URINARY SYSTEM

Urinary system rids the body of

waste materials and control the
volume and composition of
body fluids

Fungsi Ginjal
Ekskresi/Pembentukan Urine
Mempertahankan homeostasis
1.

Mengatur osmolalitas ECF

Mengatur volume ECF
Mengatur pH ECF

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

Internal structure of the kidney

Blood supply of the kidney:

21% of the cardiac output =
1200 ml/mnt

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

Vascular supply to the nephron

Proximal convoluted
tubule
Glomerulus
Arcuate vein

Efferent arteriole
Afferent arteriole
Distal convoluted tubule

Arcuate artery
Collecting duct
Vasa recta
Thick ascending limb
of the loop of Henl
Descending limb
loop of Henl

Thin ascending limb

of the loop of Henl

Cortical & Juxtamedullary

nephron
Cortical 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

Structure of the Bowmans (glomerular) capsule

Parietal layer of
glomerular capsule

Afferent arteriole
Juxtaglomerular
cell

Capsule
space
Efferent arteriole
Proximal
convoluted
tubule
Endothelium
of glomerulus

Podocyte
Pedicel

 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 382).

 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.

Formation of Urine
Involves three main processes:
1.Filtration
2.Reabsorption
3.Secretion

Filtration membrane
Is composed of three layers:
1.fenestrated glomerular endothelium
2.basement membrane
3.filtration slits are formed by the pedicels
of the podocytes
Substance are filtered are on the basis of
size and/or electrical properties

Glomerular Filtration Membrane

Insert fig. 17.8

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.

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.

The filtration barrier - podocytes

basal
lamina

pedicel

filtration
slit

fenestrated
endothelium

basal
lamina
podocyte
filtration
slit
fenestrated
endothelium

secondary
process
(pedicel)

podocyte
primary cell body
process

The filtration barrier - pedicels

Bowmans
space
pedicel

filtration
slit

capillary

Common component of the glomerular

filtrate:
Organic molecules: glucose,amino
acids
Nitrogenous waste: urea, uric acid,
creatinine
Ions: sodium, potassium, chloride

 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
(Bowmans space), GC the oncotic pressure
of the plasma in the glomerular capillaries,
and T the oncotic pressure of the filtrate in
the tubule (Bowmans space).

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

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

PI

PC

Aff.Art.

Eff.Art.
PGC

GS
PBC

Glomerular filtration rate

The 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.

Autoregulation Mechanism
To 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

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)

 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

Solute Clearance:
Rate of removal from the Blood

Figure 19-16: Inulin clearance

Concept of clearance
Qx extracted = Qx excreted
Px . Cx = Ux . V

GFR = Cx =

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)

Ux . V
Px

Effective renal plasma flow =GFR

Effective renal blood flow =

Renal blood flow =

Extraction ratio (0.9) =

ERBF = Cx =

RBF =

ERPF
1 - Hct

Hct=hematocrit

ERBF
Extraction ratio

APAH - VPAH
APAH

APAH = arterial plasma PAH

VPAH = vein plasma PAH

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