GINJAL/ KIDNEY

Drg Ervin Rizali M.Kes, AIFM, CHt, CI, CHdE

References :
Tortora : Principles of Anatomy & Physiology, 10th
Edition, 2003
Guyton &Hall : Fisiologi Kedokteran, Edisi 9, 1997
Ethel Sloane : Anatomi dan Fisiologi, Edisi 1, 2004
W.F Ganong : Fisiologi Kedokteran, Edisi 10, 1983
 GINJAL/ KIDNEY
MERUPAKAN BAGIAN TERPENTING AN IMPORTANT PART OF URINARY
DARI SISTEM URINARIA SYSTEM

 SISTEM URINARIA TERDIRI DARI :  URINARY SYSTEM CONSISTS

- 2 BUAH GINJAL OF:
- 2 BUAH URETER  2 KIDNEYS
- 1 BUAH KANDUNG KEMIH  2 URETERS
- 1 BUAH URETRA  1 BLADDER
 1 URETHRA
SISTEM INI MERUPAKAN SALAH SATU SISTEM
UTAMA UNTUK MEMPERTAHANKAN  THIS SYSTEM IS ONE OF THE MAIN
HOMEOSTATIS TUBUH SYSTEM TO REGULATE BODY’S
HOMEOSTATIC
GAMBAR SISTEM URINARIA
URINARY SYSTEM
 STRUKTUR GINJAL
THE STRUCTURE OF KIDNEY
LOKASI
TERLETAK RETROPERITONEAL
SETINGGI VERTEBRA THORAKAL 12 -
LUMBAL 1
STRUKTUR EKSTERNAL :
 BERBENTUK SEPERTI KACANG MERAH
 BERUKURAN 12,5 X 2,5 cm
 MEMILIKI BERAT SEKITAR 125 – 175 gr
(PRIA) DAN 115 – 155 gr (WANITA)
 MEMILIKI JARINGAN IKAT PEMBUNGKUS
YANG TERDIRI DARI FASIA RENALIS,
LEMAK PERIRENAL DAN KAPSUL
FIBROSA
LOCATION
IN RETROPERITONEAL AS
THORACIC 12- LUMBAR VERTEBRAE
1
EXTERNAL STRUCTURE
- RED BEAN LOOK ALIKE
- ITS SIZE: 12,5X2,5 CM
- ITS WEIGHT : ABOUT 125-175 GR (MALE)
AND 115-155 GR (FEMALE)
- IT IS COVERED BY CONNECTIVE
TISSUE WHICH CONSISTS OF RENAL
FASCIA,PERIRENAL FAT, AND FIBROUS
CAPSULE
 STRUKTUR INTERNAL / INTERNAL STRUCTURE
 HILUS : PUSAT KECEKUNGAN
TEPI MEDIAL GINJAL
 SINUS GINJAL : RONGGA
UNTUK JALAN MASUK URETER,
VENA DAN ARTERI RENALIS
 PELVIS GINJAL : MUARA DARI
KALIKS MAYOR DAN KALIKS
MINOR
 PARENKIM GINJAL :
MEDULA, TERSUSUN ATAS
PIRAMIDA DAN PAPILA GINJAL
KORTEKS, TERSUSUN ATAS
NEFRON
 HILUS: THE CENTER OF KIDNEY
MEDIAL ELLIPTICAL SIDE
 KIDNEY SINUS: ENTRY
VESTIBULE FOR URETHRA, VEIN
AND ARTERY RENAL
 KIDNEY PELVIS: THE MIDPOINT
MAYOR CALYX AND MINOR
CALYX
 KiIDNEY PARENCHYM:
MEDULLA, CONSIST OF
PYRAMID AND KIDNEY PAPILLA
CORTEX, CONSIST OF NEPHRON
 FUNGSI GINJAL
 FUNGSI UTAMA
1. MEMBUANG ZAT-ZAT SAMPAH
TUBUH DARI HASIL PROSES
PENCERNAAN DAN METABOLISME
2. PENGATURAN VOLUME DAN
KOMPOSISI CAIRAN TUBUH
 TUJUAN :
UNTUK MEMELIHARA KESTABILAN LINGKUNGAN SEL-
SEL YANG DIPERLUKAN UNTUK MELAKUKAN
BERBAGAI MACAM AKTIVITAS
DENGAN CARA
MENYARING PLASMA  MEMISAHKAN ZAT-ZAT YANG
TIDAK DIBUTUHKAN DARI FILTRAT MENGEKSKRESIKAN
DALAM URIN)  ZAT YANG DIBUTUHKAN AKAN
DIKEMBALIKAN KE DALAM DARAH

