• Nephrology (nephr- = kidney; -ology study of) is the scientific

study of the anatomy, physiology, and pathology of the

kidneys.
• The branch of medicine that deals with the male and female
urinary systems and the male reproductive system is called
urology (uˉ-ROL-oˉ-jeˉ; uro- urine).
• A physician who specializes in this branch of medicine is called
a urologist (uˉ-ROL-oˉ-jist)
Suprarenal glands, Kidneys,
Ureters, and Urinary
Bladder are retroperitoneal
organs, guys 
St. Urinarium terdiri dari
pasangan ginjal (Ren
[Nephrosi]), menghasilkan urin;
dan tractus urinarius eferen,
terdiri dari:
• Pelvis renalis
• Ureter
• Vesica Urinaria
• Urethra
• Subperitoneal detrusor vesicae), T. serosa kranial
• Corpus, Apex, Fundus • Dikelilingi o/ jar. Adiposa dan distabilisasi o/ lig.
• Trigonum Vesicae • Lig. Umbiliacales medianum, Lig. Pubovesicale
• 500 – 1500 mL. 250 – 500 mL (keinginan) bilateral (w), Lig. Puboprostaticum bilateral (p)
• T. mucosa, T. muscularis (polos, parasimpatis, M.
• Glomerulus
• Khas, b’bentuk bulat dan lebih
gelap daripada sekitarnya
karena sel-selnya tersusun lebih
padat.
• Kapsul bowman pars parietal
(epitel selapis gepeng)
• Polus tubularis, Polus
vaskularis
• Vasa aferen, Vasa eferen
• Vasa aferen -> glomerulus
-> podosit.
• Apparatus Juxtaglomerular: Sel
Juxtaglomerular + Macula densa
• Autoregulasi aliran darah ginjal dan
menjaga laju filtrasi agar tetapo
konstan
• Di tempat kontak dengan arteriol, sel-
sel tubulus distal (epitel dinding TKD)
menjadi kolumnar dan menjadi lebih
padat -> Macula densa
• Bersebelahan dengan macula densa, T.
media arteriol aferen juga
termodifikasi: sel2 otot polos m’bentuk
suatu fenotipe sekretorik -> sel
juxtaglomerular
•
 P arterial ↗ Vasokonstriktor macula
densa berhenti Kel. Adrenal →
Aldosteron
P kapiler
P arteri ↘
Glomerulus↗ Reabsorpsi Na dan air
ke TKD ↗
Glomerulus Baroreseptor (trmsk
Filtration Rate ↗ barorespt. lokal di P darahl ↗
arteriol aferen dan
sel2 JG itu sendiri
Konsentrasi Na dan Cl
P darah kembali normal
@ nefron↗, dipantau Renin
o/ Macula densa

Angiotensinogen → Angiotensin I Sekresi renin

ATP, adenosine, berhenti
senyawa vasoaktif
ACE (paru) → Angiotensin II
Vasokonstriksi arteriol
aferen
Vasokonstriktor poten
P glomerulus dan GFR ↘

