ginjal ok

7/21/2019 ginjal ok

http://slidepdf.com/reader/full/ginjal-ok-56da399636dc6 1/107

GINJAL DAN PENGATURAN

AIR DAN ION INORGANIK

Dr.YASWIR YASRIN

BAGIAN FISIOLOGI

7/21/2019 ginjal ok


7/21/2019 ginjal ok


• 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#

7/21/2019 ginjal ok


7/21/2019 ginjal ok


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

7/21/2019 ginjal ok


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

7/21/2019 ginjal ok


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.

7/21/2019 ginjal ok


7/21/2019 ginjal ok


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.

7/21/2019 ginjal ok


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–

7/21/2019 ginjal ok


7/21/2019 ginjal ok


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

7/21/2019 ginjal ok


.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#.

7/21/2019 ginjal ok


• 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.@@@ @@@/

7/21/2019 ginjal ok


• 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? @

7/21/2019 ginjal ok


• .e*anime Reab"rbi :

5Tran8"r' a*'i8

5Di8(i

5Pin"i'"i

5Om"i

7/21/2019 ginjal ok


• 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'

7/21/2019 ginjal ok


• 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

7/21/2019 ginjal ok


7/21/2019 ginjal ok


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

7/21/2019 ginjal ok


• 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.

7/21/2019 ginjal ok


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-@

7/21/2019 ginjal ok


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.

7/21/2019 ginjal ok


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.)

7/21/2019 ginjal ok


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.

7/21/2019 ginjal ok


FIGURE 16–11

"ontrol of the bladder.

icturation

7/21/2019 ginjal ok


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

7/21/2019 ginjal ok


• 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*

7/21/2019 ginjal ok


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

7/21/2019 ginjal ok


7/21/2019 ginjal ok


• &.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

7/21/2019 ginjal ok


7/21/2019 ginjal ok


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.

7/21/2019 ginjal ok


• +.,"(!#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

7/21/2019 ginjal ok


5Wa'er Di(rei

5Diabe'e Ini!i)( 3 ,en'ra# Diabe'eIni

5Ne!2r"$enic Diabe'e Ini!i)(

5Om"'ic Di(rei

7/21/2019 ginjal ok


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.

7/21/2019 ginjal ok


• 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#

7/21/2019 ginjal ok


-@@ "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

7/21/2019 ginjal ok


7/21/2019 ginjal ok


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 :

7/21/2019 ginjal ok


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

7/21/2019 ginjal ok


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

7/21/2019 ginjal ok


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

7/21/2019 ginjal ok


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

7/21/2019 ginjal ok


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.

7/21/2019 ginjal ok


7/21/2019 ginjal ok


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)"#

7/21/2019 ginjal ok


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

7/21/2019 ginjal ok


7/21/2019 ginjal ok


Pen$a'(ran *a#i(m "#e2

7/21/2019 ginjal ok


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

7/21/2019 ginjal ok


7/21/2019 ginjal ok


Pen$a'(ran *a)ar ,a#i(m "#e2

7/21/2019 ginjal ok


Pen$a'(ran *a)ar ,a#i(m "#e2Gin%a#

7/21/2019 ginjal ok


7/21/2019 ginjal ok


Pen$a'(ran K"nen'rai i"n

O#e2 Gin%a#

ISTILA

7/21/2019 ginjal ok


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 ,

7/21/2019 ginjal ok


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

7/21/2019 ginjal ok


! 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


• 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


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


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


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


• 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


?'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


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


?'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


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


?'@?'@?'=?'=?'@?'@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


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


?'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


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


:;2 normal

)

(;R+< (;R+<

RE(5+)

&I(GGI

+SI5;SIS E&+4;<I=

+<=+<;SIS E&+4;<I=

:;2

7/21/2019 ginjal ok


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



:;2

7/21/2019 ginjal ok


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


7/21/2019 ginjal ok


Pen$a'(ran a (m " eGi % #

7/21/2019 ginjal ok


Gin%a#

• "me"'ai )i'en'(*an "#e2 T(#an$Ren

TGI

. '"'a# ,a#i(m '(#an$

7/21/2019 ginjal ok


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


• Ke#ainan K#ini* :

5Ric*e'

5O'e"ma#acia

5inera#iai

5O'e!"r"i

7/21/2019 ginjal ok


• 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


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


*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


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


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


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


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


• 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


7/21/2019 ginjal ok


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


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


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


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


ginjal ok

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