KIDNEY FUNCTION
 MAIN UTILTIES :
1. TO REMOVE THE ORGANIC BODY
WASTE , EXCESS FROM DIGESTION
AND METABOLISM PROCESS.
2. TO COMPOSE BODY’S FLUID VOLUME
AND COMPOSITION
 OBJECTIVES:
TO MAINTAIN THE ENVIRONMENTAL CELLS
STABILITY WHICH ARE ESSENTIAL TO DO
VARIOUS ACTIVITIES
HOW IT WORKS:
PLASMA FILTERING SEPARATING THE
UNNECESSARY SUBSTANCES FROM THE
FILTRAT  INITIATING URINAL EXCRETION
 THE NECESSARY SUBSTANCE WILL BE
RETURNED TO THE BLOOD FLOW
 BERBAGAI FUNGSI LAIN
 PENGATURAN KESEIMBANGAN AIR DAN
ELEKTROLIT
 PENGATURAN KONSENTRASI
OSMOLALITAS CAIRAN TUBUH &
KONSENTRASI ELEKTROLIT
 PENGATURAN KESEIMBANGAN ASAM
BASA
 PENGATURAN TEKANAN DARAH
 PENGENDALIAN TERBATAS TERHADAP
KONSENTRASI GLUKOSA DAN ASAM
AMINO DARAH
OTHER UTILITIES
 BALANCING THE WATER AND
ELECTROLITES.
 SETTING UP THE BODY FLUIDS
OSMOLALITY CONCENTRATION
ELECTROLITES CONCENTRATION
 BALANCING ACID AND BASE LEVEL
 SETTING UP THE BLOOD PRESSURE
 LIMITED CONTROL TO GLUCOSE AND
AMINO ACID BLOOD CONCENTRATION
 NEFRON / NEPHRON
 UNIT STRUKTURAL DAN FUNGSIONAL GINJAL  KIDNEY’S STRUCTURAL AND FUNCTIONAL
UNITS
 JUMLAHNYA : + 1 JUTA UNIT / GINJAL
 AMOUNT: : + 1 MILLION UNITS / KIDNEY
 TERDIRI DARI :
 GLOMERULUS  CONSISTS OF:
 TUBULUS PROKSIMAL  GLOMERULUS
 ANSA HENLE  PROXIMAL TUBULES
 TUBULUS DISTAL  LOOP OF HENLE
 DUKTUS KOLIGENTES /PENGUMPUL
 DISTAL TUBULE
 2 JENIS NEFRON :
 COLIGENTES/COLLECTING
 NEFRON KORTIKAL DUCT
 NEFRON JUKSTAMEDULAR
 2 TYPES NEPHRON
 CORTICAL NEPHRON
 JUXTAMEDULLAR NEPHRON
 GLOMERULUS
 GULUNGAN KAPILER (+ 50 KAPILAR) YANG
DIKELILINGI KAPSUL EPITEL (KAPSUL BOWMAN)
MEMBENTUK KORPUSKEL GINJAL
 KORPUSKEL GINJAL TERDIRI DARI :
 LAPISAN VISCERAL (MENGANDUNG SEL-SEL
PODOSIT, PEDIKEL, DAN BARIER FILTRASI
GLOMERULUS)
 LAPISAN PARIETAL ,TERDIRI DARI :
- KUTUB VASKULAR : TEMPAT
ARTERIOL AFEREN & EFEREN
KELUAR MASUK GLOMERULUS
- KUTUB URINARIUS : TEMPAT
FILTRASI GLOMERULUS
MENUJU TUBULUS PROKSIMAL
 THE CAPILLARY ROOLS (+ 50 Capilars)
CHICH ARE SUROUNDED BY EPITHELIAL
CAPSULES AND FORMING KIDNEY
CORPUSCLE.
 KIDNEY CORPUSCLE CONSIST OF
 VISCERAL LAYER (CONSISTING PODOSIT
CELLS, PEDICELLS, AND BARRIER
GLOMERULUS FILTRATION)
 PARIETAL LAYER CONSISTOF :
- VASCULAR POLE :THE PASSAGE ON
GLOMERULUS WHERE AFFERENT
ARTERIOL AND EFFERENT
ARTERIOL GOES IN AND OUT
 - URINARIUS POLE : THE PASSAGE ON
GLOMERULUS FILTRATION
THROUGH TO PROXIMAL TUBULUS
 TUBULUS
 TUBULUS PROKSIMAL,
PANJANGNYA 15 mm DAN BERLIKU
 ANSA HENLE, TERDIRI DARI
TUNGKAI DESENDEN DAN ASENDEN
 TUBULUS DISTAL SEPANJANG
5mm, TERDIRI DARI MACULA
DENSA, SEL
JUKSTAGLOMERULAR, DAN SEL
MESANGIUM
 DUKTUS KOLIGENTES
MENGALIRKAN URINE KE DALAM
KALIKS MINOR
/ TUBULES
 PROXIMAL TUBULE,
15 mm-LONG and CURVE-SHAPED.
 LOOP OF HENLE, CONSIST OF
DESCENDENT AND ASCENDENT TAIL
 DISTAL TUBULE, 5 mm- LONG and
CONSIST OF MACULA DENSA,
JUXTAGLOMERULAR CELLS AND
MESANGIUM CELLS
 DUCTUS COLIGENTES FLOWS THE
URINE INTO MINOR CALYX
 VASKULARISASI GINJAL /
KIDNEY VASCULARISATION