P darah sistemik ↗ GFR ↘

Konsentrasi ion tubulus ↘
• TKP:
• selapis sel kuboid
• batas antar-sel sulit dilihat
• Inti terletak agak
berjauhan
• Perm. Sel yang
menghadap lumen
memiliki brush border
• TKD:
• selapis sel kuboid
• batas antar-sel lebih jelas
terlihat
• Inti terletak berdekatan
• Perm. Sel yang
menghadap lumen tidak
memiliki brush border
• A/V kortikalis radiata /
intralobularis:
• Arteri dan vena berjalan
berdampingan
• Arteriol dan venula
• Selalu berada dalam
korteks ginjal
• a/v akuata/interlobularis
• Pros. Fereini jelas dan lumen tampak kosong.
• Ansa Henle segmen tebal pars • Ansa Henle segmen tebal pars
ascendens descendens
• Mirip TKD, dengan garis tengah • Mirip TKP, diameter lebih kecil
lebih kecil • Duktus koligens
• Ansa Henle segmen tipis • Mirip TKD, dinding sel epitel
• Mirip kapiler pemb. darah, epitel terlihat lebih jelas, sel lebih tinggi
selapis gepeng; tapi sedikit lebih dan lebih pucat
tebal shg sitoplasma terlihat lebih
• Makin dekat dengan papilla renis, saluran yang ada di
dalamnya tampak berdiameter lebih besar, dindingnya dilapisi
epitel kubis tinggi selapis sampai torak dan disebut duktus
papilla Bellini -> kaliks minor
• Ureter pars pelvina
• Mukosa: (epitel
transisional) + jar.
Ikat jarang (L.
propria)
• T. muskularis:
• T. musk. Longitudinal
(dalam)
• T. musk sirkular
(tengah)
• T. musk. Longitudinal
(luar
• T. adventisi: jar. Ikat
jarang
• Mukosa: epitel
transisional + jar. Ikat
jarang (L.propria) di
bawahnya
• T. musk:
• berkas2 otot polos
tersusun berlapis
• Arah tidak m’bentuk
aturan tertentu (dalam
sajian terlihat terpotong
dalam berbagai arah)
• Diantaranya terdapat jar.
Ikat jarang
• T. adventisia: jar. Ikat
jarang, sebagian
diliputi o/ peritoneum
(T. serosa)
• T. albuginea = jar. Ikat padat fibrosa
• Kaverne
• Corpus cavernosa & corp. spongiosa =
jar. Trabekular – jar. Fibroelastik
(pangkalnya melekat pada T. albuginea)
+ serat otot
• Corp. Cavernosa – endotel – kaverne
• Kaverne korp. Kavernosum = tidak
beraturan, dua lapis
• Kaverne korp. Spongiosum = beraturan,
jar. Ikat fibrosa lebih tipis dan elastis
• A. profunda -> A. helisina
• Nephrons & collecting ducts:
• Glomerular filtration:
• Water and most solutes in blood plasma → filtration slit →
glomerular capsule → renal tubule
• Tubular reabsorption
• As filtered fluid flows through the renal tubules and through the
collecting ducts, tubule cells reabsorb about 99% of the filtered water
and many useful solutes → peritubular capillaries → vasa recta
• Tubular secretion
• As filtered fluid flows through the renal
tubules and collecting ducts, the renal tubule and duct cells
secrete other materials, such as wastes, drugs, and excess ions
• By filtering, reabsorbing, and secreting, nephrons help maintain
homeostasis of the blood’s volume and composition.
• Filtration fraction → glomerular filtrate
• On average, the daily volume of glomerular filtrate in adults is
150 liters in females and 180 liters in males
• More than 99% of the glomerular filtrate returns to the
bloodstream via tubular reabsorption → only 1–2 liters is
excreted as urine.
• Substances filtered from the blood cross three filtration barriers:
• A glomerular endothelial cell
• The basal lamina
• A filtration slit formed by a podocyte
• This sandwichlike assembly permits filtration
of water and small solutes but prevents filtration of most plasma
proteins, blood cells, and platelets.
1. Glomerular endothelial
cells:
1. Fenestrations (0.07–0.1 μm
in diameter) → permits all
solutes in blood
plasma to exit glomerular
capillaries but prevents
filtration of blood cells and
platelets.
2. Mesangial cells (located
among the glomerular
capillaries and in the cleft
between afferent and
efferent arterioles) help
regulate glomerular
filtration
2. The Basal Lamina
1. a layer of acellular material between the endothelium and the
podocytes, consists of minute collagen fibers and proteoglycans in a
glycoprotein matrix; negative charges in the matrix prevent filtration of
larger negatively charged plasma proteins.

3. Pedicels & filtration slits

1. Slit membrane permits the passage of molecules having a diameter
smaller than 0.006–0.007 μm, including water, glucose, vitamins, amino
acids, very small plasma proteins, ammonia, urea, and ions.
2. Less than 1% of albumin, the most plentiful plasma protein, passes the
slit membrane because, with a diameter of 0.007 μm, it is slightly too
big to get through
• The principle of filtration—the use of pressure to force fluids
and solutes through a membrane—is the same in glomerular
capillaries as in blood capillaries elsewhere in the body.
• However, the volume of fluid filtered by the renal corpuscle is
much larger than in other blood capillaries of the body for
three reasons:

1. Glomerular capillaries present a large surface area for

filtration because they are long and extensive. Mesangial cells
regulate how much surface area is available. When mesangial
cells are relaxed, surface area is maximal, and glomerular
filtration is very high. Contraction of mesangial cells reduces the
available surface area, and glomerular filtration decreases.
2. The filtration membrane is thin and the large fenestrations of
glomerular capillaries.

