ginjal bilingual
TRANSCRIPT
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GINJAL/ KIDNEY
Tuty S. Richata, drg., MS., AIFM.
References :References :
Tortora : Principles of Anatomy & Physiology, 10Tortora : Principles of Anatomy & Physiology, 10thth
Edition, 2003Edition, 2003Gyton &!all : "isiologi #edo$teran, Edisi %, 1%%Gyton &!all : "isiologi #edo$teran, Edisi %, 1%%Ethel 'loane : Anatomi dan "isiologi, Edisi 1, 200(Ethel 'loane : Anatomi dan "isiologi, Edisi 1, 200()*" Ganong : "isiologi #edo$teran, Edisi 10, 1%+3)*" Ganong : "isiologi #edo$teran, Edisi 10, 1%+3
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GINJAL/ KIDNEY
MERUPAKAN BAGIAN TERPENTINGMERUPAKAN BAGIAN TERPENTING
DARI SISTEM URINARIADARI SISTEM URINARIA
SISTEM URINARIA TERDIRI DARISISTEM URINARIA TERDIRI DARI :: - 2 BUA GIN!A"- 2 BUA GIN!A"
- 2 BUA URETER- 2 BUA URETER
- # BUA KANDUNG KEMI- # BUA KANDUNG KEMI
- # BUA URETRA- # BUA URETRA
SISTEM INI MERUPAKAN SA"A SATUSISTEM INI MERUPAKAN SA"A SATUSISTEM UTAMA UNTUK MEMPERTAANKANSISTEM UTAMA UNTUK MEMPERTAANKAN
$ME$STATIS TUBU$ME$STATIS TUBU
AN IMP$RTANT PART $F URINAR%AN IMP$RTANT PART $F URINAR%S%STEMS%STEM
URINAR% S%STEM &$NSISTSURINAR% S%STEM &$NSISTS
$F:$F: 2 KIDNE%S2 KIDNE%S
2 URETERS2 URETERS
# B"ADDER# B"ADDER
# URETRA# URETRA
TIS S%STEM IS $NE $F TE MAINTIS S%STEM IS $NE $F TE MAIN
S%STEM T$ REGU"ATE B$D%'SS%STEM T$ REGU"ATE B$D%'S
$ME$STATI&$ME$STATI&
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GAMBAR SISTEM URINARIA
URINARY SYSTEM
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STRUKTUR GINJAL
THE STRUCTURE OF KIDNEY
"$KASI"$KASI
TER"ETAK RETR$PERIT$NEA"TER"ETAK RETR$PERIT$NEA"
SETINGGI (ERTEBRA T$RAKA" #2 -SETINGGI (ERTEBRA T$RAKA" #2 -
"UMBA" #"UMBA" #
STRUKTUR EKSTERNA" : BERBENTUK SEPERTI KA&ANG MERA
BERUKURAN #2,) * 2,) c+
MEMI"IKI BERAT SEKITAR #2) #) gr
PRIA/ DAN ##) #)) gr 0ANITA/ MEMI"IKI !ARINGAN IKAT
PEMBUNGKUS %ANG TERDIRI DARI
FASIA RENA"IS, "EMAK PERIRENA"
DAN KAPSU" FIBR$SA
LOCATION LOCATION IN RETROPERITONEAL ASIN RETROPERITONEAL AS
THORACIC 12- LUMBAR VERTEBRAETHORACIC 12- LUMBAR VERTEBRAE
11
EXTERNAL STRUCTURE RED BEAN LOOK ALIKE
ITS SIZE: 12,5X2,5 CM
ITS WEIGHT : ABOUT 125-175 GR (MALE
AND 115-155 GR (!EMALE
- IT IS COVERED B" CONNECTIVE
TISSUE WHICH CONSISTS O! RENAL
!ASCIA,PERIRENAL !AT, AND !IBROUS
CAPSULE
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STRUKTUR INTERNA" 1STRUKTUR INTERNA" 1 INTERNAL STRUCTURE INTERNAL STRUCTURE
I"US : PUSAT KE&EKUNGANTEPI MEDIA" GIN!A"
SINUS GIN!A" : R$NGGAUNTUK !A"AN MASUK URETER,
(ENA DAN ARTERI RENA"IS PE"(IS GIN!A" : MUARA DARI
KA"IKS MA%$R DAN KA"IKS
MIN$R
PARENKIM GIN!A" :
MEDU"A, TERSUSUN ATAS
PIRAMIDA DAN PAPI"A GIN!A"
K$RTEKS, TERSUSUN ATAS
NEFR$N
HILUS: THE CENTER O! KIDNE"MEDIAL ELLIPTICAL SIDE
KIDNE" SINUS: ENTR"VESTIBULE !OR URETHRA, VEIN
AND ARTER" RENAL
KIDNE" PELVIS: THE MIDPOINTMA"OR CAL"X AND MINOR
CAL"X
K#IDNE" PARENCH"M:MEDULLA, CONSIST O!
