COUNTERCURRENT

MECHANISM
The

concentrating mechanism depends

upon the maintenance of a gradient of
increasing osmolality along the
medullary pyramids.
This gradient is produced by the
operation of the loops of Henle as
countercurrent multipliers and
maintained by the operation of the vasa
recta as countercurrent exchangers.

 The

operation of each loop of Henle

as a countercurrent multiplier
depends on the high permeability of
the thin descending limb to water (via
aquaporin-1), the active transport of
Na+ and Cl out of the thick ascending
limb, and the inflow of tubular fluid
from the proximal tubule, with outflow
into the distal tubule.

DIFFERENCES IN THE NEPHRON LOOP

The descending
limb:1. Highly permeable
to water
2. Relatively
impermeable to
sodium
The ascending limb:1. Impermeable
to water
2. Actively transports
sodium out of the
filtrate

ROLE OF UREA
Urea

contributes to the establishment of the

osmotic gradient in the medullary pyramids
and to the ability to form a concentrated
urine in the collecting ducts.
Urea transport is mediated by urea
transporters, presumably by facilitated
diffusion.
The amount of urea in the medullary
interstitium and, consequently, in the urine
varies with the amount of urea filtered, and
this in turn varies with the dietary intake of
protein.

OSMOTIC DIURESIS
The

presence of large quantities of

unreabsorbed solutes in the renal tubules
causes an increase in urine volume called
osmotic diuresis.
Osmotic diuresis is produced by the
administration of compounds such as
mannitol and related polysaccharides that
are filtered but not reabsorbed. It is also
produced by naturally occurring substances
when they are present in amounts exceeding
the capacity of the tubules to reabsorb them.
For example, in diabetes mellitus

 It

is important to recognize the difference

between osmotic diuresis and water
diuresis.
In water diuresis, the amount of water
reabsorbed in the proximal portions of
the nephron is normal, and the maximal
urine flow that can be produced is about
16 mL/min.
In osmotic diuresis, increased urine flow
is due to decreased water reabsorption in
the proximal tubules and loops and very
large urine flows can be produced.

 The

water diuresis produced by

drinking large amounts of hypotonic
fluid begins about 15 min after
ingestion of a water load and reaches
its maximum in about 40 min.
The act of drinking produces a small
decrease in vasopressin secretion
before the water is absorbed, but
most of the inhibition is produced by
the decrease in plasma osmolality
after the water is absorbed.

Ureter

Merupakan saluran yang

menghubungkan ginjal ke kandung
kemih, yang merupakan lanjutan renal
pelvis.
Panjang 10-12 inchi.
Ureter memasuki kandung kemih
melalui bagian posterior dengan cara
menembus otot detrusor di daerah
trigonum kandung kemih

 Dinding

ureter terdiri dari otot polos

& dipersarafi oleh saraf simpatis &
parasimpatis.
Kontraksi peristaltik pada ureter
ditingkatkan oleh perangsangan
parasimpatis & dihambat oleh
perangsangan simpatis.
Peristalsis dibantu gaya gravitasi
akan memindahkan urine dari ureter
ke kandung kemih.

BLADDER
FILLING
The

walls of the ureters contain smooth

muscle arranged in spiral, longitudinal,
and circular bundles, but distinct layers of
muscle are not seen.
Regular peristaltic contractions occurring
one to five times per minute move the
urine from the renal pelvis to the bladder,
where it enters in spurts synchronous with
each peristaltic wave.

 The

ureters pass obliquely through

the bladder wall and, although there
are no ureteral sphincters as such,
the oblique passage tends to keep
the ureters closed except during
peristaltic waves, preventing reflux
of urine from the bladder.

 EMPTYING
The

smooth muscle of the bladder, like

that of the ureters, is arranged in spiral,
longitudinal, and circular bundles.
Contraction of the circular muscle,
which is called the detrusor muscle,
is mainly responsible for emptying
the bladder during urination
(micturition).

Muscle bundles pass on either side of

the urethra, and these fibers are
sometimes called the internal
urethral sphincter, although they
do not encircle the urethra.
Farther along the urethra is a
sphincter of skeletal muscle, the
sphincter of the membranous urethra
(external urethral sphincter).

 Micturition

is
fundamentally a
spinal reflex
facilitated and
inhibited by
higher brain
centers and, like
defecation,
subject to
voluntary
facilitation and
inhibition.

The

first urge to void is felt at a bladder

volume of about 150 mL, and a marked

 During

micturition, the perineal muscles

and external urethral sphincter are
relaxed, the detrusor muscle contracts,
and urine passes out through the urethra.
The bands of smooth muscle on either
side of the urethra apparently play no role
in micturition, and their main function in
males is believed to be the prevention of
reflux of semen into the bladder during
ejaculation

Kandung Kemih
(Vesica Urinaria)

1.
2.

Berfungsi menampung/menyimpan urine

sementara.
Terdiri atas :
Badan (corpus) = bagian utama
kandung kemih dimana urine terkumpul.
Leher (kollum) = lanjutan dari badan
yang berbentk corong, berjalan secara
inferior dan anterior ke dalam daerah
segitiga urogenital & berhubungan
dengan urethra.

Dinding kandung kemih :

3 lapisan otot polos (detrusor muscle)
Mucosa : transitional epithellium
Dinding : tebal &
berlipat saat
kandung kemih kosong.

Trigone tiga
pembukaan :
Dua dari ureter dan Satu
ke urethra

Persarafan
N. pelvikus yang berhubungan dengan
medulla spinalis melalui pleksus sakralis (S2
dan S3).
Saraf sensorik = regangan dinding kandung
kemih refleks berkemih.
Saraf motorik = parasimpatis berakhir
pada sel ganglion yang terletak dalam
dinding kandung
kemih untuk mensarafi
otot detrusor.

Urethra
Saluran

berdinding tipis yang

memindahkan urine dari kandung kemih
ke luar tubuh degan gerak peristalsis.
Panjang : pria=8 inchi, wanita=1
inchi.
Pengeluaran urine diatur oleh dua katup
(sphincters)
Internal urethral sphincter (tanpa
sadari/involuntary)
External urethral sphincter
(disadari/voluntary)

Berkemih (Micturition/Voiding)
Kedua katup (sphincter) otot harus
terbuka agar dapat berkemih
Internal urethral sphincter : direlakskan
setelah peregangan kandung kemih
Pengkatifan ini berasal dari impulse
dikirim ke spinal cord dan kemudian
balik melalui saraf pelvic splanchnic
External urethral sphincter : harus
direlakskan secara sadar
Copyright2003PearsonEducation,Inc.publishingasBenjaminCummings

Neuroanatomy of
Lower Urinary Tract

MICTURITION REFLEX
Bladder fills

+
Stretch receptors
Spinal Cord

Parasympathetic
nerve
Bladder contracts

Internal urethral
sphincter opens

Only the external urethral sphincter is controlled voluntarily

Figure 26.21

Urination: Micturation reflex

Rugae folds

Detrusor
-Adrenergic
receptors

Hypogastic nerves (L1, L2, L3)

Sympathetic
Pelvic nerve
Visceral afferent pathway

Fundus
Sacral
Parasympatheti
c
(S1, S2, S3)

Skeletal muscle

Sacral
Pudential
nerves
Figure 19-18: The micturition reflex