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fisiologi ginjal scribd

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  • 1. FISIOLOGI GINJAL Shofa chasani Bag. Fisiologi dan sub bag penyakit ginjal hipertensi Penyakit Dalam FK UNDIP/ RSUP DR Kariadi Semarang
  • 2. Fisiologi GINJAL Regulation of body fluid osmolality and volume Regulation of electrolyte balance Regulation of acid-base balance Excretion of metabolic product and foreign substance Production and secretion of hormones
  • 3. PHYSIOLOGY OF BODY FLUID 1.PHYSICOCHEMICAL PROPERTIES OF ELECTROLYTE SOLUTION 2.VOLUME OF BODY FLUID COMPARTMENTS 3.MESASUREMENT OF BODY FLUID VOLUME 4.COMPOSITION OF BODY FLUID COMPARTMENT 5.FLUID EXCHANE
  • 4. VOLUMES OF BODY FLUID COMPARTMENT Total body water(TBW)=0,6BW=42 L ECF=1/3 TBW=14L ICF=2/3 TBW=28L Interstial fluid ¾ ECF =10,5L Plasma=1/4ecf 3.5L Cell mbr Cap. endotel
  • 5. FLUID EXCHANG BETWEEN BODY FLUID COMPARTMEN Capillary fluid exchange : Fluid movement =Kf [(Pc +Oi)- (Pt=Oc)] Kf=filtration coeff of the cap. Wall Pc=hydrostatic pressure within the cap. Lumen. Oc= oncotic pressue of the plasma. Pt = hydrostatic pressure of the interstitium Oi = oncotic pressure of the interstitial fluid.
  • 6. Celluler fluid exchange : osmotic pressure difference between ECF and ICF are responsible for fluid movement between these compartment
  • 7. ALTERATION IN STARLING FORCE . Increasing in capillary hydrostatic (Pc) Decrease in plasma oncotic pressure(Oc) Lymphatic obstruction. Increase in capillary permiabelity.
  • 8. THE ROLE OF THE KIDNEY VENOUS PRESSURE CAPILLARY HYDROS PRESSURE MOVE OF FLUID INTO INTERSTITIUM PLASMA VOLUME VOL RECEPTORS DETECT ECF NaCl and H2O Reabsorption by The kidney Restore plasma volume
  • 9. STRUCTURE AND FUNCTION OF THE KIDNEYS AND THE LOWER URINARY TRACT OBYECTIVES 1.Describe the location of the kidneys and their gross anatomical feature. 2.Describe the defferent parts of the nephron and their location within the cortex and medulla. 3.Identify the components of the glomerulus and the cell types located in each component. 4.Describe the structur of glomerular capillaries and identify which structures are filtration barriers to plasma proteins.
  • 10. OBYECTIVE 5.Describe the components of the yuxtaglomerular apparatus and the cells located in each component 6.Describe the bood supply to the kidneys. 7.Describe the innervation of the kidneys. 8.Describe the anatomy and physiology of the lower urinary tract.
  • 11. STRUCTURE OF THE KIDNEYS
  • 12.  RENAL BLOOD FLOW RBF = 25% CARDIAC OUT PUT (1.25 L/min) THE IMPORTANT FUCTION OF RBF INCLUDING : Determining the GFR Modifying the rate of solute and water reabsorption by the proximal tubule. Participating in the concentration and dilution of urine. Delivering oxygen, nutrients and hormones to the nephron cell and returning CO2 and reabsorbed fluid and solute to general circulation.
  • 13.  REGULATION OF RENAL BLOOD FLOW hemorrhage Arterial blood pressure Intra renal receptors Renin secretion Plasma renin Plasma angiotensin Constriction of Renal arterioles RBF and GFR Activity of renal Symphatic nerves Carotic sinus and Aortic arch reflexs
  • 14.  RENAL TRANSPORT MECHANISM NaCL AND WATER REABSORPTION ALONG THE NEPHRON OBJECTIVE 1.Explain the three processes involved in the production of urine a. filtration b. reabsorption c. secretion.. 2.Describe the magnitude of the processes of filtration and reab- sorption by the nephron. 3.Describe the composition of normal urine. 4.explain the basic transport mechanisms present in each nephron segment. 5.Describe how water reabsorption is “coupled” to Na+ reabsorp tion in the proximal tubule. 6.Explain how solutes, but not water , are reabsorbed by the thick ascending limb of Henle’s loop.
  • 15. Yuxtaglom: is one component of an important feedback mechanism that is involved in the autoregulation of RBF and GFR
  • 16. GLOMERULAR FILTRATION AND RENAL BLOOD FLOW OBJECTIVES 1. Describe the concepts of mass balance and clearence and explain how they are used to analyze renal trnsport 2. Define the three general process by which substances are handled by the kidneys:glom. Filtration, tub.reabsorb and tub. Secretion. 3. Explain the use of inulin and creatinine clearence to mea- sure the GFR. 4. Explain the use of p-aminohippuric acid (PAH) clearence to measure renal plasma flow(RPF) 5. Describe the composition of theglom.ultrafiltrate, and identify which molecule are not filtered by the glomerulus.
  • 17. OBJECTIVES (cont.) 6. Explain how the los of negative charges on the glom. capillaries results in proteinuri. 7.Describe starling forces involved in the formation of the glom. Ultrafiltrate , and explain how charges in each force affect the glom.filtration rate. 8.Explain how the starling force change along the length of the glom. Capillaries. 9.Describe how changes in the renal plasma flow rate influence the GFR. 10.Explain autoregulation pf renal blood flow and the GFR and identify the factors responsible for autoregulation 11.Identify the major hormones that influence RBF. 12.Explain how and why hormones influence RBF despite autoregulation.
  • 18.  
  • 19. RENAL CLEARENCE GLOMERULAR FILTRATION REABSORBTION SECRETION C x= Ux X V Px Cx=clearence x Ux=conc. x in urine V= urine flow rate/minute P= conc. x in plasma
  • 20. MEASUREMENT OF GFR — CLEARENCE OF INULIN Amount filtered = amount excreted GFR X Pin = Uin X V GFR = Uin X V Pin
  • 21. MEASUREMENT OF RENAL PLASMA FLOW AND RENAL BLOOD FLOW. RPF= CLEARENCE OF PAH PAH LOW 0,12mg/ml RPF = Upah X V P pah RBF = RPF 1 - HCT
  • 22. REQUIREMENTS FOR USE OF A SUBSTANCE TO MEASURE GFR The substance must be freely filtered by the glomerulus. The substance must not be reabsorbed or secreted by the nephron . The substance must not be metabolized or produce by the kidney. 4. The substance must not alter GFR

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