sistem uropoetika.doc
TRANSCRIPT
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SISTEM UROPOETIKA
Oleh dr Sri Wahyu B. Prasetyo
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SISTEM UROPOETIKA
KELENJAR ENDOKRIN
PEMBENTUKAN DAN
SEKRESI URIN
PENDAHULUAN
MENGATUR KESEIMB
CAIRAN & ELEKTROLIT
MEKANISME BERKEMIH
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PENDAHULUANSISTEM UROPOETIKA
-PEMBENTUK URINE
-PENYALUR URINE
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PERAN DLM HOMEOSTASIS
• membantu menatu! "#$ume %#m'#()() e$et!#$)t%'H
$)n )nte!na• mene$)m)na() '!#*u+ ()(a metab#$)(me,EKSKRESI
URINE
• .UNGSI• /0e(!e() u!)ne ,'embentuan
• +0e$en1a! en*#!)n 2 -3#!m#n !en)n
2 -3#!mn e!)t!#'#e)t)n 2 -3#!m#n a$()t!)#$
• 40menatu! 5a)!an tubu3 & )#n
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GINJAL
be!bentu a5an%uu!an /+5m 6 +%75m
+ bua3%anan 8!en*a3 *! )!)$eta !et!#'e!)t#nea$t0* 8+ 1uta ne9!#n,(atuan 9un()#na$ %ebutu3an
9un()#na$ /:4 n;a
+ JENIS NE.RON
/0ne9!#n #!t)a$
-<=>
-a$)!an 8 5e'at 96 9)$t!a()
-30 e!)t!#'#et)n +0ne9!#n 1u6tame*u$a!e
-an(a 3an$e 8 'an1an .6 #n(ent!a() u!)n
-30!en)n #$e3 a''a!atu( 1u(tame*u$a!e
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PEMBENTUKAN DAN
EKSKRESI URIN
3
P
R
O
S
E
S
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4 PROSES
/0.ILTRASI GLOMERULUS-#$e3 memb!an 9)$t!a()
-(e$ en*#te$ a')$e!
-memb!an ba(a$)(
-(e$ e')t3e$ ")(e!a$ a'(u$a B#?man
-te!9)$t!at@'$a(ma
-9)$t!at@a)!%)#n ,Na%K%C$ %()(a n)t!#en ,u!ea%a(am
u!at%!eat)n)n%m#$eu$ #!an) ,$u#(a%a(amam)n#
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Yan *)9)$t!a() a*a$a3 *a!a3 a')$e! $#me!u$u(
-a')$e! $ 88 'e!meabe$
-9)$t!a() be!$an(un *)(e$u!u3 '1 a')$e!
TEKANAN .ILTRASI
/0te 3)*!#(tat) a')$e! ,N 77 mmH
+0te #(m#t) '$a(ma ,4= mmH
40te 3)*!#(tat) 5a'(u$a b#?man ,/7 mmH
T. 77 2 ,4=/7 /= mmH
G.R T. 6 9
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• 5a!*)a5 #ut'ut ,7L:mnt
• !ena$ b$##* 9$#? ,+7> 6 7L/+7= m$:mnt
• !ena$ '$a(ma 9$#? ,77> 6 /+7= == m$:mnt
• glomerulus filtrasi rate +=> 6 == m$ /+7-/7= m$:mnt
• !eab(#!b() 8 >---u!)ne ---/ m$:mnt
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G.R
-*)'ena!u3) #$e3@-te 9)$t!a()
-9 ,$ua( 'e!m & 'e!meab $-#nt! !eab(#!b() tub
-*)#nt!#$ + mean)(me
#t#!eu$a() ,!entan <=- /<= mmH
()m'at)(a$)!an 88 G.R 88 a'' 1u(tame*u$a!e
Fat "a(#at)9
a$)!an "a(##nt!)() a a9e!ent
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Ke(e)mbanan $#me!u$u( & tubu$u(
G.R Reab(#!b() tub U!)ne
7= %< =%+
/== %7 =%7/+7 /+ /
/7= /7 7
G.R na) (e*))t%"#$ume u!)n na) b;
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+0REABSORBSI TUBULUS
• Pe!')n*a3an ba3an e(en()a$ *! $umen tub e a')$e!
'e!)tubu$u(• Sanat (e$et)9: Fat-Fat ; be!una $u#(a%aa%Na%*$$
• S)(tem t!an('#!ta() t!an( e')te$ ,
• $umen (e$ tub 5 )nt a')$e!