ARTERI RENALIS  ARTERI INTERLOBARIS 

ARTERI ARKUATA  ARTERI INTERLOBULARIS 
ARTERIOL AFEREN  GLOMERULUS  ARTERIOL
EFEREN  KAPILER PERITUBULAR  VENA
INTERLOBULARIS  VENA ARKUATA  VENA
INTERLOBARIS  VENA RENALIS
 SISTEM SARAF GINJAL /
 PERSARAFAN PADA GINJAL BERASAL
DARI GANGLION CELIAC YANG
MEMBENTUK PLEKSUS RENALIS DAN
MASUK KE DALAM GINJAL BERSAMA-
SAMA DENGAN ARTERI RENALIS
 BERASAL DARI SISTEM SARAF OTONOM
YANG BERSIFAT SIMPATIS
 BERPERAN DALAM REGULASI ALIRAN
DARAH GINJAL MELALUI PROSES
VASOKONSTRIKSI DAN VASODILATASI
ARTERIOL GINJAL
KIDNEY NERVES SYSTEM
 KIDNEY NERVES SYSTEM COMES
FROM CELIAC GANGLION WHICH
FORMS PLEXUS RENALIS AND ENTER
THE KIDNEY ALONG WITH RENAL
ARTERY
 COMES FROM SYMPATHIZED
AUTONOMIC NERVE SYSTEM
 HAS A ROLE IN KIDNEY
BLOODSTREAM REGULATION
THROUGH VASOCONSTRICTION AND
VASODILATATION PROCESS OF THE
KIDNEY ARTERIOLE
 SISTEM HORMONAL GINJAL
 ANTIDIURETIC HORMONE (ADH) :
 BERFUNGSI UNTUK MENINGKATKAN
PERMEABILITAS TUBULUS DISTAL DAN
TUBULUS PENGUMPUL TERHADAP AIR
 DISINTESIS OLEH BADAN SEL SARAF
DI HIPOTALAMUS DAN DISIMPAN
DALAM SERABUT SARAF HIPOFISIS
POSTERIOR
 HORMON ALDOSTERON :
 MERUPAKAN HORMON STEROID
 DISEKRESI OLEH SEL-SEL KORTEKS
KELENJAR ADRENAL
 BEKERJA PADA TUBULUS DISTAL DAN
PENGUMPUL UNTUK MENINGKATKAN
ABSORPSI AKTIF ION NATRIUM DAN
SEKRESI AKTIF ION KALIUM
KIDNEY HORMONAL SYSTEM
 ANTIDIURETIC HORMONE (ADH) :
 TO INCREASE DISTAL TUBULE DAN
COLLECTING TUBULE PERMEABILITY AGAINST
WATER
 SYNTHESIZED BY NERVES CELLS BODY IN
HYPOTHALAMUS AND RESTORED INSIDE
POSTERIOR HYPOPHYSIS NERVES SET
 ALDOSTERON HORMONE:
 CLASSIFIED AS STEROID HORMONE
 PRODUCED BY CORTEX CELLS ADRENAL
GLAND
 WORKS ON DISTAL AND COLLECTING
TUBULE TO INCREASE THE SODIUM IONS
ACTIVE ABSORPTION AND KALIUM ION
ACTIVE SECRETION.
EFEK ALDOSTERON TERHADAP THE EFFECT OF ALDOSTERON TO
NATRIUM DARAH NATRIUM OF BLOOD
PADA SAAT KONSENTRASI NATRIUM DARAH WHEN THE CONECENTRATION OF NATRIUM OF
TURUN BLOOD DECREASED

