ginjal ok
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GINJAL DAN PENGATURAN
AIR DAN ION INORGANIK
Dr.YASWIR YASRIN
BAGIAN FISIOLOGI
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• Pembicaraan :
1.Prini! Daar Fii"#"$i Gin%a#
&.Pen$a'(ran Keeimban$an air )ani"n in"$ani*.
+.Pen$a'(ran ,a#i(m
-.Pen$a'(ran i"n i)r"$en/.Di(re'i* )an Bebera!a Pen0a*i'Gin%a#
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I.FUNGSI GINJAL :1.en$a'(r *eeimban$an air )an i"n in"r$ani*
&.en$e#(ar*an en) !r")(c me'ab"#ime+.en$e#(ar*an ben)a ain$-.G#(*"ne"$enei/.em!r")(*i 2"rm"n 3 En4im :
5Er0'2"!"e'in5Renin 3 En4im an$i"'enin5 15&/ Di20)r"6i 7i'amin D
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PRINSIP DASAR FISIOLOGIGINJAL
II.S'r(*'(r Gin%a# Dan Si'im (rinari(5Or$an re'r!eri'"nea#5Ter)iri a'a c"r'e6 )an e)(#a5Gin%a# 'er)iri a'a 1 mi##i"n Ne8r"n
51 ne8r"n 'er)iri a'a :5 ,"r!( rena#i:
9$#"mer(#(9,a!(# B"man
5T(b(#( !r"6ima#5 Ana en#e5T(b(#i )i'a#5)(*'( *"#i$en
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FIGURE 16–2
Basic structure of a nephron. (a)
Anatomical organization. Themacula densa is not a distinct
segment but a plaque of cells in
the ascending loop of Henle where
the loop passes between the
arterioles supplying its renal
corpuscle of origin. The outer area of the idney is called the
corte! and the inner the medulla.
The blac arrows indicate the
direction of urine flow.
(b) "onsecuti#e segments of the
nephron. All segments in thescreened area are parts of the
renal tubule$ the terms to the
right of the bracets are commonly
used for se#eral consecuti#e
segments.
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FIGURE 16–3
(a) Anatomy of the renal corpuscle. Brown lines in the capillary loops indicate space between
ad%oining podocytes. (b) "ross
section of the three corpuscular membranes&capillary endothelium' basement membrane' and
epithelium (podocytes) of Bowmans capsule. or simplicity' glomerular mesangial cells are not shown in this figure.
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Section of a human kidney. For clarity, the nehron illu!trated
to !ho" nehron orientation i! not to !cale#it! outline "ould
not $e clearly %i!i$le "ithout a micro!coe. &he outer kidney,
"hich contain! all the renal coru!cle!, i! the corte', and the
inner kidney i! the medulla. (ote that in the medulla, the loo!
of )enle and the collectin* duct! run arallel to each other.
&he medullary collectin* duct! drain into the renal el%i!.
+natomy of the
u'ta*lomerular aaratu!.
FIGURE 16–-
FIGURE 16–
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The three basic components of renal function. This figure is
to illustrate only the directions of reabsorption and secretion,
not specific sites or order of occurrence. *epending on the
particular substance' reabsorption and secretion can occur at
#arious sites along the tubule.
FIGURE 16–6
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.Kece!a'an e*rei (rin
GFR < Reab"rbi = Se*rei
. FILTRASI :
5'er%a)i me#a#(i memb.$#"mer(#(
5K"m!"ii ;#'ra' 9 !#ama*ec(a#i
'am!a !r"'en )an e#.
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• Kemam!(an Fi#'rai 4a' "#e2 $#"mer(#(
I>.Reab"rbi )an e*rei T(b(#i Gin%a# E*rei Urin 9 GF < Reab"rbi = Se*rei
Zat BM Kecepatan fltrasi
&O 1? 1
Na &+ 1
G#(*"a 1?@ 1
In(#in //.@@@ 1
i"$#"bin 1.@@@ @/A#b(min C.@@@ @@@/
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• Kece!a'an Fi#'rai Reab"rbiSe*rei
Zat umlahFil Reabs !kresi "Filt #gdireabsorb
G#(*"a $r32 1?@ 1?@ @ 1@@
Bi*arb"na'me$32
-+&@ -+&@ & .