P"RAMID AND KIDNE" PAPILLA
CORTEX, CONSIST O! NEPHRON
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FUNGSI GINJAL KIDNEY FUNCTION
FUNGSI UTAMAFUNGSI UTAMA #. MEMBUANG AT-AT SAMPA#. MEMBUANG AT-AT SAMPA
TUBU DARI ASI" PR$SESTUBU DARI ASI" PR$SES
PEN&ERNAAN DAN METAB$"ISMEPEN&ERNAAN DAN METAB$"ISME
2. PENGATURAN ($"UME DAN2. PENGATURAN ($"UME DAN
K$MP$SISI &AIRAN TUBUK$MP$SISI &AIRAN TUBU
TU!UANTU!UAN :: UNTUK MEME"IARA KESTABI"AN "INGKUNGANUNTUK MEME"IARA KESTABI"AN "INGKUNGAN
SE"-SE" %ANG DIPER"UKAN UNTUK ME"AKUKANSE"-SE" %ANG DIPER"UKAN UNTUK ME"AKUKANBERBAGAI MA&AM AKTI(ITASBERBAGAI MA&AM AKTI(ITAS
DENGAN &ARA
MEN%ARING P"ASMA MEMISAKAN AT-AT %ANGTIDAK DIBUTUKAN DARI FI"TRATMENGEKSKRESIKAN DA"AM URIN/ AT %ANG
DIBUTUKAN AKAN DIKEMBA"IKAN KE DA"AM DARA
MAIN UTILTIES :MAIN UTILTIES :
11$ TO REMOVE THE ORGANIC BOD"WASTE , EXCESS !ROM DIGESTION
AND METABOLISM PROCESS$ 2$ TO COMPOSE BOD"%S !LUID VOLUME
AND COMPOSITION
OB&ECTIVES:OB&ECTIVES:TO MAINTAIN THE ENVIRONMENTAL CELLSTO MAINTAIN THE ENVIRONMENTAL CELLS
STABILIT" WHICH ARE ESSENTIAL TO DOSTABILIT" WHICH ARE ESSENTIAL TO DO
VARIOUS ACTIVITIESVARIOUS ACTIVITIES
HOW IT WORKS:
PLASMA !ILTERING SEPARATING THE
UNNECESSAR" SUBSTANCES !ROM THE
!ILTRAT INITIATING URINAL EXCRETION
THE NECESSAR" SUBSTANCE WILL BE
RETURNED TO THE BLOOD !LOW
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BERBAGAI FUNGSI "AIN OTHER UTILITIES
PENGATURAN KESEIMBANGAN AIR DAN
E"EKTR$"IT
PENGATURAN K$NSENTRASI
$SM$"A"ITAS &AIRAN TUBU 3
K$NSENTRASI E"EKTR$"IT
PENGATURAN KESEIMBANGAN ASAM
BASA PENGATURAN TEKANAN DARA
PENGENDA"IAN TERBATAS TERADAP
K$NSENTRASI G"UK$SA DAN ASAM
AMIN$ DARA
BALANCING THE WATER AND
ELECTROLITES$
SETTING UP THE BOD" !LUIDS
OSMOLALIT" CONCENTRATION
ELECTROLITES CONCENTRATION
BALANCING ACID AND BASE LEVEL
SETTING UP THE BLOOD PRESSURE
LIMITED CONTROL TO GLUCOSE AND
AMINO ACID BLOOD
CONCENTRATION
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NEFRON / NEPHRON
UNIT STRUKTURA" DAN FUNGSI$NA" GIN!A"
!UM"AN%A : 4 # !UTA UNIT 1 GIN!A"
TERDIRI DARI : G"$MERU"US
TUBU"US PR$KSIMA" ANSA EN"E TUBU"US DISTA" DUKTUS K$"IGENTES 1PENGUMPU"
2 !ENIS NEFR$N :
NEFR$N K$RTIKA" NEFR$N !UKSTAMEDU"AR
KIDNE"%S STRUCTURAL AND !UNCTIONAL
UNITS
AMOUNT: : ' 1 MILLION UNITS KIDNE"
CONSISTS O!:
GLOMERULUS PROXIMAL TUBULES
LOOP O! HENLE
DISTAL TUBULE
COLIGENTESCOLLECTING
DUCT
2 T"PES NEPHRON
CORTICAL NEPHRON
&UXTAMEDULLAR NEPHRON
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GLOMERULUS
GU"UNGAN KAPI"ER 4 )5 KAPI"AR/ %ANG
DIKE"I"INGI KAPSU" EPITE" KAPSU"
B$0MAN/ MEMBENTUK K$RPUSKE" GIN!A"
K$RPUSKE" GIN!A" TERDIRI DARI :
"APISAN (IS&ERA" MENGANDUNG SE"-SE"
P$D$SIT, PEDIKE", DAN BARIER FI"TRASI
G"$MERU"US/ "APISAN PARIETA" ,TERDIRI DARI :
- KUTUB (ASKU"AR : TEMPAT
ARTERI$" AFEREN 3 EFEREN
KE"UAR MASUK G"$MERU"US
- KUTUB URINARIUS : TEMPAT
FI"TRASI G"$MERU"USMENU!U TUBU"US PR$KSIMA"
THE CAPILLAR" ROOLS (' 5) C*+#*.
