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URINARY SYSTEM

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Urinary system rids the body of

waste materials and control the

volume and composition ofbody fluids

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un!si "in#al

$% E&s&resi'(embentu&an Urine

Mempertahan&an homeostasis

Men!atur osmolalitas E) Men!atur volume E)

Men!atur p* E)

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+% Endo&rin'*ormon ,Non E&s&resi-

Men!hasil&an renin men!atur T.

Men!hasil&an erythropoeitin  stimulasi

eritropoeisis oleh sumsum tulan!

Men!a&tif&an vitamin . den!an

men!hasil&an $/ +01dihydro2ycholecalciferolabsorbsi )a dalam usus dipermudah

Men!hasil&an prosta!landin

Men!hasil&an 

3inin

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Internal structure of the &idney

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Blood supply of the kidney4

+$5 of the cardiac output 6$+77 ml'mnt

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Nephron

Merupa&an unit fun!sional !in#al

$ !in#al terdapat 8 $/+ #uta nephron

9erdasar&an lo&asi dibeda&an atas + yicortical dan #u2tamedullary nephron

Stru&tur nephron terba!i atas 4"lomerulus dan/

Tubulus renalis: tubulus pro2imal/ loop of*enle ; tubulus distal serta collectin!duct

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Arcuate artery

Arcuate vein

Thin ascending limbof the loop of Henlé

Thick ascending limbof the loop of Henlé

Distal convoluted tubule

Proximal convolutedtubule

Collecting duct

Descending limbloop of Henlé

Vascular supply to the nephronVascular supply to the nephron

Vasa recta

lomerulus Afferent arteriole!fferent arteriole

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)ortical ; <u2tamedullary

nephronCortical Nephron

"lomerulus terleta& +'=

ba!ian luar corte2

>05 dari seluruhnephron

?oop of henle pende&

.i&elilin!i oleh &apiler

peritubular berbentu& #ala

 network

Juxtamedullary Nephron

Terleta& ba!ian dalam

corte2 de&at medulla

$05 dari seluruhnephron

?oop of henle pan#an!/

lebih dalam masu& &e

medulla

.i&elilin!i &apilerberbentu& U  vasa

recta

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Proximal

convoluted

tubule

Capsule

space

!fferent arteriole

Pedicel

Podocyte

!ndothelium

of glomerulus

Afferent arteriole

"uxtaglomerular 

cell

Parietal layer of

glomerular capsule

Structure of the Bowman’s (glomerular) capsule

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Stellate cells called mesangial cells are

located between the basal lamina and

the endothelium% They are similar to cellscalled pericytes, which are found in the

walls of capillaries elsewhere in the

body%

Mesan!ial cells are especially common

between two nei!hborin! capillaries/ and

in these locations the basal membrane

forms a sheath shared by bothcapillaries ,i!ure =>@+-%

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The mesan!ial cells arecontractile and play a role in the

re!ulation of !lomerular

filtration%

Mesan!ial cells secrete the

e2tracellular matri2/ ta&e up

immune comple2es/ and are

involved in the pro!ression of!lomerular disease%

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ormation of Urine

Involves three main processes4

$%iltration

+%Reabsorption

=%Secretion

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iltration membrane

Is composed of three layers4

$%fenestrated !lomerular endothelium

+%basement membrane=%filtration slits are formed by the pedicelsof the podocytes

Substance are filtered are on the basis ofsie and'or electrical properties

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"lomerular iltration Membrane 

Insert fg. 17.8

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"lomerular iltration Membrane

Endothelial capillary pores are lar!efenestrae%

$771B77 times more permeable toplasma/ *+7/ and dissolved solutes thancapillaries of s&eletal muscles%

(ores are small enou!h to prevent

RBCs, platelets, and WBCs frompassin! throu!h the pores%

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"lomerular iltration Membrane

iltrate must pass throu!h the basementmembrane4 Thin !lycoprotein layer%

Ne!atively char!ed%

(odocytes4 oot pedicels form small filtration slits%

(assa!eway throu!h which filtered molecules must pass%

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The filtration barrier - podocytes

fenestratedendothelium

fenestratedendothelium

 primary process

 podocytecell bodysecondary

 process

( pedicel)

filtrationslit

 basallamina

 podocyte

 pedicel filtrationfiltrationslitslit

basallamina

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The filtration barrier - pedicels