RESEPTOR GINJAL MENDETEKSI KIDNEY RECEPTOR DETECTS THIS REDUCTION

PENURUNAN INI
STIMULATE THE JUXTAGLOMERULAR
MERANGSANG APARATUS JUXTA- APARATUS TO RELEASE RENIN
GLOMERULAR MELEPASKAN RENIN
WHICH NEXT IN BLOOD WILL BE CHANGED TO
YANG KEMUDIAN DI DALAM DARAH DIUBAH BE ANGIOTENSIN
MENJADI ANGIOTENSIN

ANGIOTENSIN BEKERJA PADA KORTEKS ANGIONTENSIN WORKS IN ADRENAL CORTEX

ADRENAL DAN MENSEKRESI AND SECRETE ALDOSTERON
ALDOSTERON

PENINGKATAN ABSORPSI NATRIUM DI INCREASING OF NATRIUM ABSORPTION IN

TUBULUS KEDALAM ALIRAN DARAH DISTAL TUBULE IN BLOOD STREAM
 PEMBENTUKAN URIN / URINE FORMING

TIGA PROSES UTAMA PEMBENTUKAN THREE MAIN PROCESSES TO FORM

URIN, YAITU : URINE:

FILTRASI GLOMERULUS FILTRATION OF GLOMERULUS

REABSORPSI TUBULUS REABSORPTION OF TUBULE

SEKRESI TUBULUS  SECRETION OF TUBULE

FILTRASI GLOMERULUS GLOMERULUS FILTRATION

 DEFINISI
PERPINDAHAN CAIRAN DAN ZAT
TERLARUT DARI KAPILER
GLOMERULUS, DALAM TINGKATAN
TEKANAN TERTENTU KE DALAM
KAPSUL BOWMAN
DEFINITION
THE MOVEMENT OF FLUID AND
COMPOUNDS FROM GLOMERULUS
CAPILLARY, ON CERTAIN GRADIENT
PRESSURE INTO THE BOWMAN
CAPSULE

FAKTOR YANG MEMBANTU : FACTORS WHICH CONTRIBUTE:

 MEMBRAN KAPILER  GLOMERULUS CAPILLARY

GLOMERULUS LEBIH PERMEABEL MEMBRANE IS MORE PERMEABLE

 TEKANAN DARAH DALAM KAPILER  BLOOD PRESSURE IN
GLOMERULUS
GLOMERULUS LEBIH TINGGI
CAPILLARY IS HIGHER
 MEKANISME
FILTRASI GLOMERULUS
TEKANAN HIDROSTATIK (DARAH)
GLOMERULUS MENDORONG CAIRAN DAN
ZAT TERLARUT KE RUANG KAPSUL BOWMAN
TEKANAN HIDROSTATIK KAPSULAR
MENDORONG CAIRAN DARI KAPSUL
MENUJU GLOMERULUS DAN TEKANAN
OSMOTIK KOLOID GLOMERULUS MENARIK
CAIRAN DARI KAPSUL BOWMAN MEMASUKI
GLOMERUS
TEKANAN FILTRASI EFEKTIF (EFP) =
TEKANAN HIDROSTATIK GLOMERULUS –
(TEKANAN KAPSULAR + TEKANAN OSMOTIK
KOLOID GLOMERULUS)
EFP = 55 – ( 15 + 30 ) mmHg = 10 mmHg
/
GLOMERULUS FILTRATION
MECHANISM
GLOMERULUS HYDROSTATIC (BLO0D) PRESSURE
PUSHES THE FLUID AND COMPOUND INTO THE
BOWMAN CAPSULE CHAMBER
CAPSULLAR HYDROSTATIC PRESSURE PUSHES THE
FLUID FROM CAPSULE INTO THE GLOMERULUS
AND OSMOTIC PRESSURE OF THE COLOID
GLOMERULUS EXTRACTING THE FLUID FROM
BOWMAN CAPSULE INTO ENTERING GLOMERULUS
EFFECTIVE FILTRATION PRESSURE=EFP
GLOMERULUS HYDROSTATIC PRESSURE –
(CAPSULAR PRESSURE + OSMOTIC
PRESSURE OF GLOMERULUS COLOID)
EFP = 55 – ( 15 + 30 ) mmHg = 10 mmHg
 LAJU FILTRASI GLOMERULUS
 DEFINISI
JUMLAH FILTRAT YANG TERBENTUK PER
MENIT OLEH SEMUA NEFRON DARI
KEDUA GINJAL
 NILAI NORMAL
LAKI-LAKI 125 ml/menit (180 L/24 jam)
PEREMPUAN 110 ml/menit (160 L/24 jam)
 KOMPOSISI FILTRAT GLOMERULUS
- AIR DAN ZAT TERLARUT DENGAN
BERAT MOLEKUL RENDAH
- SEBAGIAN KECIL ALBUMIN PLASMA
GLOMERULUS FILTRATION RATE/
GFR
 DEFINITION
THE AMOUNT OF FORMED FILTRATES
PER MINUTES FROM ALL NEPHRONS OF
BOTH KIDNEYS
 NORMAL VALUE:
MALE: 125 ML/MIN (180 L/ 24 HR)
FEMALE: 110 ML/MIN (160 L/ 24 HR)
 GLOMERULUS FILTRATES COMPOSITION:
- WATER AND SOLUTION WITH LOW
MOLECULE WEIGHT
- SOME OF THE ALBUMIN PLASMA
FAKTOR YANG MEMPENGARUHI
GFR INFLUENCING GFR FACTORS
 KONTRIKSI ARTERIOL AFEREN AKAN
MENURUNKAN ALIRAN DARAH
SEHINGGA GFR TURUN
 KONTRIKSI ARTERIOL EFEREN AKAN
MENINGKATKAN ALIRAN DARAH
SEHINGGA GFR NAIK
 STIMULASI SIMPATIS 
MENYEBABKAN KONTRIKSI ARTERIOL
AFEREN SEHINGGA MENURUNKAN
GFR
 OBSTRUKSI ALIRAN URINARIA AKAN
MENURUNKAN GFR
 BERBAGAI PENYAKIT GINJAL AKAN
MENINGKATKAN PERMEABILITAS
KAPILER GLOMERULAR SEHINGGA
MENINGKATKAN GFR
 THE AFFERENT ARTERIOLE CONSTRICTION
WILL DECREASE THE FLOW OF BLOOD
STREAM UNTIL THE GFR DECREASED
 THE EFFERENT ARTERIOLE CONSTRICTION
WILL INCREASE THE FLOW OF THE BLOOD
STREAM UNTIL THE GFR INCREASE
 SYMPATHETIC STIMULATION CAUSE THE
AFFERENT ARTERIOLE CONSTRICTION UNTIL
GFR DECREASED
 THE OBSTRUCTION OF THE FLOW OF
URINARIA DECREASES GFR
 VARIOUS DISORDERS OF KIDNEY WILL
INCREASE THE CAPILLARY PERMEABILITY OF
GLOMERULAR SO THAT CAN INCREASE GFR
 REABSORPSI TUBULUS / REABSORPTION OF TUBULE
 SELEKTIF MELALUI PROSES :
DIFUSI PASIF GRADIEN KIMIA/LISTRIK
 TRANSPORT AKTIF GRADIEN KIMIA/
LISTRIK
DIFUSI TERFASILITASI
 REABSORPSI ION NATRIUM :
TRANSPORT PASIF DARI LUMEN
