;g( ?@(?

Figure 17.20


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Urea

• "ontri)utes tototal osmolalityo' interstitial%uid(

• As!ending lim)


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"olle!ting 9u!t

• Medullary area im$ermea)le to high+Na"l, that surrounds it(• The walls o' the "9 are $ermea)le to 0/1(

• 0/1 is drawn out o' the "9 )y osmosis(• Rate o' osmoti! movement is determined )y

the o' aua$orins in the !ell mem)rane(

• Permea)le to 0/1 de$ends u$on the$resen!e o' A90(• Dhen A90 )inds to its mem)rane re!e$tors on

"9. it a!ts via !AMP(• Stimulates 'usion o' vesi!les with $lasma mem)rane(

• In!or$orates water !hannels into $lasma mem)rane(


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Se!retion

• Se!retion o' su)stan!es 'rom the $eritu)ular!a$illaries into interstitial %uid(

• Then trans$orted into lumen o' tu)ule. and intothe urine(

• Allows the kidneys to ra$idly eliminate!ertain $otential to5ins(

Figure 17.22


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SecretionInsert ;g( ?@(?2

Pro5imal Tu)ule

Figure 17.14


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:


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Renal "learan!e

• A)ility o' the kidneys to remove mole!ules 'rom$lasma and e5!rete those mole!ules in the urine(

• I' a su)stan!e is not rea)sor)ed or se!reted. thenthe amount e5!reted J amount ;ltered(

/uantit* e+)rete" + • Quantity e5!reted J mg=min(

• J rate o' urine 'ormation(

• U J inulin !on!entration in urine(


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Measurement o' :FR

• I' a su)stan!e is neither rea)sor)ed norse!reted )y tu)ule6• The amount e5!reted in urine=min( will )e

eual to the amount ;ltered out o' the

glomeruli=min(• Rate at whi!h a su)stan!e is ;ltered )y

the glomeruli !an )e !al!ulated6

/uantit* fltere" 3F + •

P J inulin !on!entration in $lasma(• Amount ;ltered J amount e5!reted

3F +


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Renal Plasma "learan!e

• olume o' $lasma 'rom whi!h a su)stan!e is!om$letely removed in ? min( )y e5!retion in theurine(

• Su)stan!e is ;ltered. )ut not rea)sor)ed6•

All ;ltered will )e e5!reted(• Su)stan!e ;ltered. )ut also se!reted and e5!reted

will )e6• O :FR #:FR J ?/1 ml= min(&(


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Renal Plasma "learan!e

Renal $lasma !learan!e J +

• J urine volume $er min(

• U J !on!entration o' su)stan!e in urine• P J !on!entration o' su)stan!e in $lasma

• "om$are renal handling o' varioussu)stan!es in terms o' rea)sor$tion orse!retion(


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Renal *lood Flow

20(25! )ar"ia) output to ki"ne*s

≈1(2 l 'loo"min passes t#roug# t#e ki"ne*

• Not all )lood delivered to glomeruli is ;ltered inthe glomerular !a$sules(• Most o' glomerular )lood $asses to the e8erent

arterioles(

• /1H renal $lasma %ow ;ltered(• Su)stan!es are returned )a!k to )lood(

• CH )lood is R*"s

• H $lasma


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:lu!ose and Amino A!id Rea)sor$tion

• Filtered glu!ose and amino a!ids arenormally rea)sor)ed )y the ne$hrons(• In P"T o!!urs )y se!ondary a!tive trans$ort

with mem)rane !arriers(• "arrier mediated trans$ort dis$lays6

• Saturation(

• Tm(

• +Trans$orted mole!ules, needed to saturate !arriersand a!hieve ma5imum trans$ort rate(

• Renal trans$ort threshold6• Minimum $lasma +su)stan!e, that results in

e5!retion o' that su)stan!e in the urine(• Renal $lasma threshold 'or glu!ose J ?13/11 mg=dl(


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Ele!trolyte *alan!e

• Kidneys regulate Na-. K -. 0-. "l3. 0"123. and P4C32(• "ontrol o' $lasma Na- is im$ortant in regulation o'

)lood volume and $ressure(

• "ontrol o' $lasma o' K - im$ortant in $ro$er 'un!tiono' !ardia! and skeletal mus!les(• Mat!h ingestion with urinary e5!retion(


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Na- Rea)sor$tion

• 1H ;lteredNa- rea)sor)ed inP"T(

• Final +Na-,!ontrolled in"9 )yaldosterone(

•

Dhenaldosterone isse!reted inma5imalamounts. all

Na-

in 9"T isrea)sor)ed(

Insert ;g( ?@(/

Figure17.27


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K - Se!retion

• 1H ;ltered K - is rea)sor)ed in early $art o' the ne$hron(

• Se!retion o' K - o!!urs in "9(• Amount o' K - se!reted de$ends u$on6

• Amount o' Na- delivered to the region(

• Amount o' aldosterone se!reted(• As Na- is rea)sor)ed. lumen o' tu)ule )e!omes L!harged(

