Bag. Fisiologi dan sub bag penyakit ginjal hipertensi Penyakit Dalam FK UNDIP/ RSUP DR Kariadi Semarang
Fisiologi Fisiologi GINJALGINJAL
1.1. Regulation of body fluid osmolality Regulation of body fluid osmolality and volumeand volume
2.2. Regulation of electrolyte balanceRegulation of electrolyte balance
3.3. Regulation of acid-base balanceRegulation of acid-base balance
4.4. Excretion of metabolic product and Excretion of metabolic product and foreign substanceforeign substance
5.5. Production and secretion of Production and secretion of hormoneshormones
PHYSIOLOGY OF PHYSIOLOGY OF BODY FLUIDBODY FLUID
1.PHYSICOCHEMICAL 1.PHYSICOCHEMICAL PROPERTIES OF ELECTROLYTE PROPERTIES OF ELECTROLYTE
2.VOLUME OF BODY FLUID 2.VOLUME OF BODY FLUID COMPARTMENTSCOMPARTMENTS
3.MESASUREMENT OF BODY 3.MESASUREMENT OF BODY FLUID VOLUMEFLUID VOLUME
4.COMPOSITION OF BODY 4.COMPOSITION OF BODY FLUID COMPARTMENTFLUID COMPARTMENT
5.FLUID EXCHANE5.FLUID EXCHANE
VOLUMES OF BODY FLUID VOLUMES OF BODY FLUID COMPARTMENTCOMPARTMENT
Total body water(TBW)=0,6BW=42 L
ECF=1/3 TBW=14L ICF=2/3 TBW=28L
Interstial fluid¾ ECF =10,5L
FLUID EXCHANG BETWEEN BODY FLUID EXCHANG BETWEEN BODY FLUID COMPARTMENFLUID 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.
osmotic pressure osmotic pressure difference between ECF difference between ECF and ICF are responsible and ICF are responsible
for fluid movement for fluid movement between these between these compartment compartment
ALTERATION IN STARLING ALTERATION IN STARLING FORCEFORCE
. Increasing in capillary hydrostatic . Increasing in capillary hydrostatic (Pc)(Pc)
Decrease in plasma oncotic Decrease in plasma oncotic pressure(Oc)pressure(Oc)
Lymphatic obstruction.Lymphatic obstruction. Increase in capillary permiabelity.Increase in capillary permiabelity.
THE ROLE OF THE KIDNEYTHE ROLE OF THE KIDNEY
MOVE OF FLUID INTOINTERSTITIUM
VOL RECEPTORSDETECT ECF
NaCl and H2OReabsorption by
STRUCTURE AND FUNCTION OFTHE KIDNEYS AND THE LOWER URINARY TRACT
OBYECTIVES1.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.
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.
STRUCTURE OF THE KIDNEYS
Yuxtaglom: is one component of an important feedback mechanism that is involved in the autoregulation of RBF and GFR
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.
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 autoregulation11.Identify the major hormones that influence RBF.12.Explain how and why hormones influence RBF despite autoregulation.
RENAL CLEARENCE GLOMERULAR FILTRATION
C x= Ux X V Px
Cx=clearence xUx=conc. x in urineV= urine flow rate/minuteP= conc. x in plasma
MEASUREMENT OF GFR — CLEARENCE OF INULIN
Amount filtered = amount excreted
GFR X Pin = Uin X V
GFR = Uin X V Pin
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
REQUIREMENTS FOR USE OF A SUBSTANCE TO MEASURE GFR
1. The substance must be freely filtered by the glomerulus.2. The substance must not be reabsorbed or secreted by the nephron .3. The substance must not be metabolized or produce by the kidney.4. The substance must not alter GFR
RENAL BLOOD FLOW
RBF = 25% CARDIAC OUT PUT (1.25 L/min)
THE IMPORTANT FUCTION OF RBF INCLUDING :1. Determining the GFR2. Modifying the rate of solute and water reabsorption by the proximal tubule.3. Participating in the concentration and dilution of urine.4. Delivering oxygen, nutrients and hormones to the nephron cell and returning CO2 and reabsorbed fluid and solute to general circulation.
REGULATION OF RENAL BLOOD FLOW
Arterial blood pressure
Intra renal receptors
Plasma angiotensinConstriction ofRenal arterioles
RBF and GFR
Activity of renalSymphatic nerves
Carotic sinus andAortic arch reflexs
RENAL TRANSPORT MECHANISMNaCL AND WATER REABSORPTION ALONG THE NEPHRON
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.
