FISIOLOGI DIURESIS

dr. Rohmania Setiarini

Gross Anatomy of the Kidney

The Kidney and the Nephron

A.
B. C. D.

Renal Vein
Renal Artery Ureter Medulla

E.
F. 1.

Renal Pelvis
Cortex Ascending loop of Henle

2.
3.

Descending loop of Henle

Peritubular capillaries

4.
5. 6.

Proximal tubule
Glomerulus Distal tubule

Major Functions of the Kidneys

1. Regulation of: body fluid osmolarity and volume electrolyte 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) renin prostaglandin

The Nephron
Functional unit of the kidney (1,000,000) Responsible for urine formation:
Filtration Secretion Reabsorption

The Nephron
Structure of nephron
glomerulus proximal convoluted tubule (pct) loop of Henle descending limb ascending limb distal convoluted tubule many nephrons connect to collecting duct

Blood flow afferent arteriole efferent arteriole

Peritubular capillaries vasa recta

Renal tubules and collecting duct

THE GLOMERULUS

Plasma is filtered through the glomerular barrier

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

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!!

GFR 125 ml/min (180L/day) (about 1% is excreted)

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

Filtered (meq/24h) Glucose (g/day) 180 4,320

Reabsorbed
(meq/24h)

Excreted
(meq/24h)

Reabsorbed
(%)

180 4,318 25,410

0 2 150

100 > 99.9 99.4

Bicarbonate (meq/day) Sodium

(meq/day) 25,560

Chloride
Water Urea

(meq/day) 19,440
(l/day) (g/day) 169 48

19,260
167.5 24

180
1.5 24

99.1
99.1 50

Creatinine

(g/day)

1.8

1.8

Reabsorption
Active Transport requires ATP
Na+, K+ ATP pumps

Passive Transport Na+ symporters (glucose, a.a., etc) Na+ antiporters (H+) Ion channels Osmosis

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, and small proteins are also reabsorbed here. Loop of Henle - reabsorbs 25% of filtered Na+.

Distal tubule - reabsorbs 8% of filtered Na+. Reabsorbs HCO3Collecting duct - reabsorbs the remaining 2% of Na+ only if the hormone aldosterone is present. H20 depending on hormone ADH.

Secretion
Proximal tubule uric acid, bile salts, metabolites, some drugs, some creatinine Distal tubule Most active secretion takes place here including organic acids, K+, H+, drugs, TammHorsfall protein (main component of hyaline casts).

Hormones Produced by the Kidney

Renin:
Released from juxtaglomerular apparatus when low blood flow or low Na+. Renin leads to production of angiotensin 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 (low hemoglobin).

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

Renin, Angiotensin, Aldosterone:

Regulation of Salt/Water Balance

Aldosterone

A steroid hormone (mineralocorticoid) synthesized from cholesterol by the enzyme aldosterone synthase. It is formed in the outer-section (zona glomerulosa) of the adrenal cortex of 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 the kidneys. Aldosterone is synthesized in reaction to increases of angiotensin II or plasma potassium, which are present in proportion to sodium deficiencies.

ADH (VASOPRESSIN)

A human hormone that is mainly released when the body is low on water. It causes the kidneys to conserve water by concentrating the urine. If there is not enough water in the body
The osmotic activity of the EC solution is increased stimulation of the OSMOTIC RECEPTORS in the hypothalamus stimulation of posterior lobe of the pituitary gland activation of VASOPRESSIN increase of 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 RECEPTORS in the heart and big veins and arteries decrease of the activation of VASOPRESSIN decrease of the permeability of collecting ductus for the water water is not reabsorbed ISO- or HYPOOSMOTIC URINE

Perubahan volum urin karena adanya vasopresin

GFR (ml/mnt) Reabsopsi (%) Volum urin (L/hr) Konsentrasi urin (mOsm/kg H2O) 290

Urin&plasma isotonik Vasopresin (max antidiuresis) Vasopresin(-) (diabetes insipidus)

125

98,7

2,4

125

99,7

0,5

1400

125

87,1

23,3

30

Kinin-kallikrein system
A kinin is any of various structurally related polypeptides, such as bradykinin and kallikrein, that act locally to induce vasodilation and contraction of smooth muscle. A role in inflammation, blood pressure control, coagulation and pain. Produced and stored in distal tubule Function:

vasodilatation secretion of prostaglandins (PGE2) decrease of vasoconstriction and antidiuretic effects of angiotenzin II. increase of vasodilatation and diuretic effect of kinins

Prostaglandins
A prostaglandin is any member of a group of lipid compounds that are derived from fatty acids and have important functions in the animal body. Every prostaglandin contains 20 carbon atoms, including a 5-carbon ring. Hormone-like substances Function:

Vasodilatation Increase of perfusion Decrease of water reabsorption Decrease of active Na+ transport in tubules

Tempat kerja obat diuretik

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

12/19/2013

Terimakasih

PrAy

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