Na'ri(mme32
&//C@ &/-1@ 1/@ -
K#"ri)ame32
1.-@ 1&C@ 1?@ 1
Ure(m -C.? &+.- &+- /@
Krea'inin 1.? @ 1? @
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• .e*anime Reab"rbi :
5Tran8"r' a*'i8
5Di8(i
5Pin"i'"i
5Om"i
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• Tran8"r' a*im(m
a' Tran8"' ma*
G#(*"a +&@ m$ 3 meni'
F"8a' @1@ mO 3 meni'
S(#8a' @@C mOm 3 meni'
Aam amin" 1/ m"m 3 meni'
Garam a (ra' 1/ m$ 3 meni'
La*'a' / m$3meni'Pr"'ein +@ m$r3meni'
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• T(b(#i )i'a# :
+ Se$men 'eba# A3 *"m!#e*555 %(6'a$r"mer(#i men$"n'r"# (m!an ba#i*GFR3a#iran )ara2.
+ Reab"rbi i"n Na K )an *#"ri)a
+ Ti)a* !ermeabe# 'er2a)a! air3 (re(m
T(b(#i )i'a# ba$ian a*2ir3 '(b *"#i$en:
5 membr '(b(#er im!ermeabe# 'er2a)a!(re(m
5 Reab"rbi Nae*rei K )an
5 Permeabi#i'a )i*"n'r"# "#e2 AD
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D(*'( *"#i$en me)(#a :◦ Permeabi#i'a )i*"n'r"# AD
◦ Permeabe# 'er2a)a! (re(m
>.K"ne! ,#earance Gin%a#
5Kemam!(an $in%a# memberi2*an !#ama)ara2 )ari (a'( 4a' !era'(an a*'(
5 , 9 U 6 >
P
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• Ba2an 0an$ )i!er$(na*an :
+ In(#in
+ PA + ,rea'inin
+ I"'a#ama' ra)i"a*'i8
FIGURE 16–/
,enal handling of three hypothetical substances -' ' and /. - is
filtered and secreted but not reabsorbed. is filtered' and a
fraction is then reabsorbed. / is filtered and completely reabsorbed.
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Kecepatan $learance Beberapa Zata' Kece!a'n ,#
G#(*"a @
Na @
,#"ri)a 1.+
Ka#i(m 1&
P"!a' &/
In(#in 1&/
Krea'inin 1-@
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FIGURE 16–0
orces in#ol#ed in glomerular filtration. The symbol
denotes the osmotic force due to the presence of protein in
glomerular capillary plasma.
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FIGURE 16–
*iagrammatic representation of tubular epithelium. 0n thisand subsequent figures illustrating transport in this chapter'
the basement membrane of the tubule&a homogeneous
proteinaceous structure that plays no significant role in
transport&will not be shown. (*o not confuse the
basement membrane with the basolateral membrane of the
tubular cells' as illustrated in this and subsequent figures.)
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FIGURE 16–1
1!ample of renal handling of inulin' a substance that isfiltered by the renal corpuscles but is neither reabsorbed nor
secreted by the tubule. Therefore' the mass of inulin
e!creted per unit time is equal to the mass filtered during
the same time period' and as e!plained in the te!t' the
clearance of inulin is equal to the glomerular filtration rate.
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FIGURE 16–11
"ontrol of the bladder.
icturation
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B#a)er ;##,erebera#
,"r'e6
S'rec2 ree!'"r
Para0m!2a'e'icner7e
B#a))er
In'erna# (re'2ra# S!2in'ermecanica##0 "!en 2en
b#a))er c"n'rac'i"n
B#a))erc"n'rac'i"n
"'"r ne(r"n '"e6'erna# !2in'er
E6'erna# (re'2ara!2in'er remain
c#"e) 2en m"'"rne(r"n i 'im(#a'e)
N" Urina'i"n
E6'erna# (re'2ra#!2in'er "!en 2en
m"'"r ne(r"nin2ibi'i"n
Urina'i"n
%olunter# controlRe&e' control
(
(
(
()
icturation
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• Bebera!a Ke#ainan K#ini* :1.Inc"'inence
5'i)* a)ar mi*i "ia#3 20$ine H
&.S're Inc"n'inence Snee4in$.c"($2in$E6ercie H+.Ur$e inc"n'inence )i'em(*an !a)a ani'aUm(r C@ '2n.