• Reab(#!b() Na (5! @ *)9u()
• t!an('#!t at)9 ,Na K ATP a(e
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Pembagian Fungsional Tubuli Renal
Pars
Sekretoris
(Nefron)
Pars
Ekskretoris
K#!'u(u$um Ma$'3))
Rena$)( ,G$#me!u$u(*an Ka'(u$a B#?man
Tubu$u( #nt#!tu(
P!#()ma$
Lenun Hen$e,ascending, discending.
Tubu$u( K#$et)"u(
Dutu( Pa')$a!)( Be$$)n)
Tubu$u( K#nt#!tu( *)(ta$
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• T,C. Proksimal
• Re(#!b() '!#te)n% a0am)n#% $u#(a % Na
,> *an C$ *a!) 5a)!an 9)$t!at me$a$u) at)9t!an('#!t0
• A)! be!*)9u() (e5a!a 'a()9 men)ut)!a*)en #(m#t)0,7>
Lengkung enle
Mem'e!ta3anan !a*)en 3)'e!t#n) *a$am me*u$a
me$a$u) '!a(e( at)9 *an 'a()9 t!an('#! )#n *an'!#te)n0
Na +7>0%a)! !eab(#!b() /7>
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T. !oligentes
mu$a) 'a!( a(5en*en an(a 3en$e 2tub )n)@)m'e!meab$e
t3* a)! & u!ea
Bee!1a ata( 'ena!u3 ADH @ 'e!m)abe$ te!3a*a' a)!,!eten() a)! 0 Me*u$a ;an 3)'e!t#n)( men;ebaban
a)! aan ma(u e )nte!(t)())$ *an u!)ne men1a*) $eb)3
3)'e!t#n)(0
!eab Na *) tub *)(ta$ & #$eente( <>
T.C "istal
Pe!tua!an )#n *enan 'ena!u3 A$*#(te!#n ,!eten() Na *an
e(!e() K0
40SEKRESI TUBULUS
• Fat-Fat t* be!una @u!ea%!eat)n)n *$$
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-)nu$)n )*ea$ unt 'm6 G.R
-5!eat)n)n *)'aa) *$m $)n)(
lumen tubulus
)nu$)n $u#(a PAH
G.R0P6U60 8
TEST .UNGSI TUBULUS
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TEST .UNGSI GINJAL
Stae G.R > C!eat)n)n '$a(ma m>
A N#!ma$ N#!ma$
B 7=-<= n-+% C +=-7= +%7-%
D /=-+= 7 - %
E 7-/= < - /+ . 7 8/+
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PEMEKATAN DAN PENGENCERAN URIN
-e$eb)3an 5a)!an @ membentu u!)n en5e!
-*e3)*!a() @ membentu u!)n 'eat ab(#!b() (#$ute%a)!
mean)(me 5#unte! 5u!!ent
me a$)!an be!$a?anan a!a3
-5)'taan !a*)en #(m#t) )nte!(t me*u$a
-'a!( a(5en*en@NaC$ e$ua!%)m'e!meabe$ H+O
-'a!( *e(5en*en @ H+O e$ua!
-u1un an(a 3en$e Peat
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Pemekatan # Pengen$eran %rin
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'e!1a$anan u!)ne
• $#me!u$u(--tubu$u(--
'!#6)ma$)(--tubu$u(
*e(5en*en--an(a
3en$e--tubu$u(
a(5en*en--tubu$u(*)(ta$--tubu$u(
5#$eente(--'e$")(--
e!ete!--an*unem)3--u!et!a
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• (a$0+75m
• men3anta!an u!)ne *! )n1a$ menu1u
an*un em)3%m( (e!#n ,5ea3 a$)!an
ba$)
URETER
A$)!an u!)ne *)(ebaban@
/0a;a !a")ta()
+0#nt!a() u!ete!