CHICH ARE SUROUNDED B" EPITHELIAL
CAPSULES AND !ORMING KIDNE"
CORPUSCLE$
KIDNE" CORPUSCLE CONSIST O!
VISCERAL LA"ER (CONSISTING PODOSITCELLS, PEDICELLS, AND BARRIER
GLOMERULUS !ILTRATION
PARIETAL LA"ER CONSISTO! :
- VASCULAR POLE :THE PASSAGE ON
GLOMERULUS WHERE A!!ERENT
ARTERIOL AND E!!ERENT ARTERIOL GOES IN AND OUT
- URINARIUS POLE : THE PASSAGE
ON GLOMERULUS !ILTRATION
THROUGH TO PROXIMAL TUBULUS
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TUBULUS / TUBULES
TUBU"US PR$KSIMA",
PAN!ANGN%A #) ++ DAN BER"IKU
ANSA EN"E, TERDIRI DARITUNGKAI DESENDEN DAN ASENDEN
TUBU"US DISTA" SEPAN!ANG)++, TERDIRI DARI MA&U"ADENSA, SE"!UKSTAG"$MERU"AR, DAN SE"MESANGIUM
DUKTUS K$"IGENTESMENGA"IRKAN URINE KE DA"AMKA"IKS MIN$R
PROXIMAL TUBULE,
15 //-LONG *0 CURVE-SHAPED$
LOOP O! HENLE , CONSIST O!DESCENDENT AND ASCENDENT TAIL
DISTAL TUBULE, 5 //- LONG *0
CONSIST O! MACULA DENSA,
&UXTAGLOMERULAR CELLS AND
MESANGIUM CELLS
DUCTUS COLIGENTES !LOWS THEURINE INTO MINOR CAL"X
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VASKULARISASI GINJAL /
KIDNEY VASCULARISATION
ARTERI RENA"IS ARTERI INTER"$BARIS
ARTERI ARKUATA ARTERI INTER"$BU"ARIS
ARTERI$" AFEREN G"$MERU"USARTERI$" EFEREN KAPI"ER PERITUBU"AR
(ENA INTER"$BU"ARIS (ENA ARKUATA
(ENA INTER"$BARIS (ENA RENA"IS
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SISTEM SARAF GINJAL /
KIDNEY NERVES SYSTEM
PERSARAFAN PADA GIN!A"
BERASA" DARI GANG"I$N &E"IA&
%ANG MEMBENTUK P"EKSUS
RENA"IS DAN MASUK KE DA"AM
GIN!A" BERSAMA-SAMA DENGAN
ARTERI RENA"IS
BERASA" DARI SISTEM SARAF $T$N$M
%ANG BERSIFAT SIMPATIS
BERPERAN DA"AM REGU"ASI
A"IRAN DARA GIN!A" ME"A"UI
PR$SES (AS$K$NSTRIKSI DAN
(AS$DI"ATASI ARTERI$" GIN!A"
KIDNE" NERVES S"STEM COMES
!ROM CELIAC GANGLION WHICH
!ORMS PLEXUS RENALIS AND ENTER
THE KIDNE" ALONG WITH RENAL
ARTER"
COMES !ROM S"MPATHIZED
AUTONOMIC NERVE S"STEM
HAS A ROLE IN KIDNE"BLOODSTREAM REGULATIONTHROUGH VASOCONSTRICTION AND
VASODILATATION PROCESS O! THE
KIDNE" ARTERIOLE
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SISTEM HORMONAL GINJAL
KIDNEY HORMONAL SYSTEM
ANTIDIURETI& $RM$NE AD/ :
BERFUNGSI UNTUK MENINGKATKANPERMEABI"ITAS TUBU"US DISTA" DANTUBU"US PENGUMPU" TERADAP AIR
DISINTESIS $"E BADAN SE" SARAF DIIP$TA"AMUS DAN DISIMPAN DA"AMSERABUT SARAF IP$FISIS P$STERI$R
$RM$N A"D$STER$N :
MERUPAKAN $RM$N STER$ID DISEKRESI $"E SE"-SE" K$RTEKS
KE"EN!AR ADRENA" BEKER!A PADA TUBU"US DISTA" DAN
PENGUMPU" UNTUK MENINGKATKANABS$RPSI AKTIF I$N NATRIUM DANSEKRESI AKTIF I$N KA"IUM
ANTIDIURETIC HORMONE (ADH : TO INCREASE DISTAL TUBULE DAN
COLLECTING TUBULE PERMEABILIT"
AGAINST WATER
S"NTHESIZED B" NERVES CELLS BOD" IN
H"POTHALAMUS AND RESTORED INSIDEPOSTERIOR H"POPH"SIS NERVES SET
ALDOSTERON HORMONE:
CLASSI!IED AS STEROID HORMONE
PRODUCED B" CORTEX CELLS ADRENAL