. Kan)(n$ Kencin$ A'"ni*55
Inc"n'inence"7er".Gan$$(an S )ia'a Sa*ra#.Gan$$(an in2ibii "'a*
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Pen$a'(ran Keeimban$an Naair )an !"'ai(m
1. Keeimban$an Naair )an ")i(m
5in'a*e :5!r")(*i 2ai# me'ab"#ime
5ma(* berama ma*anan @
5Wa'er #" :
5*in
5re!irai
5TGI5(rin
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• &.Pr"e )aar $in%a#
5,airan ;#'ra' Na )an air H 5
5&3+ ba$ian reab"rbi '(b !r"6.e*anime reab"rbi:
5Tran8"r' a*'i8 *ec(a#i )ecen L3
5Di8(i5beramaan )en$an Na
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FIGURE 16–122echanism of sodium reabsorption in the cortical collecting
duct. 2o#ement of the reabsorbed sodium from the
interstitial fluid into peritubular capillaries is shown in igure
34+35. The sizes of the letters for 6a and 7 denote high
and low concentrations of these ions. The fate of the
potassium ions transported by the 6a'78AT9ase pumps is
discussed in the later section dealing with renal potassium
handling.
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• +.,"(!#in$ "8 Wa'er Reab"rb'i"n '"S")i(m Reab"rb'i"n
5Na3$#(*3aa )an ,O+ #(men , In'er
5L"ca# Om"#ari'0 '(b( ba$ian baa2"m"i
5ne' )i8(i *"n air #(men5c In'er
5Air3Na34a' 'er#ar('55 , In'er5*a!i#er5Permeabi#i'a T(b55 AD
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5Wa'er Di(rei
5Diabe'e Ini!i)( 3 ,en'ra# Diabe'eIni
5Ne!2r"$enic Diabe'e Ini!i)(
5Om"'ic Di(rei
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FIGURE 16–13
"oupling of water and sodium reabsorption. :ee te!t for
e!planation of numbers. The reabsorption of solutes other than sodium&for e!ample' glucose' amino acids' and
bicarbonate&also contributes to the difference in osmolarity
between lumen and interstitial fluid' but the reabsorption of
all these substances is ultimately dependent on direct or
indirect cotransport and countertransport with sodium$
therefore' they are not shown in the figure.
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• Lan$*a2 0an$ men0ebab*an in'er'i'ia#me)(#a 2i!er"m"'i* :
1.Ana en#e 9 cairan !r"6 '(b(#(+@@
&.Tran8"r' a*'i8 Acen)en L3 *"nenrai
nai* &@@ mOm
+.Di8( i"n !a)a T(b(#i (n'(*
men$imban$i Tran8"r a*'i85 &@@"m3#
-,airan '(b(#i )ecen)en A33 in'er'i'ia#
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-@@ "m3#
/.Tamba2an cairan )ari T(b !r"6 *ecairan 2i!er"m"'i* men$a#ir *ecab
Acen)en 'e*anan cairan in'er'i'ia#2i!er"m"'i* /@@ "m3#
C.,airan cab Deen)en *eeimban$an
)en$an cairan in'er'i'ia#552i!er"m"'i*.Penamba2an 4a' 'er#ar(' MMM cairanme)(#a
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Keim!(#an Reab"rbi Na,# ber(#an$!a)a e$men 'eba# cab Acen)en A3)an !enamba2an Na,# bar( 'er(
mener( )ari '(b(#i !r"6 *e A3 a*anmenin$*a'*an 'e*anan Om )ari cairanin'er'i'ia#.
Rin$*aan me*anime !eme*a'an (rin
)an !er"ba2an "m"#ari'a !a)aberba$ai e$men '(b(#i :
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5T(b(#i Pr"6 : 5C/ ;#'ra'55 reab"bi
5!ermebi#i'a &" MM "m"i3)i8(i
5Om"#ari'a +@@ "m3#5,ab )ecen)en A3 :5Air )iab"rbi me)(#a5!emeabi#i'a air 3Na,# ber*(ran$2in$$a "m"#ari'a menin$*a' AD
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5AD ber*(ran$ "m"#ari'a cairan
in'er'i'ia# 1&@@ "m3# )an (re(me
)i*i' reab"rbi
5Se$men 'i!i A3 :
5Im!ermeabe# 'er2a)a! air
5M !ermeabe# 'er2a)a! Na,#
5 Ure(m )i8(i *e cab Acen)en L3
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5Se$men 'eba# L3 :
5Im!emeabe# 'er2a)a! air
5Tran8"r' a*'i8 *e #(men '(b(#(Na,#
)an K *e caban$ Acen)en ('rine
encer.
