Renal Physiology

Zulkhah Noor

06/09/15

THE URINARY SYSTEM

Kidneys
Blood supply: Renal arteries and
veins
Ureter
Urinary bladder
Urethra

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Anatomi fisiologis ginjal

2 ginjal : kanan & kiri, dinding posterior
abdomen, di luar rongga peritoneum
Berat 1 ginjal : 150 gr, seukuran kepalan
tangan
Suplai darah : arteri renalis masuk melalui
hilum, lalu bercabang menjadi arteri
interlobaris a. arkuata a. interlobularis
arteriol aferen menuju kapiler glomerulus
Darah yang menuju kedua ginjal sebesar :
1200 ml/menit (21% curah jantung)
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Unit fungsional ginjal

Unit fungsional ginjal : nefron

Tiap ginjal terdiri atas 1 juta nefron
Tiap nefron dapat membentuk urin
Ginjal tidak dapat membentuk nefron
Komponen utama nefron :
Glomerulus dilapisi sel epitel & dibungkus
kapsula bowman
Tubulus saluran panjang yang mengubah
cairan filtrasi glomerulus menjadi urin

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THE NEPHRON IS THE FUNCTIONAL

UNIT OF THE KIDNEY

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FUNCTIONS OF THE KIDNEY

Pengaturan keseimbangan air dan elektrolit
Pengaturan konsentrasi osmolalitas cairan tubuh
dan konsentrasi elektrolit
Pengaturan keseimbangan asam basa
Ekskresi produk sisa metabolik (urea, asam urat,
metabolit hormon) dan bahan kimia asing
Pengaturan tekanan arteri (sekresi renin)
Sekresi hormon (eritropoetin)
Glukoneogenesis (sintesis glukosa)
Pengaturan produksi vitamin D3 (bentuk aktif)

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THREE BASIC RENAL

PROCESSES
Glomerular Filtration: Filtering of blood
into tubule forming the primitive urine
Tubular Reabsorption: Absorption of
substances needed by body from tubule
to blood
Tubular Secretion: Secretion of
substances to be eliminated from the
body/from the blood into the tubule
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BASIC RENAL PROCESSES

Efferent Arteriole
Afferent
Arteriole

Glomerulus

GF

Kidney
Tubule

TR
Peritubular Capillary

TA

Urine Excreted
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Glomerular Filtration
First step in urine formation
180 liters/day filtered
Entire plasma volume filtered 65 times/day
Proteins not filtered: negatively charge
large molecules are filtered less easily than
pos charge mol of equal mol size.
Filterability of substances : decreases with
increasing molecular weight

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Forces Involved in
Glomerular
Filtration
Glomerular Capillary
Blood Pressure : arterial pressure
Afferent arteriolar pressure
Efferent arteriolar resistance
Plasma Colloid
Osmotic Pressure

Bowmans Capsule
Hydrostatic Pressure

Net Filtration Pressure

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60

32

18
10

Factors that can decrease the GFR

and phathophysiologic causes
Glom. Capilary Filtration Coef. (Kf) : Renal
desease, DM, hypertentioncapilar desease)
Bowmans Capsule Hydrostatic Pressure :
Urinary tract obstruction (kidney stone)
Glom.capilary plasma prot: renal blood flow,
plasma protein
Systemic arterial pressure : arterial pressure
(only small effect)
Efferent arteriolar resistance : angiotensin II
(drugs that block angiotensin II formation)
afferent arteriolar resistance : sympathetic
activity, vasoconstrictor hormones (NE,
endothelin)
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Autoregulation of GFR and Renal

Blood Flow in preventing extreme
change inrenal
excretion
Arterial pressure
Glom.hydrostatic pressure
GFR
Proximal
NaCl reabsorbtion

Macula densa NaCl

renin
angiotensin II

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efferent arteriolar
resistance

afferent arteriolar resistance

Tubular Reabsorption
By passive diffusion: water (osmosis)
By primary active transport: Sodium,
Potassium,calcium, hydrogen,
chloride, a few other ions
By secondary active transport:
Sugars and Amino Acids
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Tubular Reabsorption is a Function of the