3. Glomerular capillary blood pressure is high. Because the

efferent arteriole is smaller in diameter than the afferent
arteriole.
• Glomerular filtration depends on three main pressures:
• One pressure promotes filtration
• Two pressures oppose filtration
1. Glomerular blood hydrostic pressure (GBHP)
1. is the blood pressure in glomerular capillaries.
2. Generally is about 55 mmHg
3. Promotes filtration by forcing water and solutes in blood plasma through
the filtration membrane
2. Capsular hydrostatic pressure (CHP)
1. is the hydrostatic pressure exerted against the filtration membrane by
fluid already in the capsular space and renal tubule.
2. CHP opposes filtration and represents a “back pressure” of about 15
mmHg.
3. Blood colloid osmotic pressure (BCOP)
1. Is due to the presence of proteins such as albumin, globulins, and
fibrinogen in blood plasma, also opposes filtration.
2. The average BCOP in glomerular capillaries is 30 mmHg.
• Glomerular Filtration Rate (GFR): The amount of filtrate formed in all
renal corpuscles of both kidneys/min
• In adults, the GFR averages 125 mL/min in males and 105 mL/min in
females.
• Homeostasis of body fluids requires that the kidneys maintain a
relatively constant GFR. If the GFR is too high, needed substances
may pass so quickly through the renal tubules that some are not
reabsorbed and are lost in the urine. If the GFR is too low, nearly all
the filtrate may be reabsorbed and certain waste products may not
be adequately excreted.
• GFR is directly related to the pressures that determine net filtration
pressure; any change in net filtration pressure will affect GFR.
• GFR is nearly constant when the mean arterial blood pressure is
anywhere between 80 and 180 mmHg.
• The mechanisms that regulate glomerular filtration rate operate
in two main ways:
• by adjusting blood flow into and out of the glomerulus
• by altering the glomerular capillary surface
• There are 3 mechanisms control GFR:
• Renal autoregulation
• Neural regulation
• Hormonal regulation
A. Renal Autoregulation of GFR
A. The myogenic mechanism: normalizes renal blood flow and GFR within
seconds after a change in blood pressure
B. Tubuloglomerular mechanism: Tubuloglomerular feedback operates
more slowly than the myogenic mechanism.
B. Neural Regulation of GFR
A. Blood vessels of both of the kidneys supplied by sympathetic ANS fibers
→ norepinephrin (causes vasoconstriction through the activation of
α1 receptors, which are particularly plentiful in the smmooth msucle
fibers of afferent arteries)
B. At rest: sympathetic stimulation low → afferent and efferent arteriols
are dilated and GFR prevails
C. Moderate sympathetic stimulation → afferent and efferent arteriols
contrict to the same degree → blood flow into and out glom. is
restricted to same extent → GFR decreases slightly
D. Greater sympathetic stimulation → vasoconstriction af and ef
predominates → blood flow to glom. greatly decreased → GFR drops.
 P arterial ↗ Vasokonstriktor macula
densa berhenti Kel. Adrenal →
Aldosteron
P kapiler
P arteri ↘
Glomerulus↗ Reabsorpsi Na dan air
ke TKD ↗
Glomerulus Baroreseptor (trmsk
Filtration Rate ↗ barorespt. lokal di P darahl ↗
arteriol aferen dan
sel2 JG itu sendiri
Konsentrasi Na dan Cl
P darah kembali normal
@ nefron↗, dipantau Renin
o/ Macula densa

Angiotensinogen → Angiotensin I Sekresi renin

MD inhibits JGC to
berhenti
release Nitric Oxide
(vasodilator)
ACE (paru) → Angiotensin II
Vasokonstriksi arteriol
aferen
Vasokonstriktor poten
P glomerulus dan GFR ↘

P darah sistemik ↗ GFR ↘

Konsentrasi ion tubulus ↘
C. Hormonal Regulation of GFR
A. Angiotensin II → GFR ↘
B. ANP (Atrial Natriuretic Peptide; stimulated by strecthing of atria,
occurs when blood volume increases) →relaxation of glomerular
mesangial cells → increasing capillary surface area → GFR ↗
• Epithelial cells all along the renal tubule and duct carry out
reabsorption, but proximal convoluted tubule cells make the
largest contribution. Most small proteins and peptides that
pass through the filter also are reabsorbed
• The secretion of H+ helps control blood pH.
• The largest amount of solute and water reabsorption from filtered
fluid occurs in the proximal convoluted tubules, which reabsorb:
• 65% of the filtered water, Na, and K
• 100% of most filtered organic solutes such as glucose and amino acids
• 50% of the filtered Cl
• 80–90% of the filtered HCO3
• 50% of the filtered urea
• and a variable amount of the filtered Ca2, Mg2, and HPO42 (phosphate).
• In addition, proximal convoluted tubules secrete a variable amount of
H, ammonium ions (NH4), and urea.
• Other Na symporters in the PCT
reclaim filtered HPO4
(phosphate) and SO42
(sulfate) ions, all amino acids,
and lactic acid in a similar way
• Cells lining the proximal convoluted tubule and the descending
limb of the nephron loop are especially permeable to water
because they have many molecules of aquaporin-1 (ak-kwa-
POˉ R-in). This integral protein in the plasma membrane is a
water channel that greatly increases the rate of water
movement across the apical and basolateral membranes.
• Because all of the proximal convoluted tubules reabsorb about
65% of the filtered water (about 80 mL/min), fluid enters the next
part of the nephron, the nephron loop, at a rate of 40–45 mL/min
• The chemical composition of the tubular fluid now is quite different
from that of glomerular filtrate because glucose, amino acids, and
other nutrients are no longer present.
• The nephron loop reabsorbs about
• 15% of the filtered water
• 20–30% of the filtered Na and K
• 35% of the filtered Cl
• 10–20% of the filtered HCO3
• a variable amount of the filtered Ca2 and Mg2
• Here, for the first time,
reabsorption of water via osmosis
is not automatically coupled to
reabsorption of filtered solutes
because part of the nephron loop
is relatively impermeable to water.