5Se$men aa# T(b(#i )i'a# :9 )en$an cab 'eba# Acen)en
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5,aban$ A*2ir T(b(#i )i'a# 3D(* K"#i$en:
5Om"#ari'a 'er$an'(n$ *"nen'rai
AD
5D(* K"##i$en me)(#a
5Om"#ari'a 'er$an'(n$ !a)a AD
5"m"#ari'a cairan in'er'i'ia# me)(#a
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5Gan$$(an !eme*a'an (rin :
5Se*rei AD
5Ker(a*an ar( ba#i*5Ke'i)a* mam!(an '(b )i'a#3)(*
*"##i$en mere!"n AD.
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5 Pen$a'(ran e*rei ADPenin$*a'an Pen(r(nan
Om"#ari'a !#ama
>"#(me )ara2ber*(ran$
BP men(r(n
Na(ea
i!"6ia
m"r!in a#*"2"#
ni*"'ine *#"ni)in
i*#"8"8ama) 2a#"!eri)"#
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5e*anime Pen$a'(ran E*rei Na )an air:
5N"rma#5555 e*rei $in%a# )ia'(r "#e2a(!an
5Gan$$(an rin$an555 *"m!enai 'b2
5$$n bera'555 i'emi*:BP3"rm"n )an
in2ibii
5Dia'(r : 5in2ibii GFR
5*ece!a'an reab"rbi
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Pen$a'(ran *a#i(m "#e2
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Pen$a'(ran *a#i(m "#e2$in%a#
• K !a)a ;#'ra' $#"mer(#(55 reab"rbi
'(b(#i !r"*ima# 3 e*rei D(*K"##i$en
.Ka)ar K )i'en'(*an "#e2 :
5Die'5"rm"n a#)"'er"n
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Pen$a'(ran *a)ar ,a#i(m "#e2
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Pen$a'(ran *a)ar ,a#i(m "#e2Gin%a#
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Pen$a'(ran K"nen'rai i"n
O#e2 Gin%a#
ISTILA
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ISTILA
• Ai)emia : P )ara2 .+/• A#*a#emia : P )ara2 . M -/• Ai)"i : !r"e !a'"#"$i* )imana 'er%a)i !enin$*a'an
i"n a'a( *e2i#an$an i"n Bi*arb"na'• A#*a#"i : Pr"e !a'"#"$i* )imana 'er%a)i !enin$*a'an