Epithelial Cells Making up the Tubule

Lumen
Cells

Plasma

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Sodium Reabsorption
PUMP: Na/K ATPase
Sodium

Lumen
Cells
Potassium

Plasma
Chloride
Water

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Transport Maximum: maximum rate of

substance can be reabsorbed from the
tubules
Substance

Transport
maximum
Glucose
320 mg/min
Phosphate
0.10 mM/min
Sulfate
0.06 mM/min
Amino acids
1.5 mM/min
Urate
15 mg/min
Lactate
75 mg/min
Plasma protein 30 mg/min
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Reabsorption in Proximal
Tubule (Summary)

Glucose and Amino Acids

67% of Filtered Sodium
Other Electrolytes
65% of Filtered Water
50% of Filtered Urea
All Filtered Potassium

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Glucose and Amino Acids are reabsorbed by

secondary active transport

They are actively transported across

the apical cell membranes of the
epithelial cells
Their active transport depends on
the sodium gradient across this
membrane
All other steps are passive
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GLUCOSE REABSORPTION HAS A

TUBULAR MAXIMUM

Glucose
Reabsorbed
mg/min

Filtered

Excreted

Reabsorbed

Renal threshold (300mg/100 ml)

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Plasma Concentration of Glucose

Tubular Secretion
Protons (acid/base balance)
Potassium
Organic ions

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Potassium Secretion
PUMP: Na/K ATPase
Sodium

Lumen
Cells
Potassium

Plasma
Chloride
Water

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Secretion in Proximal
Tubule (Summary)
Variable Proton secretion for
acid/base regulation
Organic Ion secretion

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Filtration, Reabsorbtion, and Excretion

Rates different substaces
Amount
filtered

Amount
Amount
Absorbed excreted

% of
filtered
Load
Reabs.

Glu (g/day)

180

180

100

HCO3
(mEq/day

4.320

4.318

99.9

Sodium
(mEq/day)

25.560

25.410

150

99.4

Chloride
(mEq/day)

19.440

19.260

180

99.1

Potassium
(mEq/day)

756

664

92

87.8

Urea
(mEq/day)

46.8

23.4

23.4

50

Creatinine
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(g/day)

1.8

1.8

REGULATION OF URINE
CONCENTRATION
Medullary countercurrent system
Vasopressin

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Medullary countercurrent
system
Osmotic gradient established by long
loops of Henle
Descending limb
Ascending limb

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Descending limb
Highly permeable to water
No active sodium transport

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Ascending limb
Actively pumps sodium out of tubule
to surrounding interstitial fluid
Impermeable to water

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COUNTERCURRENT MAKES
THE OSMOTIC GRADIENT
From
Proximal
Tubule
Active
Sodium
Transport
Passive
Water
Transport

300

300

100

450

450

250

600

600

400

750

750

550

900

900

700

1050

1050

850

1200

1200

1000

1200

1000

1200

Long Loop
of Henle
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To Distal
Cortex
Tubule
Medulla

Secretion in Distal Tubule

(Summary)
Variable Proton for acid/base
regulation
Variable Potassium controlled by
aldosterone

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Reabsorption in Distal
Tubule (Summary)
Variable Sodium controlled by
Aldosterone
Chloride follows passively
Variable water controlled by
vasopressin
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Rennin-AngiotensinAldosterone System
Stimulates Sodium Reabsorption in
distal and collecting tubules
Naturetic peptide inhibits
In absence of Aldosterone, 20mg of
sodium/day may be excreted
Aldosterone can cause 99.5%
retention
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Rennin-AngiotensinAldosterone System
Fall in NaCl, extracellular fluid volume, arterial blood pressure
Helps
Correct

Juxtaglomerular
Apparatus
Liver

Lungs

Renin

+
Angiotensinogen

Adrenal
Cortex

Converting
Enzyme

Angiotensin I

Angiotensin II

Increased
Sodium
Reabsorption
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Aldosterone

