k - 5 glomerular function (fisiologi)
TRANSCRIPT
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URINARY SYSTEM
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Urinary system rids the body of waste materials and control the
volume and composition of body fluids
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Fungsi Ginjal
1. Ekskresi/Pembentukan Urine• Mempertahankan homeostasis
– Mengatur osmolalitas ECF– Mengatur volume ECF– Mengatur pH ECF
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2. Endokrin/Hormon (Non Ekskresi)• Menghasilkan renin mengatur TD• Menghasilkan erythropoeitin stimulasi
eritropoeisis oleh sumsum tulang• Mengaktifkan vitamin D dengan menghasilkan 1,
25-dihydroxycholecalciferol absorbsi Ca dalam usus dipermudah
• Menghasilkan prostaglandin• Menghasilkan Kinin
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Internal structure of the kidney
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Blood supply of the kidney: 21% of the cardiac output =
1200 ml/mnt
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Nephron
• Merupakan unit fungsional ginjal• 1 ginjal terdapat ± 1,2 juta nephron• Berdasarkan lokasi dibedakan atas 2 yi cortical
dan juxtamedullary nephron• Struktur nephron terbagi atas : Glomerulus
dan,• Tubulus renalis; tubulus proximal, loop of
Henle & tubulus distal serta collecting duct
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Arcuate artery
Arcuate vein
Thin ascending limb of the loop of Henlé
Thick ascending limb of the loop of Henlé
Distal convoluted tubule
Proximal convoluted tubule
Collecting duct
Descending limb loop of Henlé
Vascular supply to the nephronVascular supply to the nephron
Vasa recta
Glomerulus Afferent arterioleEfferent arteriole
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Cortical & Juxtamedullary nephronCortical Nephron• Glomerulus terletak 2/3 bagian
luar cortex• 85% dari seluruh nephron• Loop of henle pendek
• Dikelilingi oleh kapiler peritubular berbentuk jala network
Juxtamedullary Nephron• Terletak bagian dalam cortex
dekat medulla• 15% dari seluruh nephron• Loop of henle panjang, lebih
dalam masuk ke medulla• Dikelilingi kapiler berbentuk U
vasa recta
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Proximalconvoluted
tubule
Capsulespace
Efferent arteriole
Pedicel
PodocyteEndothelium of glomerulus
Afferent arteriole
Juxtaglomerularcell
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 cells called pericytes, which are found in the walls of capillaries elsewhere in the body.
• Mesangial cells are especially common between two neighboring capillaries, and in these locations the basal membrane forms a sheath shared by both capillaries (Figure 38–2).
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• The mesangial cells are contractile and play a role in the regulation of glomerular filtration.
• Mesangial cells secrete the extracellular matrix, take up immune complexes, and are involved in the progression of glomerular disease.
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Formation of UrineInvolves three main processes: • 1.Filtration• 2.Reabsorption • 3.Secretion
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Filtration membrane
Is composed of three layers: 1.fenestrated glomerular endothelium2.basement membrane3.filtration slits are formed by the pedicels of the podocytes
Substance are filtered are on the basis of size and/or electrical properties
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Glomerular Filtration Membrane
Insert fig. 17.8
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Glomerular Filtration Membrane
• Endothelial capillary pores are large fenestrae.• 100-400 times more permeable to plasma,
H20, and dissolved solutes than capillaries of skeletal muscles.
• Pores are small enough to prevent RBCs, platelets, and WBCs from passing through the pores.
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Glomerular Filtration Membrane
• Filtrate must pass through the basement membrane:– Thin glycoprotein layer.– Negatively charged.
• Podocytes:– Foot pedicels form small filtration slits.– Passageway through which filtered molecules must pass.