baa a'a( *e2i#an$an i"n • B(er Bae: %(m#a2 e#(r(2 c"n%($a'e baeQ 0an$ a)a
)a#am mm"#3L )ara2• N"rma# B(er Bae : %(m#a2 b(er bae !a)a P )an *a)ar,O+ n"rma#
• Bae E6ce : Se#ii2 an'ara b(er bae )an n"rma# b(erbaeN"rma# 9 5&/ 5 =&/H
= C < @ +/ - -/ < =55555555555I555555555555555I55555555I555555555I555555555555555I555555
ai)"i a#*a#"i
SO SS ,
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ENDERSON ASSELBAL,
P 9 !K = #"$ ,O+5
&,O+
9 !K = #"$ ,O+5
a. P,O&
!K 9 C1A 9 @@+
,O+5 9 &- &1 < &/ mm"#3#HPc"& 9 -@ +/ < -/ mm2$H
! 9 !K = #"$ ,O 57;29;616
21TAB;<07
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! 9 !K = #"$ ,O+
a 6 P,O&
!K 9 C1A 9 @@+
,O+5 9 &- &1 5 &/ mm"#3#H
P,O& 9 -@ +/ 5 -/ mm$H
! 9 C1 = #"$ &-
@@+ 6 -@
9 C1 = #"$ &-
1& 9 C1 = #"$ &@
1
9 C1 = 1+
9 -
21TAB;<07
7;29;616
,1:90,AT;:07
7/21/2019 ginjal ok
http://slidepdf.com/reader/full/ginjal-ok-56da399636dc6 72/107
• Si'em b(er• Peran Gin%a#• Peran !ar(5!ar(
• N"n bi*arb"na')i!ar(5!ar( : b = O& bO& = 5
)i%arin$an : bO& = b = O&
• Bi*arb"na')i!ar(5!ar( : ,O+
5 = = &,O+&O = ,O&
:istim 7ompensasi
:istim Buffer
7/21/2019 ginjal ok
http://slidepdf.com/reader/full/ginjal-ok-56da399636dc6 73/107
PLASA : 5 Pr"'ein
: 5 Bi*arb"na' +/
: 5 F"8a' an"r$ani* &
ERITROSIT : 5 em"$#"bin +/
5 Bi*arb"na' 1?
5 F"8a' an"r$ani* &
5 F"8a' "r$ani* +
Si!tim 4uffer 5aya enyan**ah
7/21/2019 ginjal ok
http://slidepdf.com/reader/full/ginjal-ok-56da399636dc6 74/107
en$e#(ar*an aam :
• ai# me'ab"#ime !r"'ein
• ai# *a'ab"#ime 8"8"#i!i)
• O*i)ai *arb"2i)ra'• O*i)ai Li!i)
eran Ginal
eran aru7aru
7/21/2019 ginjal ok
http://slidepdf.com/reader/full/ginjal-ok-56da399636dc6 75/107
H=;
0nsp
H=;
aru7aru
H";58
H=";5
";=
1-9
;=
H>
H";58 H";5
8
HHb HHb HHb
Hb;= Hb;= Hb;=
;=
H>
H=";5
";=
8arin*an
9ena
Sirkula!i
arterieta$oli!me
+!ido!i! Re!iratorik
7/21/2019 ginjal ok
http://slidepdf.com/reader/full/ginjal-ok-56da399636dc6 76/107
• De!rei !(a' !erna8aan
• Ob'r(*i a#(ran na8a• Para#ii "'"' !erna8aan
EKANISE KOPENSASI• Si'em B(er : P,O& ,O& $aH
,O&
&,O+ = B(8er5 B(8er =,O+
5
• e*anime $in%a# : ,O+5 )i!er'a2an*an
hipo#entilasi
9";=
terlarut
:1:F*AH:1:F*AH:B<:B<6;,2A6;,2A :B<:B<
7/21/2019 ginjal ok
http://slidepdf.com/reader/full/ginjal-ok-56da399636dc6 77/107
?'5=?'5=?'=?'=?'@?'@9H9H
3@ 33@ 3' 3' 3=C 3=C 3,AT0; H";,AT0; H";55
C'C5-p";C'C5-p";==
='?='?='?='?3'=3'=C.C5 - p";C.C5 - p";==
DCDCDCDC@C mmHg@C mmHg9";9";==
55=@=@=@ mmolEl=@ mmolElH";H";55
7;297;297;29.7;29.<< 7;29.7;29.
+lkalo!i! Re!iratorik
7/21/2019 ginjal ok
http://slidepdf.com/reader/full/ginjal-ok-56da399636dc6 78/107
Ran$an$an !(a' !erna8aan em"i a#ii#a'
N+ i!"*emiaH
i!er7en'i#ai
P,O&
EKANISE KOPENSASI Si'im B(er
,O+5 = b(er B(er5 = &,O+ ,O&
e*anime Gin%a#
Bi*arb"na' )i*e#(ar*an "#e2 $in%a# )a#am ben'(*Na&,O+ 0an$ beri8a' a#*a#i
+lkalo!i! Re!iratorik
:1:F*AH:1:F*AH:B<:B<6;,2A6;,2A
7/21/2019 ginjal ok
http://slidepdf.com/reader/full/ginjal-ok-56da399636dc6 79/107
?'GC?'GC?'GG?'GG?'@?'@9H9H
55'5 355'5 3@C 3@C 3=C 3=C 3,AT0; H";,AT0; H";55
C'C5-p";C'C5-p";==
C'4C'4C'4C'43'=3'=C.C5 - p";C.C5 - p";==
=C=C=C=C@C mmHg@C mmHg9";9";==
=C=C=@=@=@ mmolEl=@ mmolElH";H";55
7;297;297;29.7;29.<<
+!ido!i! eta$olik
7/21/2019 ginjal ok
http://slidepdf.com/reader/full/ginjal-ok-56da399636dc6 80/107
Aam )ari #(ar ai# "*i)ai 'a* #en$*a!
