Retno Sintowati, dr. M.Sc.

Epitel tubulus kontortus proksimalis

Sifat fisik
 Volume : 600-2500 ml/hari
Tergantung : banyaknya minum, suhu udara,
mcm makanan, aktvts fisik, kead mental, penykt
 Berat jenis : 1,003-1,030
 Reaksi : pH 4,7-8 (±6.0)
 > asam pd : intake protein tinggi, asidosis, puasa
 Alkalis pd : urin yg lama, sayur & buah, muntah
 Warna : kuning kecoklatan
(urokrom, urobilin, hematophorphirin)
 Bau : baru  agak harum
lama  amonia
Zat-zat dalam urin
 1. Fisiologis/normal
 2. Patologis/abnormal
1) NORMAL :
 NPN  Urea, amonia, as. amino, kreatinin, asam
urat, asam hipurat
 Allantoin, as. Oksalat, as. Glukoronat, as. Sitrat,
zat yg mgdg sulfur, KH, hormon, P, Cl, Na, Ca, Mg
2) ABNORMAL :
a. Protein : Fisiologis (<75 mg/hari)  makan
protein >>, gangguan sirkulasi renal, graviditas
 Protein patologis :
 Prerenal : multiple myeloma, leukemia,
Hodgkin’s disease
 Renal : Nefritis, proses degenerasi, keracunan
 Post renal : Infeksi ( ureter, v. urunaria,
urethra)
b. Glukosa (krg dr l gr/hr)
Elementary glukosuria, Renal glukosuria, DM
c. Keton bodies : Puasa, gang metab KH, hamil,
narkose, alkalosis
d. Bilirubin : Hepatitis
e. Darah : Nefritis, Cystitis, Nefrolithiasis,
Cystolithiasis
f. Porfirin : Hodgkin’s, Anemia pernisiosa,
hemolitika, Serosis, Pankreatitis akuta
 Zat Normal
1. UREA/ureum
 Katabolisme protein ▲
 80-90% dari NPN urin
 Kerusakan hepar  Urea urin ▼
 Siklus Ure a oleh hepar
BIOSINTESA UREA DIBAGI 4 TAHAP

Asam  Amino Asam  Keto

transaminasi

 Ketoglutarat L -glutamat

Deaminasi oksidatif

Pengangkutan amonia
NH3

Siklus Urea
UREA
 Urea is routinely measured in the blood as: Blood
Urea Nitrogen (BUN). BUN levels may be elevated (a
condition called uremia) in both acute and chronic
renal (kidney) failure. Various diseases damage the
kidney and cause faulty urine formation and excretion.
Congestive heart failure leads to a low blood
pressure and consequent reduced filtration rates
through the kidneys, therefore,BUN may be elevated.
Urinary tract obstructions can also lead to an
increased BUN. In severe cases, hemodialysis is used to
remove the soluble urea and other waste products
from the blood.
2. AMONIA
 Normal amonia urin sedikit
 Amonia urin ▲ pd kerusakan hepar, ketosis &
asidosis ok DM, diet tinggi protein
 Amonia urin ▼ pada asidosis ok faktor ginjal
Ammonia Excretion:
Animals such as fish that live in the water excrete ammonia.
Humans also excrete small amounts of NH3 which is
converted by the acid in the urine to NH4+ (ammonium ions).
Ammonia is excreted only as a defense against an
acidosis condition because the neutralization of acid by
ammonia has the effect of conserving bases in the blood.
 Asidosis  glutaminase ↑  amonia ↑
 Untuk mencegah Asidosis Metabolik :
 1. Pengasaman Urin
 2. Sekresi Amonia
 Makin rendah pH urin  makin cepat amonia
berdifusi ke urin
 Pada metab anaerob menghasilkan asidosis
metabolik. Jg pd diabetes tak terkontrol.
 Glutaminase I : suatu enzim yang bergantung pada
fosfat, terletak dalam mitokondria sel tubulus ginjal,
bertambah aktivitasnya selama asidosis metabolik
dengan mengkatalisis pembentukan amonia melalui
deaminasi glutamin dan mengekskresikan H+
sebagai garam amonium.
Pengasaman urin
Sekresi amonia
3. ASAM AMINO  btk bebas & terikat
Keracunan kloroform, CCl4  ekskresi ▲
Cystinuria & aminoasiduria  ekskresi ▲
(gangguan absorbsi tubulus)
Bayi prematur  ekskresi 10x bayi aterm
4. KREATIN & KREATININ
 Creatine is synthesized in the liver by methylation
of guanidoacetate using SAM as the methyl donor.
Guanidoacetate itself is formed in the kidney from
the amino acids arginine and glycine.
 Dewasa  ekskresi kreatin (-)/sedikit
 Anak2  eks kreatin agak tinggi
 ♀ eks kreatinin 2-2,5x ♂
 Hamil, puasa, infeksi, hipertiroid  eks ▲
 Hipotiroid  eks ▼
 Kreatinin  katabolisme kreatin
 Koefisien kreatin : banyaknya kreatinin (mg) yg
diekskresi tiap kgBB/hari
In muscle and brain
 Synthesis of Creatine and Creatinine
 Creatine is used as a storage form of high energy phosphate.
The phosphate of ATP is transferred to creatine, generating
creatine phosphate, through the action of creatine
phosphokinase. The reaction is reversible such that when
energy demand is high (e.g. during muscle exertion)
creatine phosphate donates its phosphate to ADP to yield
ATP.
 Both creatine and creatine phosphate are found in muscle,
brain and blood. Creatinine is formed in muscle from
creatine phosphate by a nonenzymatic dehydration and loss
of phosphate. The amount of creatinine produced is related
to muscle mass and remains remarkably constant from day
to day. Creatinine is excreted by the kidneys and the level of
excretion (creatinine clearance rate) is a measure of renal
function.
5. ASAM URAT
 Hasil katabolisme protein inti basa purin
(daging, hati, ginjal, kacang-kacangan)
 Katabolisme : Eksogen ( dalam jaringan) &
Endogen ( dalam inti/nukleus)
 Pd pH urin normal  larut sbg garam Na
dan K urat
 Pd pH > asam  m’btk kristal asam urat &
amonium urat
 H
C H
N H
HN C Glycine C Glutamine
CH Glutamine (2) CH
HN Aspartate
HC C Aspartate
CO2
N N N10-Formyl-THF (2) H C CH
H H CO2 N
H