GLAND WORKS ON DISTAL AND COLLECTING
TUBULE TO INCREASE THE SODIUM IONS
ACTIVE ABSORPTION AND KALIUM ION
ACTIVE SECRETION$
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EFEK ALDOSTERON TERHADAP
NATRIUM DARAH
PADA SAAT K$NSENTRASI NATRIUM DARATURUN
RESEPT$R GIN!A" MENDETEKSI
PENURUNAN INI
MERANGSANG APARATUS !U*TA-G"$MERU"AR ME"EPASKAN RENIN
%ANG KEMUDIAN DI DA"AM DARA DIUBAMEN!ADI ANGI$TENSIN
ANGI$TENSIN BEKER!A PADA K$RTEKSADRENA" DAN MENSEKRESI
A"D$STER$N
PENINGKATAN ABS$RPSI NATRIUM DITUBU"US KEDA"AM A"IRAN DARA
THE EFFECT OF ALDOSTERON TO
NATRIUM OF BLOOD
WHEN THE CONECENTRATION O! NATRIUM O!BLOOD DECREASED
KIDNE" RECEPTOR DETECTS THIS REDUCTION
STIMULATE THE &UXTAGLOMERULAR
APARATUS TO RELEASE RENIN
WHICH NEXT IN BLOOD WILL BE CHANGED TO
BE ANGIOTENSIN
ANGIONTENSIN WORKS IN ADRENAL CORTEX
AND SECRETE ALDOSTERON
INCREASING O! NATRIUM ABSORPTION IN
DISTAL TUBULE IN BLOOD STREAM
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PEMBENTUKAN URIN / URINE FORMING
TIGA PR$SES UTAMA PEMBENTUKAN
URIN, %AITU :
FI"TRASI G"$MERU"US
REABS$RPSI TUBU"US
SEKRESI TUBU"US
THREE MAIN PROCESSES TO !ORM
URINE:
!ILTRATION O! GLOMERULUS
REABSORPTION O! TUBULE
SECRETION O! TUBULE
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FILTRASI GLOMERULUS GLOMERULUS FILTRATION
DEFINISI
PERP-./A!A. A-RA. /A. ATTERART /AR- #AP-ER
G45ER', /AA5 T-.G#ATA.
TE#A.A. TERTE.T #E /AA5#AP' 64)5A.
FAKT$R %ANG MEMBANTU :
5E56RA. #AP-ER
G45ER' "EBI PER5EA6E
TE#A.A. /ARA! /AA5 #AP-ER
G45ER' E6-! T-.GG-
DEFINITION
THE MOVEMENT OF FLUID ANDCOMPOUNDS FROM GLOMERULUS
CAPILLARY, ON CERTAIN GRADIENT
PRESSURE INTO THE BOWMANCAPSULE
FACTORS WHICH CONTRIBUTE:FACTORS WHICH CONTRIBUTE:
GLOMERULUS CAPILLARY GLOMERULUS CAPILLARY
MEMBRANE IS MORE PERMEABLE MEMBRANE IS MORE PERMEABLE
BLOOD PRESSURE INBLOOD PRESSURE IN
GLOMERULUS GLOMERULUS
CAPILLARY IS HIGHERCAPILLARY IS HIGHER
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/MEKANISME
FILTRASI GLOMERULUS
TEKANAN IDR$STATIK DARA/
G"$MERU"US MEND$R$NG &AIRAN DANAT TER"ARUT KE RUANG KAPSU"B$0MAN
TEKANAN IDR$STATIK KAPSU"ARMEND$R$NG &AIRAN DARI KAPSU"MENU!U G"$MERU"US DAN TEKANAN
$SM$TIK K$"$ID G"$MERU"US MENARIK&AIRAN DARI KAPSU" B$0MAN MEMASUKIG"$MERUS
TEKANAN FI"TRASI EFEKTIF EFP/ 6TEKANAN IDR$STATIK G"$MERU"US TEKANAN KAPSU"AR 4 TEKANAN $SM$TIKK$"$ID G"$MERU"US/E!P 55 3 ( 15 ' 4) //H 1) //H
GLOMERULUS FILTRATION
MECHANISM
GLOMERULUS H"DROSTATIC (BLO)D PRESSURE
PUSHES THE !LUID AND COMPOUND INTO THE
BOWMAN CAPSULE CHAMBER
CAPSULLAR H"DROSTATIC PRESSURE PUSHES THE
!LUID !ROM CAPSULE INTO THE GLOMERULUS
AND OSMOTIC PRESSURE O! THE COLOID
GLOMERULUS EXTRACTING THE !LUID !ROMBOWMAN CAPSULE INTO ENTERING GLOMERULUS
E!!ECTIVE !ILTRATION PRESSURE 6EFPGLOMERULUS H"DROSTATIC PRESSURE 3
(CAPSULAR PRESSURE ' OSMOTICPRESSURE O! GLOMERULUS COLOID