)ari #ema* ben)a *e'"n
)ari *arb"2i)ra' aam #a*'a' Ke2i#an$an bi*arb"na' me#a#(i $in%a# a'a( a#(ran cerna
EKANISE KOPENSASI Si'im B(er
= = ,O+5 &,O+
= = b(8er b(8er
&,O+ = b(8er B(8er = ,O+5
e*anime !ar(&,O+ &O = ,O& 2i!er7en'i#ai
e*anime Gin%a#
mem!er'a2an*an bi*arb"na'
menin$*a'*an reab"r!i )an re$enerai
H";58
:1:F*AH:1:F*AH:B<:B<6;,2A6;,2A
7/21/2019 ginjal ok
http://slidepdf.com/reader/full/ginjal-ok-56da399636dc6 81/107
?'@?'@?'=?'=?'@?'@9H9H
=C 3=C 33='G 33='G 3=C 3=C 3,AT0; H";,AT0; H";5588
C'C5-p";C'C5-p";==
C'?GC'?G3'=3'=3'=3'=C.C5 - p";C.C5 - p";==
=G=G@C@C@C mmHg@C mmHg9";9";==
3G3G3G3G=@ mmolEl=@ mmolElH";H";55
7;297;297;29.7;29.<<
+lkalo!i! eta$olik
7/21/2019 ginjal ok
http://slidepdf.com/reader/full/ginjal-ok-56da399636dc6 82/107
Pemberian bi*arb"na'
O*i)ai $aram )ari aam "r$ani*#a*'a'i'ra'ae'a'H
Ke2i#an$an = m(n'a2H K = me#.$in%a#H
EKANISE KOPENSASI Si'im b(8er
,O+5 = b(8er b(8er5 = &,O+
e*anime Par(
menin$*a'*an !,O& )en$an 2i!"7en'i#ai e*anime Gin%a#
memb(an$ bi*arb"na' )en$an men$(ran$ireab"r!i )an re$enerai
:1:F*AH:1:F*AH
7;29:B<:B<
7;296;,2A6;,2A
<
7/21/2019 ginjal ok
http://slidepdf.com/reader/full/ginjal-ok-56da399636dc6 83/107
?'G?'G?'4?'4?'@?'@9H9H
='3 3='3 353'4 353'4 3=C 3=C 3,AT0; H";,AT0; H";5588
C'C5-p";C'C5-p";==
3'5G3'5G3'=3'=3'=3'=C.C5 - p";C.C5 - p";==
@G@G@C@C@C mmHg@C mmHg9";9";==
5555=@ mmolEl=@ mmolElH";H";5588
7;297;297;29.7;29.<<
9co=H";58
7/21/2019 ginjal ok
http://slidepdf.com/reader/full/ginjal-ok-56da399636dc6 84/107
6;,2A<
6;,2
A<
3
@5
=
3. Asidosis ,espiratori (primer p";= )
=. Alalosis 2etaboli (primer H";58 )
5. Alalosis ,espiratori (primer 9";= )
@. Asidosis 2etaboli (primer H";58
)
9H
:;2 normal
7/21/2019 ginjal ok
http://slidepdf.com/reader/full/ginjal-ok-56da399636dc6 85/107
:;2 normal
)
(;R+< (;R+<
RE(5+)
&I(GGI
+SI5;SIS E&+4;<I=
+<=+<;SIS E&+4;<I=
:;2
7/21/2019 ginjal ok
http://slidepdf.com/reader/full/ginjal-ok-56da399636dc6 86/107
2
)
(;R+<
+SI5;SIS RESIR+&;RI=
&erkomen!a!i atau +<=+<;SIS E&+4;<I=
terkomen!a!i
RE(5+)
&I(GGI+<=+<;SIS E&+4;<I= dan
+SI5;SIS RESIR+&;RI=
+SI5;SIS RESIR+&;RI=
:;2
7/21/2019 ginjal ok
http://slidepdf.com/reader/full/ginjal-ok-56da399636dc6 87/107
2
+<=+<;SIS RESIR+&;RI=
&erkomen!a!i atau +SI5;SIS E&+4;<I=
terkomen!a!i
)
(;R+<
RE(5+)
&I(GGI +<=+<;SIS RESIR+&;RI=