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KANDUNG KEMIH• !e(e!"#a! u!)ne
URETRA• mene$ua!an u!)ne
*! an*un em)3?t be!em)3
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G)n1a$ men3a()$an 4 3#!m#n
- !en)n @ *) bt (e$ 1u(ta$#me!u$u(
menatu! 5a)!an *an e$et!#$)t
-e!)t!#'#et)n @ *)bt 5a')$e! 'e!)tubu$e!ne9!#n #!t)a$%
'embt e!)t!#()t
-a$()t!)#$ @ tubu$u( '!#6)ma$ menatu! Ca '$a(ma
KELENJAR ENDOKRIN
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SISTEM RENIN ANGIOTENSIN
ALDOSTERON&ngiotensinogen
&ngiotensin '
&ngiotensin ''
&ktiitas Simatis
*. Tak+ikari
-. !ontraksimiokar
asokosntriksi
Resistensi erifer
Skresi &losteron
*. Restensi Na
-. Ekskresi !
3. Retensi $airan
/. olume ara+ 0
Skresi &"
Retensi $airan
Tensi "ara+ meningkat
Renin
& C E
!onisi "e+irasi,
NaCl 1,T"1
Sel 2uta
Paru
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Inte!a() HPT & a$()t!)#$ *$m men#nt!#$ Ca '$a(ma
Ca '$a(ma
PTH
At)9 ")t D
u(u(
Ca '$a(ma 88
)n1a$
E(!e() Ca
Reab(#!b() Ca
Ke$1 'a!at)!#)*
Re(#!'() Ca 88
tu$an
Se!a' Ca 88
a$()t#n)n
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H#!m#n Pa!at)!#)*
• .6@
- Mem#b)$)(a() Ca *a!) tu$an
- Men)natan 'embuanan '3#('at(e3)na a*a! '3#('at e(t!a(e$ tu!un
- Men)natan ab(#!b() Ca *a!) t!atu(
*)e(t)"u( - Men)natan Ca 'a*a tubu$u( )n1a$
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-!eab(#!b() *an (e!e()
-e(e)mbanan a(am ba(a
MENGATUR KESEIMB
CAIRAN & ELEKTROLIT
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Membuan )#n H ,3($ metab#$)(me (9 a(am
D) tubu$u( )n1a$
/0Petua!an )#n H * Na
+0Se!e() NH
40Bu99e! '3#('at :H+PO
CES (e$ tub $umen tubu$u( ,H
CO+H+O CO+ H+O Na Na
H+CO4 HCO4- H+CO4
K
NaHCO4 HCO4- HCO4- H
NH4 NH
HPO- H+PO
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KONTROL RE.LEK KONTROL OLUNTER
MEKANISME BERKEMIH
Re(e't !ean
'a!a()m'at)(
0U
S U Inte!num te!bua
#nt!a()
0U te!)() K#!te (e!eb!um
N m#t#!)
S U e(te!num tutu'
S U e(te!num bua
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• Mean)(me be!em)30
2 D)'ena!u3) 'a!a()m'at)( (e!ta )m'u$( (a!a9"#$unte!0
2 Ot#t 'a*a an*un em)3 ;an mene$)$)n)
1a$an e$ua! e u!et!a ,(9)nte! u!et!a )nte!na$
(enant)a(a be!#nt!a() men1aa (u'a;a
$uban )n) teta' te!tutu'0 D)'ena!u3) #$e3
(a!a9 'a!a()m'at)(0
2 Ot#t (9)nte! u!et!a e(te!na$ te!*)!) *a!) #t#t!ana ;an e!1an;a (e5a!a "#$unte!0
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• D) *)n*)n an*un em)3 te!*a'at #t#t *et!u(#!;an b)$a be!#nt!a() men;ebaban u!)n *a$am
an*un em)3 te!*#!#n e$ua!0
• B)$a *a$am an*un em)3 te!*a'at u!)n 4== 2
== m$% maa te!1a*) !an(anan 'e!eanan'a*a *)n*)n an*un em)30
• Kemu*)an )m'u$( )n) *))!)m e #ta% (e3)na
men;ebaban a*an;a )m'u$( 'a!a()m'at)( ;anmen;ebaban #nt!a()n;a #t#t *et!u(#!%
!e$a(a() #t#t (9)nte! )nte!na$ *an e(te!na$0
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• A*a 1ua mean)(me 'en5ea3an
be!em)30• Ha$ )n) *)mun)nan *enan a*an;a
)m'u$( "#$unte! ;an men;ebaban b)(a
*)tun*an;a #nt!a() #t#t *et!u(#! *an!e$a(a()n;a #t#t (9)nte!0
• Sam'a) umu! /< bu$an% )m'u$( "#$unte! )n)
be$um bee!1a *enan ba)0