Purine Pyrimidine

(C5H7N4) (C4H6N2)
 GMP AMP
↓ ↓
 Guanosin IMP
↓ ↓
↓ Inosin
↓
 Guanin Hipoxantin
↓ ↓‫٭‬

Xantin
↓‫٭‬
 Asam urat  URIN
‫ ٭‬tmp kerja xantin oxidase, dihambat oleh
Alopurinol
Uric Acid Excretion
 Humans – excreted into urine as insoluble crystals
 Birds, terrestrial reptiles, some insects – excrete
insoluble crystals in paste form (hewan urikotelik)
 Excess amino N converted to uric acid
 Others – further modification :

Uric Acid  Allantoin  Allantoic Acid  Urea 

Ammonia
 Ekskresi asam urat total man  400-600mg/24jam
 Aspirin dosis tinggi hambat ekskresi & reabsorpsi
urat.
6. ALLANTOIN
 Derivat asam urat  oksidasi partikel asam urat dg
adanya enzim urikase oksalat
 Manusia  eks allantoin 5-25 mg/hari
 Mamalia  90% hasil akhir metabolisme protein
inti basa purin  dlm btk Allantoin

7. ASAM OKSALAT
 Ekskresi : 10-25 mg/hari
 Asam oksalat merupakan : hsl metab vit C
dan hsl metab KH tak sempurna
 Eks oksalat ▲ jk m’konsumsi : tomat, apel,
anggur, kubis, bayem.
8. ASAM GLUKORONAT
 diekskresi dlm btk ester dan glikoid (
dibentuk di hepar)
 Eks : 0,3-1,0 gram/hari
 Eks ▲ pada penggunaan :
- Asetil salisilat
- Sulfonamide
- Terpentin
- Antipirin
- Phenol pthalin
9. ASAM SITRAT
 HASIL METAB KH
 Premenstrual  eks ▼
 Di tulang sbg  Ca sitrat

10. ASAM HIPURAT

 Hsl konjugasi asam benzoat dan glisin di
hepar
 Asm benzoat byk tdp pd sayuran, buah-
buahan, dan pemecahan fenilalanin dan
tirosin ( usus )
11. Senyawa yang mengandung SULFUR
a. SULFUR NETRAL  hasil oksidasi tak sempurna
asam amino yg mengandung S
b. SULFAT
- Anorganik  oksidasi sempurna asam amino
yg mengandung S
- Organik  dari konjugasi senyawa aromatis 
fenol dg sulfat
12. KLORIDA
 DIEKSKRESI BERUPA NaCl dan NH4Cl
 Intake NaCl 8-15 gram/hari  eks Cl - 10 gr/hr
 Eks Cl- tergantung intake NaCl, respirasi,
hormon suprarenalis
13. PHOSPHAT
 HASIL METAB PROTEIN
 EKS PHOSPHAT : GIT & UROPOETIKA (60%)
 EKS PHOSPHAT DIPENGARUHI OLEH :
Hormon paratiroid dan vitamin D
 H. paratiroid  reabs PO4- oleh tubulus ▼ 
eks PO4- ▲
 Defisiensi vit D  abs PO4- usus ▼ eks PO4-
urin▼
 pH urin alkalis  pengendapan garam-garam PO4-
 NEPHROLITHIASIS
14. NATRIUM & KALIUM
 Puasa  protein jaringan dikatabolisir 
pelepasan K dari sel  eks K ▲
 Pemberian aldosteron  eks Na ▼, eks K ▲
 Eks K melalui : filtrasi glom & sekresi tubulus
 Sekresi tubulus dipengaruhi oleh asam basa
darah :
- Alkalosis  sekresi K ▲
- Asidosis  sekresi K ▼
15. CALSIUM & MAGNESIUM
 Pd hiperfungsi gld paratiroid  eks Ca ▲
karena [Ca] ▲ yg berasal dr mobilisasi Ca
tulang
 Pd pemberian vit D  eks Ca ▲ karena
absorbsi Ca mukosa GIT ▲ [Ca] darah ▲
 Ca & Mg terutama diekskresi lewat usus,
lewat urin relatif kecil kecuali pada keadaan
patologis metabolisme tulang.
Bahan yg kadarnya sedikit
 KH  <1.5 gr/hr
 Elementary glukosuria  hamil, mkn gula
 Laktosuria  menyusui, anggur
 Protein  <75 mg/hr (30-200 mg)
 Elemen anorganik : Fe, Cu, Zn, dll
 Hormon  gonadotropin, estrogen, androgen,
pregnandiol, kortex adrenal, HCG,
 Vitamin, enzim, lipid
ALHAMDULILLAHI ROBBIL ‘ALAMIIN