+SI5;SIS E&+4;<I= dan
+<=+<;SIS RESIR+&;RI=
7/21/2019 ginjal ok
http://slidepdf.com/reader/full/ginjal-ok-56da399636dc6 88/107
7/21/2019 ginjal ok
http://slidepdf.com/reader/full/ginjal-ok-56da399636dc6 89/107
7/21/2019 ginjal ok
http://slidepdf.com/reader/full/ginjal-ok-56da399636dc6 90/107
Pen$a'(ran a (m " eGi % #
7/21/2019 ginjal ok
http://slidepdf.com/reader/full/ginjal-ok-56da399636dc6 91/107
Gin%a#
• "me"'ai )i'en'(*an "#e2 T(#an$Ren
TGI
. '"'a# ,a#i(m '(#an$
7/21/2019 ginjal ok
http://slidepdf.com/reader/full/ginjal-ok-56da399636dc6 92/107
Gin%a#:5C@ ,a !#ama )i;#'rai ca! B"man
)i reab"rbi T(b Pr"*ima#
5Di*"n'r"# "#e2 : 5GIT
5"rm"n :5Para'20r"i)
51&/ Di0)r"6i7i'aminD
5,a#ci'"nin
• Ke#ainan K#ini* :
7/21/2019 ginjal ok
http://slidepdf.com/reader/full/ginjal-ok-56da399636dc6 93/107
• Ke#ainan K#ini* :
5Ric*e'
5O'e"ma#acia
5inera#iai
5O'e!"r"i
7/21/2019 ginjal ok
http://slidepdf.com/reader/full/ginjal-ok-56da399636dc6 94/107
• Pence$a2an:
5E'r"$en 5 !"'men"!a(e
5BB
5Die' 1@@@51/@@ m$32
5>i' D
5Bi!2"!2"na'
5An'i Reab"rbi 55 ,a#ci'"nin )an
Se#ec'i7e E'r"$en Ree!'"r ")(#a'"r
7/21/2019 ginjal ok
http://slidepdf.com/reader/full/ginjal-ok-56da399636dc6 95/107
DIURETIK DAN BEBERAPA
PENYAKIT GINJAL
DIURETIK :5a' 0an$ )a!a' menin$*a'*an #a%( 7"#(me (rin5Pen$$"#"n$an Di(re'i* me*anime *er%a'em!a' *er%a
7/21/2019 ginjal ok
http://slidepdf.com/reader/full/ginjal-ok-56da399636dc6 96/107
*ol
+iuretik
Mekanisme kera Tempat kera
Om"'i* In2ibii reab"rbi air T(b !r"6ima#
Len$*(n$ In2ibii *"'ran Na3K3,# )i#(men Ba$ 'eba# A3 Ac
Tia4i) In2ibii *"'ran Na,# Aa# '(b )i'a#
In2ibii ,A In2ibii Se*rei )ane*rei,O+ i"n
T(b !r"6ima#
In2ibii*"m!e'i'i8A#)"'er"n
In2ibii ree!'"r '(b(#i D(* *"##i$en
B#"* ,2ane#
Na
In2ibii reab"rbi Na )an
e*rei i"n
D(* *"##i$en
7/21/2019 ginjal ok
http://slidepdf.com/reader/full/ginjal-ok-56da399636dc6 97/107
BERAPA PENYAKIT GINJAL 51- USA 1/ %('a !en)eri'a 5Pen$e#"m!"**an: 1.$a$a# $in%a# a*(' $$aH
&.Ga$a# $in%a# *r"ni* $$*H 5e#i!('i : 5!emb(#(2 )ara2 5$#"mer(#(
5'(b(#( 5in'er'i'ia# 5ba$ian (rinari(
7/21/2019 ginjal ok
http://slidepdf.com/reader/full/ginjal-ok-56da399636dc6 98/107
GGA : 5Prerena#:(!#ai )ara2 0an$ ber*(ran$ 5In'ra rena# 5P"' rena#
E'i"#"$i : 1.Pen(r(nan 7"#(me in'ra 7a*(#er &.Ga$a# %an'(n$