• Potential di8eren!e drives se!retion o' K - into tu)ule(• Trans$ort !arriers 'or Na- se$arate 'rom trans$orters 'or K -(


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K - Se!retion #!ontinued&

• Final +K -,!ontrolled in"9 )yaldosterone(•

Dhenaldosterone isa)sent. no K - ise5!reted in theurine(

• 0igh +K -, or

low +Na-,stimulates these!retion o'aldosterone(

• 4nly means )ywhi!h K - is

Insert ;g( ?@(/C

Figure17.25


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>u5taglomerular A$$aratus

• Region in ea!h ne$hron where the a8erentarteriole !omes in !onta!t with the thi!kas!ending lim)


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>u5taglomerular A$$aratus #!ontinued&

Insert ;g( ?@(/

Figure

17.26


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Na-. K -. and 0- Relationshi$

• Na- rea)sor$tionin "9 !reatesele!tri!algradient 'or K -

se!retion(• Plasma +K -,

indire!tly a8e!ts+0-,(

• Dhen

e5tra!ellular +0-,in!reases. 0- moves into the!ell. !ausing K - todi8use into the

E"F(

Insert ;g( ?@(/@

Figure 17.28

"om$osition o' normal


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"om$osition o' normalurine• More than H o' the ;ltrate $rodu!ed ea!h

day is rea)sor)ed )e'ore rea!hing the renal$elvis(

• :eneral !hara!teristi!s6

• $0J(1

• S(:(J?(1123?(121

• osmolarityJ3?22m4sm=<

• water323@H

• volumeJ?/11 m


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Aging and the urinarysystem• Age related !hanges in!lude6

• de!lining num)ers o' 'un!tionalne$hrons6dro$s )y 213C1H

• redu!ed :FR6thais results 'orm de!reased

num)ers o' glomeruli( 9amage to ;ltrationa$$aratus. redu!tion in renal )lood %ow(

• redu!ed sensitivity to A906distal $ortion o'ne$hron and !olle!ting system less

res$onsive to A90( More sodium ions lost inurine(


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reter

• Meru$akan saluran yangmenghu)ungkan gin7al ke kandungkemih. yang meru$akan lan7utan renal

$elvis(• Pan7ang ?13?/ in!hi(

• Ureter memasuki kandung kemihmelalui )agian $osterior dengan !ara

menem)us otot detrusor di daerahtrigonum kandung kemih


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• 9inding ureter terdiri dari otot $olos di$ersara; oleh sara' sim$atis

$arasim$atis(• Kontraksi $eristaltik $ada ureter

ditingkatkan oleh $erangsangan$arasim$atis diham)at oleh

$erangsangan sim$atis(• Peristalsis di)antu gaya gravitasi akan

memindahkan urine dari ureter kekandung kemih(


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esi!a Urinaria

• *er'ungsi menam$ung=menyim$anurine sementara #/13C11 ml&(

• Terdiri atas 6

?( *adan #!or$us& J )agian utamakandung kemih dimana urineterkum$ul(

/(


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9inding kandung kemih 6

• 2 la$isan otot $olos #detrusor mus!le&

• Mu!osa 6 transitional e$ithelliumB

• 9inding 6 te)al )erli$at saat kandung kemihkosong(

Trigone L tiga$em)ukaan 6

?(9ua dari ureter

/(Satu ke urethra


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*erkemih

• *erkemih adalah $roses $engosongan kandungkemih ketika terisi

• Peristiwa ini meli)atkan / taha$an6

• Pertama. kandung kemih terisi se!ara $rogresi'sam$ai dindingnya meregang di atas am)ang. halini mengaki)atkan langkah kedua yaitu suature%eks sara' yang dise)ut re%eks )erkemih untukmengosongkan kandung kemih

MICTURITION REFLEX


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MICTURITION REFLEX

Bladder fills

Stretch receptors

Parasympathetic

er!e

Bladder cotractsIteral "rethral

sphicter opes

Oly the e#teral "rethral sphicter is cotrolled !ol"tarily

+

+

Spial Cord

euronmotorik

ortekssere'rum

fngter uretraekterna

tertutup waktuneuronmotorik

terangsang

Pengaruh $usat yang le)ih


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g $ y gtinggi terhada$ re%eks

)erekmih• Pusat yg le)ih tinggi men7aga re%eks)erkemih diham)at ke!uali 7ika ingin)erkemih diinginkan

•

Pusat yg le)ih tinggi da$at men!egah)erkemih meski$un re%eks )erkemihter7adi. melalui kontraksi tonuss$hin!ter ekstena se!ara kontinu

hingga waktu yang diinginkan• >ika ti)a waktu )erkemih. $usat korteks

da$at mem'asilitasi $usat )erkemihsakralis untuk mem)antumemun!ulkan re%eks )erkemih


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Sistem Urinaria Blok II

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