TUBULUS KE DALAM SEL EPITEL TUBULUS
TRANSPORT AKTIF DARI SEL EPITEL
TUBULUS KE INTERSTITIAL
 REABSORPSI ION KLOR & ION
NEGATIF
BERDIFUSIPASIF KE DALAM SEL
EPITEL TUBULUS
BERGERAK PASIF MENGIKUTI
PERGERAKAN NATRIUM DARI SEL EPITEL
TUBULUS KE INTERSTITIAL
 SELECTIVE THROUGH THE PROCESS OF:
 PASSIVE DIFUSION OF CHEMICAL
OR ELECTRIC GRADIENT
 ACTIVE TRANSPORT OF CHEMICAL/
ELECTRIC GRADIENT
 FACILITATED DIFUSION
 REABSORPTION OF THE ION OF
NATRIUM
 PASSIVE TRANSPORT FROM THE LUMEN OF
TUBULE INTO THE EPITHELIUM CELL OF
TUBULE
 ACTIVE TRANSPORT FROM EPITHELLIUM
CELL OF TUBULE TO THE INTERSTITIAL
 REABSORPTION OF THE ION OF CHLOR
AND NEGATIVE ION
 PASSIVELY DIFUSED INTO THE EPITHELIAL
CELL OF TUBULE
 MOVE PASSIVELY FOLLOWING THE MOVEMENT
OF NATRIUM FROM EPTHELLIAL CELL OF
TUBULE TO THE INTERSTITIAL
 REABSORPSI GLUKOSA, FRUKTOSA & ASAM
AMINO
 CARIER -NYA BERUPA KOTRANSPOR
 MAKSIMUM TRANSPOR (TM) GLUKOSA :
ADALAH JUMLAH MAKSIMUM GLUKOSA YANG
DAPAT DI TRANSPOR PER MENIT, YAITU
SEKITAR 200 mg GLUKOSA ATAU 100 ml PLASMA
 BILA KADAR GLUKOSA DARAH YG MELEBIHI
NILAI TM (MELEWATI AMBANG PLASMA
GINJAL) MAKA TERJADI GLIKOSURIA
REABSORPSI AIR, UREA DAN ION-ION ORGANIK:
 AIR BERGERAK BERSAMA ION NATRIUM
MELALUI OSMOSIS
 UREA SECARA PASIF DIREABSORPSI AKIBAT
GRADIEN YANG TERBENTUK SAAT AIR
DIREABSORPSI
 ION –ION ORGANIK ( KALIUM, KALSIUM,
FOSFAT dan SULFAT) DIREABSORPSI MELALUI
TRANSPOR AKTIF
 GLUCOSE REABSORPTION, FRUCTOSE, &
AMINO ACID
 ITS CARRIER IS CO-TRANSPORT
 GLUCOSE MAXIMUM TRANSPORT :
IS MAXIMUM AMOUNT OF TRANSPORTABLE
GLUCOSE PER-MINUTE WHICH AROUND 200 mg
GLUCOSE or 100 ml PLASM
 IF THE BLOOD GLUCOSE LEVEL EXCEED THE TM
LEVEL (PASSES THE KIDNEY PLASM
THRESHOLD),THE GLICOSURIA WILL OCCUR
WATER REABSORPTION, UREA, AND ORGANIC
IONS:
 WATER MOVES ALONG WITH NATRIUM IONS
THROUGH OSMOTIC PROCESS
 UREA WILL BE PASSIVELY REABSORPED DUE
TO EXISTING GRADENT DURING WATER RE-
ABSORPTION
 ORGANIC IONS (KALIUM, CALSIUM, PHOSPATE,
AND SULFATE) RE-ABSORPED THROUGH
 ACTIVE ION-TRANSPORT
 SEKRESI TUBULUS / TUBULE SECRETION
 MEKANISME SEKRESI TUBULUS MELALUI
PROSES AKTIF YANG MEMINDAHKAN ZAT
KELUAR DARI DALAM KAPILER
PERITUBULAR MELEWATI SEL-SEL
TUBULUS MENUJU CAIRAN TUBULUS
UNTUK DIKELUARKAN DALAM URINE
 ZAT-ZAT YANG DIKELUARKAN ADALAH ION
HIDROGEN, KALIUM, AMONIUM, PRODUK
AKHIR METABOLIK KREATININ DAN ASAM
HIPURAT, SERTA OBAT-OBAT TERTENTU
SEPERTI PENISILIN
 TUBULE SECRETION MECHANISM
THROUGH ACTIVE PROCESS WHICH
TRANSFER SUBSTANCES OUT FROM
PERITUBULAR CAPILLARY, PASSING
THROUGH TUBULE CELLS, HEADING TO
TUBULE ‘S LIQUID AND BEING THROWN
AWAY IN FORM OF URINE
 EXPELLED SUBSTANCES ARE THE IONS
OF HYDROGEN, POTASSIUM, AMONIUM,
THE FINAL PRODUCT OF CREATININ AND
HIPURIC ACID, ALSO THE CERTAIN
MEDICINES SUCH AS PENICILLIN
 ANSA HENLE
 SISTEM ARUS BOLAK-BALIK GANDA  DOUBLED ALTERNATIVE CURRENT
DALAM ANSA HENLE : SYSTEM INSIDE ANSA HENLE:

 TUBE SHAPE ITS INFLOW WILL BE

 BERBENTUK TUBA SEHINGGA INFLOW
PARALLEL WITH THE OUTFLOW
AKAN PARALEL DENGAN OUTL LOW

 TUNGKAI DESENDEN SANGAT PERMEABEL  DESCENDENT TAIL IS PERMEABLE TO

TERHADAP AIR DAN IMPERMEABEL WATER AND IMPERMEABLE TO Na CL
TERHADAP NaCL

 TUNGKAI ASENDEN IMPERMEABEL  ASCENDENT TAIL IS IMPERMEABLE TO

TERHADAP AIR NAMUN PERMEABEL WATER BUT IT IS PERMEABLE TO NaCL
TERHADAP NaCL
 PEMBENTUKAN URIN PEKAT FORMATION OF CONDENSED
URINE
INSUFISIENSI MASUKAN AIR
INSUFFICIENT WATER INTAKE
PENURUNAN VOL.DARAH PENINGKATAN
TEK.OSMOTIK DRH DECREASING OF INCREASING OF OSMOTIC
BLOOD VOLUME BLOOD PRESSURE
MERANGSANG SEKRESI ADH OLEH HIPOTALAMUS

ADH DIBAWA KE GINJAL STIMULATE ADH SECRETION BY HYPOTHALAMUS

TUB.DISTAL  SEMIPERMEABEL, ADH BROUGHT TO THE KIDNEY

DUKT.KOLIGENTES  PERMEABEL
TERHADAP AIR
DISTALTUBULESEMIPERMEABLE,COLIGENTES
DUCTPERMEABLE TO WATER
AIR MASUK KEMBALI KE DALAM VASKULAR  URIN
SEDIKIT MENGANDUNG AIR  TERBENTUK
URINE PEKAT
WATER GOES BACK TO THE VASCULAR URINE
CONTAINS LESS WATER FORMING URINE
 PEMBENTUKAN URIN
ENCER
MASUKAN AIR YANG BERLEBIHAN
PENINGKATAN VOL.DARAH PENURUNAN
TEKANAN OSMOTIK DRH
MENGHAMBAT SEKRESI ADH OLEH HIPOTALAMUS
RESPON GINJAL TERHADAP PENURUNAN ADH
TUB.DISTAL  MENAHAN AIR, DUKT. KOLIGENTES
 PERMEABEL TERHADAP AIR, SEHINGGA AIR
MASUK KE DALAM DUKT. KOLIGENTES
URIN BANYAK MENGANDUNG AIR  TERBENTUK
URINE ENCER
FORMATION OF THIN URINE
THE OVER INCOME WATER
INCREASING OF BLOOD DECREASING OF OSMOTIC
VOLUME BLOOD PRESSURE
INHIBIT ADH SECRETION BY HYPOTHALAMUS
KIDNEY GIVE THE RESPONSE OF THE DECREASING
ADH
DISTAL TUBULEHOLD THE WATER, COLIGENTES
DUCT. PERMEABLE TO WATER ,SO WATER
ENTER TO THE COLIGENTES DUCT
URINE CONTAINS A LOT OF WATER  FORMING
URINE
 KARAKTERISTIK URINE
 KOMPOSISI URINE :
95% AIR DAN 5% ZAT TERLARUT :
 ZAT BUANGAN NITROGEN (UREA,
ASAM URAT DAN KREATININ)
 ASAM HIPURAT
 BADAN KETON
 ELEKTROLIT
 HORMON / KATABOLIT HORMON
 TOKSIN/ZAT KIMIA ASING, VITAMIN,
ENZIM
 KONSTITUEN ABNORMAL (ALBUMIN,
GLUKOSA, SEL DARAH MERAH, ZAT
KAPUR, BATU GINJAL
 VOLUME URINE PER HARI : 600 – 2500 ml
(1 -2 cc/ kgBB/jam)
 SIFAT FISIK :
 WARNA KUNING PUCAT DANJERNIH
 BAU KHAS URINE ADALAH BAU AMONIA
 PH URINE BERKISAR ANTARA 4,8 – 7,5
 BERAT JENIS URINE BERKISAR ANTARA
1,001 – 1,035
CHARACTERISITIC OF
URINE
COMPOSITION OF URINE
95% WATER AND 5% SOLUTION
WASTED NITROGEN (UREA, URIC ACID,
CREATININ)
 HIPURIC ACID
KETON BODIES
ELECTROLITE
HORMONE/ CATABOLITE HORMONE
TOXIN/ UNIDENTIFIED
CHEMICALS,VITAMIN,ENZYME)
 ABNORMAL CONSTITUENT (ALBUMIN, GLUCOSE,
RED BLOOD CELL, KIDNEY STONES)
URINE VOLUME EACH DAY: 600-2500 ml
PHYSICAL CHARACTERISTIC
PALE YELLOWISH AND CLEAR
SMELLED AS AMONIA
URINE ACIDITY ABOUT Ph 4,8- 7,5
THE MASS INTENSITY OF URINE
BETWEEN 1,001-1,035
 GANGGUAN GINJAL / THE DEFECT OF KIDNEY