+.Ke#ainan 2em")inami* $in%a# !rim -.7a")i#a'ai !eri8er )an 2i!"'eni
7/21/2019 ginjal ok
http://slidepdf.com/reader/full/ginjal-ok-56da399636dc6 99/107
GAGAL GINJAL Rena# 5$#"mer(#( 5e!i' '(b(#i 5in'er'i'ia#
.ne*r"i '(b(#i
.ne*r"i *rn i*2emia .ne*r"i '(b(#i *rn '"*in 3 "ba'
GGA P" Rena# : 1.S(mba'an bi#a'era# (re'er3!e#7i rena# &.(mba'an *an)(n$ *encin$ +.S(mba'an (re'er
7/21/2019 ginjal ok
http://slidepdf.com/reader/full/ginjal-ok-56da399636dc6 100/107
A*iba' GGA : 5Re'eni : )ara23,E3en) !r")(c' 5E)ema 3 i!er'eni 5Re'eni K ? m$3L55 8a'a#
5"#i$"(ria 3 An(rea 5Kema'ian ) ?51-
Ga$a# Gin%a# Kr"ni*55 %(m#a2 ne8r"n '(r(n
5Ber*(ran$n0a %(m#a2 ne8r"n &@ 5K#ini be#(m m(nc(# *er(a*an ne8r"n @ .
7/21/2019 ginjal ok
http://slidepdf.com/reader/full/ginjal-ok-56da399636dc6 101/107
• BERAPA PENYEBAB GGK :
5 im(n"#"$i
5 me'ab"#i*
5!emb(#(2 )ara2 $in%a#
5in8e*i
5'(b(#( !rimer
5"b'r(*i 'ra* (rinari(
5Ke#ainan *"n$$eni'a#
7/21/2019 ginjal ok
http://slidepdf.com/reader/full/ginjal-ok-56da399636dc6 102/107
7/21/2019 ginjal ok
http://slidepdf.com/reader/full/ginjal-ok-56da399636dc6 103/107
Sin)r"ma NEFROTIK 55 PROTEINUREA .E'i"#"$i :
5GNK 5Ami#"i)"i
5Sin)r"ma Ne8r"'i* !er(ba2an minima# .Ne8r"!a'i : ana* M )eaa
.Ke#ainan F(n$i Ne8r"n !) GGK 62i#an$n0a 8(n$i ne8r"n
5N"rma# 1?@ L Fi#'rai3&- %am 5*er(a*an ne8r"n @ 55 8(n$i bai* 5Kema'ian 'er%a)i bi#a ne8r"n /51@ N"rma#
7/21/2019 ginjal ok
http://slidepdf.com/reader/full/ginjal-ok-56da399636dc6 104/107
6.I"'en(ria5 *e$a$a#an !en$enceran3!e5 me*a'an (rin : 5a#iran cairan '(b(#( menin$*a'
5a#iran ce!a' me#ea'i A3
PENGARU GAGAL GINJAL PD ,AIRAN TUBU5UREIA:
5Ter$an'(n$ : 5a(!an 5'in$*a' $an$$(an 8(n$i $in%a#
7/21/2019 ginjal ok
http://slidepdf.com/reader/full/ginjal-ok-56da399636dc6 105/107
5Pen$ar(2 !en'in$ :
5E)ema
ai)"i
5*"nen'rai ni'r"$en n"n !r"ein
'er)iri a'a (re(m*rea'inin.(ric Ac
5Uremia
5Anemia
5"'e"ma#aia
7/21/2019 ginjal ok
http://slidepdf.com/reader/full/ginjal-ok-56da399636dc6 106/107
IPERTENSI: 1.*e$a$a#an e*rei Na : 5rei'eni !emb(#(2 )ara2 nai*
5*"e;en GFR '(r(n 5reab"rbi Na T(b nai* &.*er(a*an #"*a# !enin$*a'an e* renin
Pen$"ba'an $a$a# $in%a# )en$an )ia#iiDen$an $in%a# b(a'an.
7/21/2019 ginjal ok
http://slidepdf.com/reader/full/ginjal-ok-56da399636dc6 107/107
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