OBJECTIVE - COUNT.
7. Describe how Starling forces regulate solute and water reabsorption across the proximal tubule.8. Explain glomerulotubular balance and its phy- siological significance .9. Identify the major hormones that regulate NaCl and water reabsorption by its nephron segment
1. GFR2. Renin secretion.3. Aldosteron secretion4. NaCl reabsorption by the collecting duct.5. ADH scretion
ADH ( secretion : H2O and NaCl excretion ) 1. H2O reabsorption by the collecting duct. 2. NaCl reabsorption by the thick asc,of Henle’s loop 3. NaCl reabsorption by the collecting duct.
Lung Ang II
Na+ excretion H2O excretion
RENINThree factors play an important role in stimulating renin secretion : 1. Perfussion presure 2. Sympathetic nerve activity 3. Delivery of NaCl to the macula densa
ANP antagonize those of RAAS1. Vasodelation of aff and eff ---GFR 2. Inhibition of renin secretion3. Inhibition of aldosteron secretion4. Inhibition of NaCl reabsorption5. Inhibition of secretion and activity of ADH
CONTROL OF Na+ EXCRETION WITH NORMAL ECF
EUVOLEMIA: NaCl ingested and axcreted--- balance
1.Na+ reabsorption by the proximal tubule, Henle’s loop , and the distal tubule is regulate so that a re- latively constan portion of the filtered load of Na+ is diliveredto the collecting duct..2.Reabsorption of Na+ by the collecting duct is regu lated such that the amount of Na+ excreted in the urine matches the amount ingested in the diet. ------------ maintain the euvolemic state.
CONTROL OF Na+ EXCRETION WITH INCREASE ECV
The signal acting on the kidneys include: 1. Activity of the renal sympathetic 2. Release of ANP. 3. Inhibition of ADH secretion. 4. Renin secretion Three general responses to an increases in ECV : 1. GFR increases 2. Reabsorption of Na+ decreases in the prox. tubule. 3. Reabsorption of Na+ decreases in the collec. duct.
CONTROL OF Na+ EXCRETION WITH DECREASES ECV
The signal acting on kidneys include : 1. Increases renal sympathetic activity. 2. Increases secretion of renin. 3. Inhibition of ANP secretion. 4. Stimulation of ADH secretion.
Three general respons to decreases ECV: 1. GFR decreases. 2. Increases of Na+ reabsorption in the prox. tubule. 3. Increases of Na+ reabsorption in the collecting duct.
REGULATION OF ACID-BASE BALANCE
Objective 1. Explain the chemistry of the CO2/HCO3 buffer system and its role as the primary physiological buffer of ECF. 2. Describe the metabolic process that produce acid and al kali and their net effect on systemic acid-base balance. Distinguish between volatile and non volatile acids. 3. Explain the concept of net acid excretion by the kidneys and the importance of urinary buffers in this process. 4. Describe the mechanisms of H+ secretion in the various segment s of the nephron and how these mechanisms are regulated. 5. Distinguish between the reabsorption of filtered HCO3 and the formation of new HCO3.
REGULATION OF ACID-BASEBALANCE objective cont
6. Describe the mechanisms of ammonia production and excretion by the kidneys, and explain their importance in renal acid exfretion and thus systemic A-B balance.7. Describe the three general mechanisms used by the bo- dyto defend against acid-base disturbances: a. intra and extracelluler buffering. b. respiratory compensation c. renal compensation.8. Distinguish between simple metabolic and respiratory acid-base disorders and the body’s response to them.9. Analyze acid-base disorders and distinguis between simple and mixed disorders.
pH = 6,1 + log HCO3 pCO2
Metabolic production of non volatile Acid and alkali from the diet.
Food source acid/alkali quantity produced (mEq/day)
1.Explain how the body maintains K+ homeostasis2.Describe the distribution of K+ within the body compart.3.Identify the hormon and factors that regulate plaqsma K+ levels.4.Describe the transport pattern of K+ along the nephron.5.Describe the cellular mechanism of K+ secretion by distal tubule and collecting duct, and how secretion is regulated.6.Explain how plasma K+ levels ,aldosteron, ADH, tubular fluid flow rate , acid-base balance , and Na+ concentra- tion in tubular fluid influence K+ secretion.