E!P 55 3 ( 15 ' 4) //H 1) //H
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"A!U FI"TRASI G"$MERU"US GLOMERULUS !ILTRATION RATE
G!R
DEFINISI !UM"A FI"TRAT %ANG TERBENTUK PERMENIT $"E SEMUA NEFR$N DARI
KEDUA GIN!A"
NI"AI N$RMA""AKI-"AKI #2) +71+89it #5 "12;
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FAKT$R %ANG MEMPENGARUI
G!R IN!LUENCING G!R !ACTORS
K$NTRIKSI ARTERI$" AFEREN AKANMENURUNKAN A"IRAN DARASEINGGA GFR TURUN
K$NTRIKSI ARTERI$" EFEREN AKANK$NTRIKSI ARTERI$" EFEREN AKANMENINGKATKAN A"IRAN DARAMENINGKATKAN A"IRAN DARASEINGGA GFR NAIKSEINGGA GFR NAIK
STIMU"ASI SIMPATISSTIMU"ASI SIMPATISMEN%EBABKAN K$NTRIKSIMEN%EBABKAN K$NTRIKSIARTERI$" AFEREN SEINGGAARTERI$" AFEREN SEINGGAMENURUNKAN GFRMENURUNKAN GFR
$BSTRUKSI A"IRAN URINARIA AKANMENURUNKAN GFR
BERBAGAI PEN%AKIT GIN!A" AKANMENINGKATKAN PERMEABI"ITASKAPI"ER G"$MERU"AR SEINGGAMENINGKATKAN GFR
THE AFFERENT ARTERIOLE CONSTRICTION
WILL DECREASE THE FLOW OF BLOOD
STREAM UNTIL THE GFR DECREASED
THE EFFERENT ARTERIOLE CONSTRICTIONTHE EFFERENT ARTERIOLE CONSTRICTION
WILL INCREASE THE FLOW OF THE BLOODWILL INCREASE THE FLOW OF THE BLOOD
STREAM UNTIL THE GFR INCREASE STREAM UNTIL THE GFR INCREASE
SYMPATHETIC STIMULATIONSYMPATHETIC STIMULATION CAUSE THECAUSE THE
AFFERENT ARTERIOLE CONSTRICTION UNTIL AFFERENT ARTERIOLE CONSTRICTION UNTIL
GFR DECREASEDGFR 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
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REABS$RPSI TUBU"US 1 REABSORPTION O! TUBULE
SELEKTIF MELALUI PROSES :
DIFUSI PASIF GRADIEN KIMIA/LISTRIK
TRANSPORT AKTIF GRADIEN KIMIA/
LISTRIK
DIFUSI TERFASILITASI
REABSORPSI ION NATRIUM :
TRANSPORT PASIF DARI LUMEN
TUBULUS KE DALAM SEL EPITEL TUBULUS
TRANSPORT AKTIF DARI SEL EPITEL
TUBULUS KE INTERSTITIAL
REABSORPSI ION KLOR & ION
NEGATIF
BERDIFUSI PASIF KE DALAM SEL
EPITEL TUBULUS
BERGERAK PASIF MENGIKUTI
PERGERAKAN NATRIUM DARI SEL EPITEL
TUBULUS KE INTERSTITIAL
SELECTIVE THROUGH THE PROCESS OF:
PASSIVE DIFUSION OF CHEMICAL
OR ELECTRIC GRADIENT
ACTIVE TRANSPORT OF CHEMICAL/
ELECTRIC GRADIENT
FACILITATED DIFUSION
REABSORPTION OF THE ION OF
NATRIUM
PASSIVE TRANSPORT FROM THE LUMEN OF
TUBULE INTO THE EPITHELIUM CELL OF
TUBULE
ACTIVE TRANSPORT FROM EPITHELLIUM
CELL OF TUBULE TO THE INTERSTITIAL
REABSORPTION OF THE ION OF CHLOR
AND NEGATIVE ION
PASSIVELY DIFUSED INTO THE EPITHELIAL CELL
OF TUBULE
MOVE PASSIVELY FOLLOWING THE MOVEMENT
OF NATRIUM FROM EPTHELLIAL CELL OF
TUBULE TO THE INTERSTITIAL
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REABS$RPSI G"UK$SA, FRUKT$SA 3 ASAMREABS$RPSI G"UK$SA, FRUKT$SA 3 ASAM
AMIN$AMIN$ CARIERCARIER -N%A BERUPA K$TRANSP$R-N%A BERUPA K$TRANSP$R
MAKSIMUM TRANSP$R TM/ G"UK$SA :MAKSIMUM TRANSP$R TM/ G"UK$SA :