 GLOMERULONEFRITIS  GLOMERULONEPHRITIS
INFLAMASI GLOMERULUS AKIBAT INFEKSI GLOMERULUS INFLAMATION CAUSED BY
: INFECTION

AKUT : AKIBAT RESPON IMUN TERHADAP

TOKSIN BAKTERI
TERTENTU (STREPTOKOKUS BETA A)
KRONIK : AKIBAT INFEKSI
STREPTOKOKUS PADA
GLOMERULONEFRITIS AKUT atau
AKIBAT INFEKSI SEKUNDER
SISTEMIK LAIN
 MERUSAK GLOMERULUS dan
TUBULUS
ACUTE: CAUSED BY IMUNITY RESPONSE
OF THE CERTAIN BACTERIAL TOXIN
(STREPTOCOCCUS BETA A)
CHRONIC: CAUSED BY STREPTOCOCCUS
INFECTION ON ACUTE
GLOMERULUSNEPHRITIS OR CAUSED BY
ANOTHER SECONDARY SYSTEMIC
INFECTION
 DAMAGING GLOMERULUS AND
TUBULE
 PIELONEFRITIS
INFLAMASI GINJAL DAN PELVIS
GINJAL AKIBAT INFEKSI atau
OBSTRUKSI TRAKTUS
URINARIUS
 BATU GINJAL
PENGENDAPAN GARAM
KALSIUM, MAGNESIUM, ASAM
URAT ATAU SISTIN
 GAGAL GINJAL : HILANGNYA
FUNGSI GINJAL
 PIELONEFRITIS
INFLAMATION OF KIDNEY AND
KIDNEY’S PELVIS CAUSED BY
THE INFECTION OR THE
OBSTRUCTIVE URINARY TRACT
 KIDNEY STONES
SEDIMENTATION OF CALCIUM,
MAGNESIUM, URIC ACID OR CISTIN
 KIDNEY’S FAILURE
THE LOSS OF KIDNEY’S FUNCTION
 GAGAL GINJAL
1. GAGAL GINJAL AKUT
HAMPIR SELURUH KERJA GINJAL TIBA-
TIBA BERHENTI TETAPI KEMUDIAN
MEMBAIK MENDEKATI FUNGSI NORMAL
PENYEBAB UTAMA
 PRERENAL : AKIBAT PENURUNAN ALIRAN
DARAH KE GINJAL SECARA TIBA-TIBA,
DITANDAI OLEH OLIGURIA MENDADAK
SAMPAI ANURIA
 INTRARENAL : TERJADI AKIBAT
KELAINAN DIDALAM GINJAL
 POSTRENAL : TERJADI AKIBAT ADANYA
SUMBATAN PADA SISTEM PENGUMPUL
URIN

KIDNEY FAILURE
1. ACUTE KIDNEY’S FAILURE
MOST OF THE WORKING KIDNEY
SUDDENLY STOPPED BUT THEN IT’S
GETTING BETTER AND CLOSER TO THE
NORMAL FUNCTION
MAIN CAUSES
 PRERENAL : IN RESULT OF THE DECREASING
BLOOD STREAM TO THE KIDNEY AT THE
SUDDEN , CHARACTERIZED BY ACUTE OLIGURIA
AND MIGHT BE ANURIA
 INTRARENAL :OCCUR BY THE DEFECT INSIDE
THE KIDNEY
 POSTRENAL: OCCUR BY THE PLUG IN THE
SYSTEM OF URINE COLLECTOR
2. GAGAL GINJAL KRONIK
GANGGUAN KERUSAKAN PARENKIM GINJAL
YANG PROGRESIF DAN SECARA BERTAHAP
MENURUNKAN SELURUH FUNGSI GINJAL
PENYEBAB UTAMA
 GLOMERULONEFRITIS GANGGUAN IMUNOLOGIS
 GANGGUAN METABOLIK (DIABETES MELITUS)
 GANGGUAN PEMBULUH DARAH GINJAL
(NEFROSKLEROSIS)
 INFEKSI (PIELONEFRITIS)
 GANGGUAN TUBULUS PRIMER (NEFROTOKSIN)
 OBSTRUKSI TRAKTUS URINARIUS (HIPERTROFI
PROSTAT)
 KELAINAN KONGENITAL (POLIKISTIK)
2. CHRONIC KIDNEY FAILURE
THE DISORDERS IN THE PROGRESSIVE DAMAGE
OF KIDNEY’S PARENCHYME AND GRADUALLY
DECREASE ALL OF THE KIDNEY’S FUNCTION
MAIN CAUSES
 GLOMERULONEFRITIS DEFECT OF IMMUNOLOGIC
 DEFECT OF METABOLISM (DIABETES MELITUS)
 DEFECT OF KIDNEY’S BLOOD VESSELS
(NEFROSCLEROSIS)
 INFECTION (PIELONEFRITIS)
 DEFECT OF PRIMARY TUBULE ( NEFROTOXIN)
 DAMAGED URINARY TRACT (HYPERTROPHYPROSTAT)
 CONGENITAL DISORDERS (POLYCYSTIC)