• Although about 15% of the

filtered water is reabsorbed in the
descending limb of the nephron
loop, little or no water is
reabsorbed in the ascending limb.
In this segment of the tubule, the
apical membranes are virtually
impermeable to water.
• Fluid enters the distal convoluted tubules at a rate of about 25 mL/
min because 80% of the filtered water has now been reabsorbed.
• The early part of DCT reabsorbs:
• 10–15% of the filtered water
• 5% of the filtered Na
• 5% of the filtered Cl
• Reabsorption of Na and Cl occurs by means of Na–Cl symporters in
the apical membranes → leakage channel → peritubular capillaries
• The early DCT also is a major site where parathyroid hormone (PTH)
stimulates reabsorption of Ca2. The amount of Ca2 reabsorption in
the early DCT varies depending on the body’s needs.
• In contrast to earlier segments of the
nephron, Na passes through the
apical membrane of principal cells
via Na leakage channels rather than
by means of symporters or antiporter
(Figure 26.16)

• The concentration of Na in the

cytosol remains low, as usual,
because the sodium–potassium pumps
actively transport Na across the
basolateral membranes → passively
diffuses into the peritubular
capillaries from the interstitial spaces
around the tubule cells.
• Normally, transcellular and paracellular reabsorption in the proximal
convoluted tubule and nephron loop return most filtered K to the
bloodstream. To adjust for varying dietary intake of potassium and to
maintain a stable level of K in body fluids, principal cells secrete a
variable amount of K (Figure 26.16).

• Because the basolateral sodium–potassium pumps continually

bring K into principal cells, the intracellular concentration of K
remains high. K leakage channels are present in both the apical
and basolateral membranes. Thus, some K diffuses down its
concentration gradient into the tubular fluid, where the K
concentration is very low. This secretion mechanism is the main source
of K excreted in the urine.
• Five hormones affect the extent of Na, Cl, Ca2, and water
reabsorption as well as K secretion by the renal tubules.
• These hormones include:
• angiotensin II
• Aldosterone
• antidiuretic hormone
• atrial natriuretic peptide
• parathyroid hormone
• Renal-Angiotensin-Aldosterone-System

Blood volume ↘ Blood pressure ↘ Sympathetic stimulation

Afferent arterioles’ walls

are streched less

JGC → Renin

Angitensinogen (hepatocytes) → Angiotensin I

AT1 −ACE→ ATII

• Angiotensin II affects renal physiology in three main ways:
1. It decreases the glomerular filtration rate by causing
vasoconstriction of the afferent arterioles.
2. It enhances reabsorption of Na, Cl, and water in the PCT by
stimulating the activity of Na–Hantiporters.
3. It stimulates the adrenal cortex to release aldosterone
(alDOS-ter-oˉn), a hormone that in turn stimulates the principal
cells in the collecting ducts to reabsorb more Na and Cl and
secrete more K. The osmotic consequence of reabsorbing
more Na and Cl is that more water is reabsorbed, which
causes an increase in blood volume and blood pressure
• Antidiuretic Hormone (ADH) /
Vasopressin
• Atrial Natriuretic Peptide

Blood Volume ↗

Heart → ANP

Inhibit reabsorption of Na Suppresses the secretion

and water in PCT and of aldosterone and ADH
collecting duct

Excretion of Na in Urine output ↗

urine ↗ (natriuresis) (diuresis)

Blood vol and

press ↘
• Parathyroid Hormone
• Although the hormones mentioned thus far involve regulation of
water loss as urine, the kidney tubules also respond to a hormone
that regulates ionic composition.

Lower than normal level

of Ca in blood

Parathyroid Gl. → PTH

Inhibits HPO4 (phospate)

Stimulates cells in early DCT
reabsorption in PCT

Reabsorp more Ca into the blood

Phospate excretion