ADA"A !UM"A MAKSIMUM G"UK$SA %ANGADA"A !UM"A MAKSIMUM G"UK$SA %ANGDAPAT DI TRANSP$R PER MENIT, %AITUDAPAT DI TRANSP$R PER MENIT, %AITU
SEKITAR 255 +g G"UK$SA ATAU #55 +7 P"ASMASEKITAR 255 +g G"UK$SA ATAU #55 +7 P"ASMA
BI"A KADAR G"UK$SA DARA %G ME"EBIIBI"A KADAR G"UK$SA DARA %G ME"EBIINI"AI TM ME"E0ATI AMBANG P"ASMANI"AI TM ME"E0ATI AMBANG P"ASMA
GIN!A"/ MAKA TER!ADI G"IK$SURIAGIN!A"/ MAKA TER!ADI G"IK$SURIA
REABS$RPSI AIR, UREA DAN I$N-I$N $RGANIK: AIR BERGERAK BERSAMA I$N NATRIUM
ME"A"UI $SM$SIS
UREA SE&ARA PASIF DIREABS$RPSI AKIBAT
GRADIEN %ANG TERBENTUK SAAT AIR
DIREABS$RPSI
I$N I$N $RGANIK KA"IUM, KA"SIUM,F$SFAT da9 SU"FAT/ DIREABS$RPSI ME"A"UI
TRANSP$R AKTIF
GLUCOSE REABSORPTION, !RUCTOSE, 9GLUCOSE REABSORPTION, !RUCTOSE, 9
AMINO ACID AMINO ACID ITS CARRIER IS CO-TRANSPORT ITS CARRIER IS CO-TRANSPORT
GLUCOSE MAXIMUM TRANSPORT :GLUCOSE MAXIMUM TRANSPORT :
IS MAXIMUM AMOUNT O! TRANSPORTABLEIS MAXIMUM AMOUNT O! TRANSPORTABLE
GLUCOSE PER-MINUTE WHICH AROUND 2)) /GLUCOSE PER-MINUTE WHICH AROUND 2)) /
GLUCOSE 1)) / PLASM GLUCOSE 1)) / PLASM
I! THE BLOOD GLUCOSE LEVEL EXCEED THEI! THE BLOOD GLUCOSE LEVEL EXCEED THE
TM LEVEL (PASSES THE KIDNE" PLASMTM LEVEL (PASSES THE KIDNE" PLASM
THRESHOLD,THE GLICOSURIA WILL OCCURTHRESHOLD,THE GLICOSURIA WILL OCCUR
WATER REABSORPTION, UREA, AND ORGANIC
IONS: WATER MOVES ALONG WITH NATRIUM IONS
THROUGH OSMOTIC PROCESS
UREA WILL BE PASSIVEL" REABSORPED DUE
TO EXISTING GRADENT DURING WATER RE- ABSORPTION
ORGANIC IONS (KALIUM, CALSIUM, PHOSPATE,
AND SUL!ATE RE-ABSORPED THROUGH
ACTIVE ION-TRANSPORT
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SEKRESI TUBULUS / TUBULE SECRETION
MEKANISME SEKRESI TUBU"US ME"A"UI
PR$SES AKTIF %ANG MEMINDAKAN AT
KE"UAR DARI DA"AM KAPI"ER
PERITUBU"AR ME"E0ATI SE"-SE"
TUBU"US MENU!U &AIRAN TUBU"US
UNTUK DIKE"UARKAN DA"AM URINE
AT-AT %ANG DIKE"UARKAN ADA"A
I$N IDR$GEN, KA"IUM, AM$NIUM,
PR$DUK AKIR METAB$"IK KREATININ
DAN ASAM IPURAT, SERTA $BAT-$BAT
TERTENTU SEPERTI PENISI"IN
TUBULE SECRETION MECHANISM
THROUGH ACTIVE PROCESS WHICH
TRANS!ER SUBSTANCES OUT !ROM
PERITUBULAR CAPILLAR", PASSING
THROUGH TUBULE CELLS, HEADING TO
TUBULE ;S LI
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ANSA HENLE
SISTEM ARUS B$"AK-BA"IK GANDASISTEM ARUS B$"AK-BA"IK GANDA
DA"AM ANSA EN"E :DA"AM ANSA EN"E :
6ER6E.T# T6A 'E!-.GGA -."4)6ER6E.T# T6A 'E!-.GGA -."4)
A#A. PARAE /E.GA. 4T 4)A#A. PARAE /E.GA. 4T 4)
T.G#A- /E'E./E. 'A.GAT PER5EA6ET.G#A- /E'E./E. 'A.GAT PER5EA6E
TER!A/AP A-R /A. -5PER5EA6ETER!A/AP A-R /A. -5PER5EA6E
TER!A/AP .aTER!A/AP .a
T.G#A- A'E./E. -5PER5EA6ET.G#A- A'E./E. -5PER5EA6E
TER!A/AP A-R .A5. PER5EA6ETER!A/AP A-R .A5. PER5EA6ETER!A/AP .aTER!A/AP .a
DOUBLED ALTERNATIVE CURRENTDOUBLED ALTERNATIVE CURRENT
S"STEM INSIDE ANSA HENLE:S"STEM INSIDE ANSA HENLE:
TUBE SHAPE ITS INFLOW WILL BETUBE SHAPE ITS INFLOW WILL BE
PARALLEL WITH THE OUTFLOW PARALLEL WITH THE OUTFLOW
DESCENDENT TAIL IS PERMEABLE TODESCENDENT TAIL IS PERMEABLE TO
WATER AND IMPERMEABLE TO Na CLWATER AND IMPERMEABLE TO Na CL
ASCENDENT TAIL IS IMPERMEABLE TO ASCENDENT TAIL IS IMPERMEABLE TO
WATER BUT IT IS PERMEABLE TO NaCLWATER BUT IT IS PERMEABLE TO NaCL
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PEMBENTUKAN URIN PEKAT FORMATION OF CONDENSED
URINE
INSUFISIENSI MASUKAN AIR
PENURUNAN ($".DARA PENINGKATAN
TEK.$SM$TIK DR
MERANGSANG SEKRESI AD $"E IP$TA"AMUS
AD DIBA0A KE GIN!A"
TUB.DISTA" SEMIPERMEABE",
DUKT.K$"IGENTES PERMEABE"
TERADAP AIR
AIR MASUK KEMBA"I KE DA"AM (ASKU"ARURIN SEDIKIT MENGANDUNG AIR
TERBENTUK URINE PEKAT
INSU!!ICIENT WATER INTAKE
DECREASING O! INCREASING O! OSMOTIC
BLOOD VOLUME BLOOD PRESSURE
STIMULATE ADH SECRETION B" H"POTHALAMUS
ADH BROUGHT TO THE KIDNE"
DISTALTUBULE
SEMIPERMEABLE,COLIGENTES
DUCT
PERMEABLE TO WATER
WATER GOES BACK TO THE VASCULAR
URINE
CONTAINS LESS WATER !ORMING URINE
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PEMBENTUKAN URIN FORMATION OF THIN URINE
ENCER
MASUKAN AIR %ANG BER"EBIAN
PENINGKATAN ($".DARA PENURUNAN
TEKANAN $SM$TIK DR
MENGAMBAT SEKRESI AD $"E IP$TA"AMUS
RESP$N GIN!A" TERADAP PENURUNAN AD
TUB.DISTA" MENAAN AIR, DUKT. K$"IGENTES
PERMEABE" TERADAP AIR, SEINGGA AIR
MASUK KE DA"AM DUKT. K$"IGENTES
URIN BAN%AK MENGANDUNG AIR TERBENTUK
URINE EN&ER
THE OVER INCOME WATER
INCREASING O! BLOOD DECREASING O! OSMOTIC
VOLUME BLOOD PRESSURE
INHIBIT ADH SECRETION B" H"POTHALAMUS
KIDNE" GIVE THE RESPONSE O! THE DECREASING
ADH
DISTAL TUBULE HOLD THE WATER, COLIGENTES
DUCT$ PERMEABLE TO WATER ,SO WATERENTER TO THE COLIGENTES DUCT
URINE CONTAINS A LOT O! WATER !ORMING
URINE
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KARAKTERISTIK URINE CHARACTERISITIC OF
URINE
KOMPOSISI URINE :95% AIR DAN 5% ZAT TERLARUT :
ZAT BUANGAN NITROGEN (UREA,
ASAM URAT DAN KREATININ)ASAM HIPURATBADAN KETONELEKTROLIT
HORMON / KATABOLIT HORMON TOKSIN/ZAT KIMIA ASING, VITAMIN,
ENZIMKONSTITUEN ABNORMAL (ALBUMIN,
GLUKOSA, SEL DARAH MERAH, ZATKAPUR, BATU GINJAL
VOLUME URINE PER HARI : 600 !500 "#
($ ! &&/ 'BB/*")
SI+AT +ISIK :ARNA KUNING PU-AT DAN JERNIHBAU KHAS URINE ADALAH BAU AMONIAPH URINE BERKISAR ANTARA ., ,5BERAT JENIS URINE BERKISAR ANTARA
$,00$ $,015
COMPOSITION OF URINE
95% WATER AND 5% SOLUTION
WASTED NITROGEN (UREA, URIC ACID,
CREATININ) HIPURIC ACIDKETON BODIESELECTROLITEHORMONE/ CATABOLITE HORMONE
TOXIN/ UNIDENTIFIEDCHEMICALS,VITAMIN,EN!ME)
ABNORMAL CONSTITUENT (ALBUMIN,
GLUCOSE, RED BLOOD CELL, KIDNE! STONES)
URINE VOLUME EACH DA!" #$$&5$$ '
PH!SICAL CHARACTERISTIC
PALE !ELLOWISH AND CLEARSMELLED AS AMONIAURINE ACIDIT! ABOUT P *,+ ,5THE MASS INTENSIT! OF URINE
BETWEEN -,$$--,$.5
