FISIOLOGI DIURESIS

7/27/2019 FISIOLOGI DIURESIS

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FISIOLOGI DIURESIS

dr. Rohmania Setiarini


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Gross Anatomy of the Kidney


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A. Renal Vein

B. Renal Artery

C. Ureter

D. Medulla

E. Renal Pelvis

F. Cortex

1. Ascending loop ofHenle

2. Descending loop of

Henle

3. Peritubular

capillaries

4. Proximal tubule

5. Glomerulus

6. Distal tubule

The Kidney and the Nephron


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Major Functions of the Kidneys

1. Regulation of:

body fluid osmolarity and volumeelectrolyte balance

acid-base balance

blood pressure

2. Excretion of

metabolic products

foreign substances (pesticides, chemicals etc.)

excess substance (water, etc)

3. Secretion of

erythropoitin

1,25-dihydroxy vitamin D3(vitamin D activation)

reninrosta landin


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The Nephron

Functional unit of the kidney

(1,000,000)

Responsible for urine formation:

Filtration

Secretion

Reabsorption


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The Nephron

Blood flow -

afferent arteriole

efferent arteriole

Peritubular capillaries

vasa recta

Structure of nephron

glomerulus

proximal

convoluted

tubule (pct)

loop of Henle

descendinglimb

ascending

limb

distalconvoluted

tubule

many nephrons

connect to collecting

duct


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Renal tubules

and collecting

duct


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THE GLOMERULUS


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Components of plasma cross the three layers of the glomerular barrier during filtration

Capillary endothelium

Basement membrane

Epithelium of Bowmans Capsule

The ability of a molecule to cross the membrane depends on size, charge, and shape

Plasma is filtered through the

glomerular barrier


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Glomerular Filtration Rate

(GFR)

Measure of functional capacity of the

kidney Dependent on difference in pressures

between capillaries and Bowmans space

Normal = 120 ml/min =7.2 L/h=180 L/day!!


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GFR 125 ml/min (180L/day)

(about 1% is excreted)


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Filtration, reabsoption, and excretion rates of substances by the kidneys

Filtered Reabsorbed Excreted Reabsorbed

(meq/24h) (meq/24h) (meq/24h) (%)

Glucose (g/day) 180 180 0 100

Bicarbonate (meq/day) 4,320 4,318 2 > 99.9

Sodium (meq/day) 25,560 25,410 150 99.4

Chloride (meq/day) 19,440 19,260 180 99.1

Water (l/day) 169 167.5 1.5 99.1

Urea (g/day) 48 24 24 50Creatinine (g/day) 1.8 0 1.8 0


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Reabsorption

Active Transportrequires ATP

Na+, K+ ATP pumps

Passive Transport-Na+ symporters (glucose, a.a., etc)

Na+ antiporters (H+)

Ion channels

Osmosis


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What is Reabsorbed Where?

Proximal tubule- reabsorbs 65 % of filtered Na+as well as Cl-,

Ca2+, PO4, HCO3-.75-90% of H20. Glucose, carbohydrates,

amino acids, andsmall proteinsare also reabsorbed here.

Loop of Henle- reabsorbs 25% of filtered Na+.

Distal tubule- reabsorbs 8% of filtered Na+.Reabsorbs HCO3-

Collecting duct- reabsorbs the remaining 2% of Na+only if the

hormone aldosteroneis present. H20depending on hormoneADH.


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Secretion

Proximal tubuleuric acid, bile

salts, metabolites, some drugs, some

creatinine

Distal tubuleMost active secretion

takes place here including organic

acids, K+, H+, drugs, Tamm-

Horsfall protein (main componentof hyaline casts).


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Hormones Produced by the

Kidney Renin:

Released from juxtaglomerular apparatus when lowblood flow or low Na+. Renin leads to production ofangiotensin II, which in turn ultimately leads to retention

of salt and water.

Erythropoietin: Stimulates red blood cell development in bone marrow.

Will increase when blood oxygen low and anemia (lowhemoglobin).

Vitamin D3: Enzyme converts Vit D to active form 1,25(OH)2VitD.

Involved in calcium homeostasis.


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Renin, Angiotensin, Aldosterone:

Regulation of Salt/Water Balance


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Aldosterone

A steroid hormone(mineralocorticoid) synthesizedfrom cholesterolby the enzyme aldosterone synthase.

It is formed in the outer-section (zona glomerulosa) of

the adrenal cortexof the adrenal gland. It helps regulate the body's electrolyte balance by

acting on the mineralocorticoid receptor(MR). It diminishes the excretion of Na+ions and therefore

water, and stimulates the excretion of K+ions by thekidneys.