DUAL CONTROL OF
ALDOSTERONE SECRETION
Increased
Plasma
Potassium

Fall in sodium
ECF Volume
Blood Pressure

Increased Aldosterone secretion

Increased Tubular
Potassium Secretion
Increased Urinary
Potassium Secretion

Increased Tubular
Sodium Reabsorption

Fall in Urinary
Sodium Excretion

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Collecting Duct (Summary)

Variable water reabsorption
controlled by vasopressin
Variable Proton secretion for
acid/base balance

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WHEN VASOPRESSIN (ANTI DIURETIC

HORMONE [ADH]) IS ABSENT A DILUTE
URINE IS PRODUCE
Interstitial Fluid
300

100

450

100

600

Collecting
Duct

750

100

900

100

1050

100

1200
1200

No Water Flow
Out of Duct
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100

Pores
Closed

100
100

From
Distal
Tubule

Cortex
Medulla

THE OSMOTIC GRADIENT CONCENTRATES

THE URINE WHEN VASOPRESSIN (ANTI
DIURETIC HORMONE [ADH]) IS PRESENT
From
Interstitial Fluid
Cortex
Distal
300

300

450

400

600

Collecting
Duct

750

700

900

850

1050

1000

1200
1200

Pores
Open

Passive Water Flow

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550

1100
1200

Tubule

Medulla

DIURETICS
ACE Inhibitors (Angiotensin
Converting Enzyme): Cause loss of
salt---> water follows
Atrial Naturetic Peptide (ANP) also
inhibits sodium reabsorption
Osmotic diuretics: Are not
reabsorbed
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Renal Failure
Acute: Sudden onset, rapid reduction
in urine output - usually reversible
Chronic: Progressive, not reversible
Up to 75% function can be lost before
it is noticeable
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Penyakit penyakit ginjal

Penyakit ginjal dikelompokkan :
Gagal ginjal akut seluruh atau hampir
semua kerja ginjal berhenti tapi membaik
mendekati normal lagi
Gagal ginjal kronis ginjal secara lambat
kehilangan fungsi nefronnya satu per satu
yang menurunkan seluruh fungsi ginjal

Salah satu penyebab kematian dan

cacat tubuh yang penting di seluruh
dunia
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Gagal ginjal akut

Penyebabnya dibagi 3 :
Akibat penurunan suplai darah ke ginjal (gagal
ginjal akut prerenal)
Gagal ginjal akut intrarenal akibat kelainan di
dalam ginjal itu sendiri
Gagal ginjal akut post renal ada sumbatan
pada sistem pengumpul urin dimana saja mulai
kaliks sampai keluar kandung kemih

Efek pada tubuh : penumpukan air dan

garam berlebih, hiperkalemia, asidosis
metabolik
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Gagal ginjal kronis

Disebabkan hilangnya sejumlah besar nefron
secara progresif dan ireversibel
Penyebab penting gagal ginjal kronis :

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Gaqngguan imunologis : glomerulonefritis, lupus

Gangguan metabolik : diabetes melitus
Gangguan pembuluh darah ginjal : arterosklerosis
Infeksi
Gangguan tubulus primer (obat, toksin)
Obstruksi kronis
Kelainan kongenital

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Hemodialisa
Prinsip dasar dialisa mengalirkan darah
melalui membran tipis yang terdapat
cairan dialisa untuk membuang zat yang
tidak diinginkan
Pada gagal ginjal akut dapat digunakan
untuk membantu pasien melewati masa
kritis
Pada gagal ginjal kronik dilakukan
hemodialisa sepanjang hidup
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06/09/15

THE URINARY BLADDER

STORES THE URINE
Gravity and peristaltic contractions
propel the urine along the ureter
Parasympathetic stimulation
contracts the bladder and micturition
results if the sphincters (internal and
external urethral sphincters) relax
The external sphincter is under
voluntary control
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Reflex and Voluntary

Control of Micturition
Bladder filling
reflexively
contracts the
bladder
Internal Sphincter
mechanically
opens

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Stretch receptors in
bladder send
inhibitory impulses
to external sphincter
Voluntary signals
from cortex can
override the reflex
or allow it to take
place