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GANGGUAN GINJAL / THE DEFECT OF KIDNEY
GLOMERULONE+RITISINF"AMASI G"$MERU"US AKIBAT
INFEKSI :
AKUT : AKIBAT RESP$N IMUNTERADAP T$KSIN BAKTERI
TERTENTU STREPT$K$KUS BETA A/
KR$NIK : AKIBAT INFEKSI
STREPT$K$KUS PADA
G"$MERU"$NEFRITIS AKUT atau
AKIBAT INFEKSI SEKUNDER
SISTEMIK "AIN
MERUSAK G"$MERU"US da9
TUBU"US
GLOMERULONEPHRITIS GLOMERULUS IN!LAMATION CAUSED B"
IN!ECTION
ACUTE: CAUSED B" IMUNIT" RESPONSE
O! THE CERTAIN BACTERIAL TOXIN
(STREPTOCOCCUS BETA A CHRONIC: CAUSED B" STREPTOCOCCUS
IN!ECTION ON ACUTE
GLOMERULUSNEPHRITIS OR CAUSED B"
ANOTHER SECONDAR" S"STEMIC
IN!ECTION
DAMAGING GLOMERULUS ANDTUBULE
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PIELONE+RITISIN+LAMASI GINJAL DAN
PELVIS GINJAL AKIBAT IN+EKSI*2*3 OBSTRUKSI TRAKTUS
URINARIUS
BATU GINJAL PENGENDAPAN GARAM
KALSIUM, MAGNESIUM,
ASAM URAT ATAU SISTIN GAGAL GINJAL : HILANGN4A
+UNGSI GINJAL
PIELONEFRITISINFLAMATION OF KIDNE!
AND KIDNE!S PELVIS
CAUSED B! THE INFECTIONOR THE OBSTRUCTIVEURINAR! TRACT
KIDNE! STONES
SEDIMENTATION OF CALCIUM,MAGNESIUM, URIC ACID OR
CISTIN
KIDNE!S FAILURE THE LOSS OF KIDNE!S FUNCTION
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GAGAL GINJAL KIDNEY FAILURE
#. GAGA" GIN!A" AKUT#. GAGA" GIN!A" AKUT AMPIR SE"URU KER!A GIN!A" TIBA-AMPIR SE"URU KER!A GIN!A" TIBA-
TIBA BERENTI TETAPI KEMUDIANTIBA BERENTI TETAPI KEMUDIAN
MEMBAIK MENDEKATI FUNGSI N$RMA"MEMBAIK MENDEKATI FUNGSI N$RMA"
PEN%EBAB UTAMAPEN%EBAB UTAMA
PRERENA" :PRERENA" : AKIBAT PENURUNAN A"IRANAKIBAT PENURUNAN A"IRANDARA KE GIN!A" SE&ARA TIBA-TIBA,DARA KE GIN!A" SE&ARA TIBA-TIBA,
DITANDAI $"E $"IGURIA MENDADAKDITANDAI $"E $"IGURIA MENDADAK
SAMPAI ANURISAMPAI ANURIAA
INTRARENA"INTRARENA" : TER!ADI AKIBAT: TER!ADI AKIBAT
KE"AINAN DIDA"AM GIN!A"KE"AINAN DIDA"AM GIN!A"
P$STRENA"P$STRENA" : TER!ADI AKIBAT ADAN%A: TER!ADI AKIBAT ADAN%ASUMBATAN PADA SISTEM PENGUMPU"SUMBATAN PADA SISTEM PENGUMPU"
URINURIN
1$ ACUTE KIDNE"%S !AILURE 1$ ACUTE KIDNE"%S !AILURE MOST O! THE WORKING KIDNE"MOST O! THE WORKING KIDNE"
SUDDENL" STOPPED BUT THEN IT%SSUDDENL" STOPPED BUT THEN IT%S
GETTING BETTER AND CLOSER TO THEGETTING BETTER AND CLOSER TO THE
NORMAL !UNCTION NORMAL !UNCTION
MAIN CAUSESMAIN CAUSES
PRERENAL : IN RESULT O! THE DECREASINGPRERENAL : IN RESULT O! THE DECREASINGBLOOD STREAM TO THE KIDNE" AT THEBLOOD STREAM TO THE KIDNE" AT THE
SUDDEN , CHARACTERIZED B" ACUTESUDDEN , CHARACTERIZED B" ACUTE
OLIGURIA AND MIGHT BE ANURIAOLIGURIA AND MIGHT BE ANURIA
INTRARENAL :OCCUR B" THE DE!ECT INSIDEINTRARENAL :OCCUR B" THE DE!ECT INSIDE
THE KIDNE" THE KIDNE"
POSTRENAL: OCCUR B" THE PLUG IN THEPOSTRENAL: OCCUR B" THE PLUG IN THE
S"STEM O! URINE COLLECTORS"STEM O! URINE COLLECTOR
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