#o$man%sspace

capillary

pedicel

filtration

slit

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)ommon component of the !lomerular

filtrate4

Organic molecules4 !lucose/amino

acids

Nitrogenous waste4 urea/ uric acid/

creatinine ons4 sodium/ potassium/ chloride

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Rumus te&anan filtrasi

3f/ the !lomerular ultrafiltration coefficient/ isthe product of the !lomerular capillary wall

hydraulic conductivity ,ie/ its permeability-

and the effective filtration surface area%

(") is the mean hydrostatic pressure in the

!lomerular capillaries/ (T the mean

hydrostatic pressure in the tubule

,9owmanCs space-/ D") the oncotic pressureof the plasma in the !lomerular capillaries/

and DT the oncotic pressure of the filtrate in

the tubule ,9owmanCs space-%

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orces affectin! filtration

"lomerular hydrostatic pressure ,bloodpressure- promotes filtration600 mm*!

)apsular hydrostatic pressure opposes

filtration6$0 mm*!

"lomerular osmotic pressure opposes

filtration6=7 mm*!

Net filtration pressure 6

00 @ ,$0=7- 6$7 mm*!

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A&A '()(* &A+ T!,-(#AT DA-A. '(-T,A)(

-/.!,0-0)

12 Tekanan darah kapiler

gomerulus 3PC4 5 66 mmHg

72 Tekanan osmotik koloid

 plasma 3(()4 5 89 mmHg

82 Tekanan hidrostatik kapsul

#o$man 3P#C4 5 16 mmHg

Tekanan filtrasi netto :

5 PC ; 3(() ; P#C4

5 66 < 389=164

5 19 mmHg

PG

PB

 GS

PP!

 ! 

Aff. Art. Eff. Art.

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"lomerular filtration rate

The total amount of filtrate formed by the &idney perminutes

Se&itar +75 dari renal plasma flow

Nilai "R ditentu&an oleh4

,$- &eseimban!an antara te&anan hidrostatis danosmoti&

,+- filtration coefficient &apiler ,3f- yaitupermeabilitas dan area permu&aan filtrasi

"R normal $+0 ml'min/ atau $>7 ?'day%

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 Autore!ulation Mechanism

To counteract chan!es in "R

 Myo!enic mechanism

Increased systemic pressure4 Autore!ulation4

afferent arteriole diameter decreased ,constricted-to maintain the "R

.ecreased systemic pressure4 Autore!ulation4

afferent arteriole diameter increased ,dilated- tomaintain the "R

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Fualities of a!ents to measure "R

nulin! "#olysaccharide from $ahalia plant%

reely filterable at !lomerulus .oes not bind to plasma proteins

9iolo!ically inert

Non1to2ic/ neither synthesied nor metaboliedin &idney

Neither absorbed nor secreted

.oes not alter renal function

)an be accurately Guantified ?ow concentrations are enou!h ,$71+7 m!'$77 ml plasma-

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Creatinine! End product of muscle creatine metabolism

Used in clinical settin! to measure "R but lessaccurate than inulin method

Small amount secrete from the tubule

#ara&aminohippurate "#'(%! 

 An or!anic anion not present in body reely filtered/ secreted but not reabsorbed by

nephron

Non1to2ic/ neither synthesied nor metabolied

in &idney ?ow concentrations are enou!h ,$7 m!'$77 ml plasma-

R( 6 )learance(A*6 U(A*%H ' ((A*

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Solute )learance4

 Rate of removal from the 9lood

'igure 1><1?: (nulin clearance

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)oncept of clearance

@hereCx 5 Clearance of substance B 3mgmin4

"x 5 0rine concentration of B 3mgml4

Px 5 Plasma concentration of B 3mgml4

V 5 0rine flo$ rate of B 3mlmin4G#$  5 x  5

Px

"x 2 V

F2 e2tracted 6 F2 e2creted

  (2 % )2 6 U2 % H

Effective renal plasma flow 6"R

%$B# 5 x  5& - 'ct

%$P#

Renal blood flow 6$B# 5

%traction ratio

%$B#

Effective renal blood flow 6

E2traction ratio ,7%- 6P'

P' - VP'

Hct5hematocrit

VPAH 5 vein plasma PAH

APAH 5 arterial plasma PAH

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)('N* +O)('N* +O