Aldosterone is synthesized in reaction to increases ofangiotensin IIor plasmapotassium, which are present

in proportion to sodium deficiencies.
http://en.wikipedia.org/wiki/Steroid_hormonehttp://en.wikipedia.org/wiki/Cholesterolhttp://en.wikipedia.org/w/index.php?title=Aldosterone_synthase&action=edithttp://en.wikipedia.org/wiki/Zona_glomerulosahttp://en.wikipedia.org/wiki/Adrenal_cortexhttp://en.wikipedia.org/wiki/Adrenal_glandhttp://en.wikipedia.org/w/index.php?title=Mineralocorticoid_receptor&action=edithttp://en.wikipedia.org/wiki/Angiotensin_IIhttp://en.wikipedia.org/wiki/Blood_plasmahttp://en.wikipedia.org/wiki/Potassiumhttp://en.wikipedia.org/wiki/Potassiumhttp://en.wikipedia.org/wiki/Blood_plasmahttp://en.wikipedia.org/wiki/Angiotensin_IIhttp://en.wikipedia.org/w/index.php?title=Mineralocorticoid_receptor&action=edithttp://en.wikipedia.org/wiki/Adrenal_glandhttp://en.wikipedia.org/wiki/Adrenal_cortexhttp://en.wikipedia.org/wiki/Zona_glomerulosahttp://en.wikipedia.org/wiki/Zona_glomerulosahttp://en.wikipedia.org/wiki/Zona_glomerulosahttp://en.wikipedia.org/w/index.php?title=Aldosterone_synthase&action=edithttp://en.wikipedia.org/wiki/Cholesterolhttp://en.wikipedia.org/wiki/Steroid_hormone


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ADH (VASOPRESSIN)

A human hormone that is mainly released when the body islow on water.

It causes the kidneys to conserve water by concentratingthe

urine. If there is not enough water in the body

The osmotic activity of the EC solution is increased stimulation of theOSMOTIC RECEPTORSin the hypothalamus stimulation of posteriorlobe of the pituitary gland activation of VASOPRESSIN increaseof the permeability of collecting ductus for the water reabsorption

HYPERTONIC URINE If there is too much water in the body

The increase volume stimulates VOLUME RECEPTORSin the heartand big veins and arteries decrease of the activation ofVASOPRESSIN decrease of the permeability of collecting ductus forthe water water is not reabsorbed ISO- or HYPOOSMOTIC

URINE
http://en.wikipedia.org/wiki/Waterhttp://en.wikipedia.org/wiki/Water


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Perubahan volum urin karena adanya vasopresin

GFR (ml/mnt) Reabsopsi

(%)

Volum urin

(L/hr)

Konsentrasi

urin

(mOsm/kg

H2O)

Urin&plasma

isotonik

125 98,7 2,4 290

Vasopresin

(max

antidiuresis)

125 99,7 0,5 1400

Vasopresin(-)

(diabetes

insipidus)

125 87,1 23,3 30


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Kinin-kallikrein system

A kininis any of various structurally relatedpolypeptides, such as bradykininand kallikrein, thatact locally to induce vasodilationand contraction of

smooth muscle.A role in inflammation, blood pressurecontrol,

coagulationand pain.

Produced and stored in distal tubule

Function: vasodilatation

secretion of prostaglandins (PGE2)

decrease of vasoconstriction and antidiuretic effects ofangiotenzin II.

increase of vasodilatation and diuretic effect of kinins
http://en.wikipedia.org/wiki/Polypeptideshttp://en.wikipedia.org/wiki/Bradykininhttp://en.wikipedia.org/w/index.php?title=Kallikrein&action=edithttp://en.wikipedia.org/wiki/Vasodilationhttp://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Blood_pressurehttp://en.wikipedia.org/wiki/Coagulationhttp://en.wikipedia.org/wiki/Painhttp://en.wikipedia.org/wiki/Painhttp://en.wikipedia.org/wiki/Coagulationhttp://en.wikipedia.org/wiki/Blood_pressurehttp://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Vasodilationhttp://en.wikipedia.org/w/index.php?title=Kallikrein&action=edithttp://en.wikipedia.org/wiki/Bradykininhttp://en.wikipedia.org/wiki/Polypeptides


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Prostaglandins

A prostaglandinis any member of a group of lipidcompounds that are derived from fatty acidsandhave important functions in the animalbody.

Every prostaglandin contains 20 carbonatoms,including a 5-carbon ring.

Hormone-like substances

Function: Vasodilatation

Increase of perfusion

Decrease of water reabsorption

Decrease of active Na+transport in tubules
http://en.wikipedia.org/wiki/Lipidhttp://en.wikipedia.org/wiki/Fatty_acidhttp://en.wikipedia.org/wiki/Animalhttp://en.wikipedia.org/wiki/Carbonhttp://en.wikipedia.org/wiki/Carbonhttp://en.wikipedia.org/wiki/Animalhttp://en.wikipedia.org/wiki/Fatty_acidhttp://en.wikipedia.org/wiki/Lipid


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Tempat kerja obat diuretik


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12/19/2013

PENUAAN

Penurunan nefron yg fungsional

Penurunan GFR. Glomerulus sedikit,

kerusakan pada aparatus filtrasi, penurunan

aliran darah ginjal Penurunan sensitivitas pada ADH shg byk

sodium hilang melalui urin.

Permasalahan dengan reflex kencing


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PrAy 26

erim k sih

FISIOLOGI DIURESIS

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