MEKANISME

KERJA
DIURETIK
Kania Deazara |
 Blood Pressure
CardIac Output Total PerIpheral ResIstance
STROKE ArterIal Venous
HEART RATE
VOLUME Pressure Pressure

SSO ElektrolIt Preload Afterload ContractIlIty CCB ARB

DIURE Vasod
Inotr
SImpatIs ParasImpatIs TICS! ilato ACE
opik
Beta !! r
block
er
DIURETIK X DIURESIS
Many diuretics exert their effects on specific membrane
transport proteIns in renal tubular epithelial cells. Other
diuretics exert osmotIc effects that prevent water reabsorption,
inhibit enzymes, or interfere with hormone receptors in renal
epithelial cells.
 CA
inhibitor
Tiazid

Diuretik
Osmotik Diuretik Aldosterone
kuat antagonist

Diuretik
Osmotik

Diuretik
Osmotik
RENAL TUBULE TRANSPORT MECHANISM
Proximal Convoluted
•Tubule
NaHCO3, NaCl, glucose, amino acids, & other organic solutes are
reabsorbed via transport system
• 66% filtered Na+
• K+ reabsorbed via paracellular
• 65%
• Water reabsorbed passively (maintaining osmolality)
• 60%
 Lumen  APICALBASOLA Interstisiu
CARBONIC Urin MEMBRA TERAL m  Darah
ANHIDRASE NE

MEMBRA
NE 2
Na + Na+
1 ATP
Na+ Na+ + K K+
NHE3 5
HCO3- + H+ H+ + HCO3- HCO3-
H2CO3 3 H2CO3
CA
CA
H2O+CO2 H2O+CO2
4
Tubul
us
Proks
1
 Lumen  APICALBASOLA Interstisiu
CARBONIC Urin MEMBRA TERAL m  Darah
ANHIDRASE NE

MEMBRA
NE
INHIBITOR Na+ Na+

HCO3- + H+ HH++ + HCO3-
H2CO3 H2CO3
CA
CA
H2O+CO2 H2O+CO2

Tubul
us
Proks
RENAL TUBULE TRANSPORT MECHANISM
Loop of henle
•(thick
NaCl reabsorbtion ascending
• 25% filtered NaCl
limb)
• Diluting Segment
Water impermeable -> reabsorbsi NaCl, H20 engga -> urin encer

Loop of henle (thin

descending limb)
Water is extracted by osmotic forces found in the hypertonic medullary
interstitium.
 Lumen  APICALBASOLA Interstisiu
Loop of Urin MEMBRA TERAL m  Darah

henle NE

MEMBRA
NE
1 
Na+ Na+ Na+ Na+
K+ K+ ATP
2Cl- 2Cl- K+ K+
2
(+) K+ K+ K+
Potensial 3 Cl- Cl-

4
Ca2+, Mg2+ Ansa Ca2+, Mg2+
Henle
asende
2
 Lumen  APICALBASOLA Interstisiu
DIURETIK KUAT Urin MEMBRA TERAL m  Darah
(LOOP NE

MEMBRA
NE
DIURETIC) Na+

K+
2Cl- X

Ca2+, Mg2+ Ansa

Henle
asende
RENAL TUBULE TRANSPORT MECHANISM
DISTAL CONVOLUTED
•TUBULE
Only about 10% of the filtered NaCl is reabsorbed
• Diluting Segment
• Ca 2+ is actively reabsorbed by the DCT epithelial cell via an apical Ca
2+ channel and basolateral Na + /Ca 2+ exchanger. This process is
regulated by parathyroid hormone.
 Lumen  APICALBASOLA Interstisiu
THIAZID Urin MEMBRA TERAL m  Darah
NE MEMBRA
 NE
1 2
Na+ Na+ Na+ Na+
ATP
Cl- Cl- K+ K+

Ca2+ Ca2+ Na+ Na+

3
Ca2+ Ca2+

Tubulus
Kontortu
3 s Distal
 Lumen  APICALBASOLA Interstisiu
THIAZID Urin MEMBRA TERAL m  Darah
NE MEMBRA
dIURETICS  NE

Na+
ATP
Cl- X

Tubulus
Kontortu
s Distal
RENAL TUBULE TRANSPORT MECHANISM
Collecting tubule system (the
connecting tubule, the collecting tubule, and
• 2–5% of NaCl reabsorption
the collecting
• mineralocorticoids exertduct)
a significant influence
• ADH in principal cell markedly increases water permeability, and this
leads to the formation of a more concentrated final urine (osmotic
diuretic inhibits ADH effect)
• the most important site of K + secretion by the kidney and the site at
which virtually all diuretic-induced changes in K + balance occur
• PRINCIPAL CELLS -> Na+, K+, Water transport
• INTERCALATED CELLS ->
• α : H+ secretion
• Β : HCO3- secretion
 Lumen  Kolektiv Interstisiu
DIURETIK Urin us m  Darah
Cl- Sel Cl-
HEMAT 5
1
Utama Aldosteron

KALIUM Na+ R
Na+
2
3 Na+ Na+
POTASSIUM K+ K+
K+
ATP
K+
4
SPARING H2O R ADH

Sel
Interkal
asiHCO - HCO3-
ATP 6 3

4 H+ Cl- Cl-
 Lumen  Kolektiv Interstisiu
DIURETIK Urin us m  Darah
Sel
HEMAT Utama Aldosteron

KALIUM Na+ R
Na+
POTASSIUM ATP
K+
SPARING R

Sel
Interkal
asi
REFERENCE
• KATZUNG
• LIPPINCOTT
• GOODMAN & GILLMAN
Thank

youw!