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The filtration barrier - podocytes
fenestratedendothelium
fenestratedendothelium
primaryprocess
podocytecell bodysecondary
process(pedicel)
filtrationslit
basallamina
podocyte
pedicel filtration filtration slitslitbasal
lamina
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The filtration barrier - pedicels
Bowman’s space
capillary
pedicel
filtration slit
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Common component of the glomerular filtrate:
• Organic molecules: glucose,amino acids
• Nitrogenous waste: urea, uric acid, creatinine
• Ions: sodium, potassium, chloride
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• Rumus tekanan filtrasi
• Kf, the glomerular ultrafiltration coefficient, is the product of the glomerular capillary wall hydraulic conductivity (ie, its permeability) and the effective filtration surface area.
• PGC is the mean hydrostatic pressure in the glomerular capillaries, PT the mean hydrostatic pressure in the tubule (Bowman’s space), πGC the oncotic pressure of the plasma in the glomerular capillaries, and πT the oncotic pressure of the filtrate in the tubule (Bowman’s space).
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Forces affecting filtration• Glomerular hydrostatic pressure (blood
pressure) promotes filtration=55 mmHg• Capsular hydrostatic pressure opposes
filtration=15 mmHg• Glomerular osmotic pressure opposes
filtration=30 mmHg• Net filtration pressure =
55 – (15+30) =10 mmHg
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GAYA FISIK YANG TERLIBAT DALAM FILTRASI GLOMERULUS
1. Tekanan darah kapiler gomerulus (PGC) = 55 mmHg
2. Tekanan osmotik koloid plasma (IIGS) = 30 mmHg
3. Tekanan hidrostatik kapsul Bowman (PBC) = 15 mmHg
Tekanan filtrasi netto := PGC – (IIGS – PBC) = 55 - (30+15)= 10 mmHg
PGC
PBC
GS
PCPI
I C
Aff. Art. Eff. Art.
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Glomerular filtration rateThe total amount of filtrate formed by the kidney per minutes
• Sekitar 20% dari renal plasma flow
• Nilai GFR ditentukan oleh:(1) keseimbangan antara tekanan hidrostatis dan osmotik (2) filtration coefficient kapiler (Kf) yaitu permeabilitas dan area permukaan filtrasi
• GFR normal 125 ml/min, atau 180 L/day.
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Autoregulation MechanismTo counteract changes in GFR Myogenic mechanism• Increased systemic pressure: Autoregulation:
afferent arteriole diameter decreased (constricted) to maintain the GFR
• Decreased systemic pressure: Autoregulation: afferent arteriole diameter increased (dilated) to maintain the GFR
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Qualities of agents to measure GFR
• Inulin: (Polysaccharide from Dahalia plant)
– Freely filterable at glomerulus– Does not bind to plasma proteins– Biologically inert– Non-toxic, neither synthesized nor
metabolized in kidney– Neither absorbed nor secreted– Does not alter renal function– Can be accurately quantified– Low concentrations are enough (10-20 mg/100 ml plasma)
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• Creatinine:– End product of muscle creatine metabolism– Used in clinical setting to measure GFR but less
accurate than inulin method– Small amount secrete from the tubule
• Para-aminohippurate (PAH):
– An organic anion not present in body– Freely filtered, secreted but not reabsorbed by
nephron– Non-toxic, neither synthesized nor metabolized in
kidney– Low concentrations are enough (10 mg/100 ml plasma)
– RPF = ClearancePAH = UPAH.V / PPAH
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Solute Clearance: Rate of removal from the Blood
Figure 19-16: Inulin clearance
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Concept of clearance
Where,Cx = Clearance of substance X (mg/min)
Ux = Urine concentration of X (mg/ml)
Px = Plasma concentration of X (mg/ml)
V = Urine flow rate of X (ml/min)GFR = Cx =
Px
Ux . V
Qx extracted = Qx excreted
Px . Cx = Ux . V
Effective renal plasma flow =GFR
ERBF = Cx =1 - HctERPF
Renal blood flow = RBF =Extraction ratioERBF
Effective renal blood flow =
Extraction ratio (0.9) = APAH
APAH - VPAH
Hct=hematocrit
VPAH = vein plasma PAHAPAH = arterial plasma PAH
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