Escolar Documentos
Profissional Documentos
Cultura Documentos
By
M. Rasjad Indra
Main function
Excretion of metabolic waste products &
foreign chemicals
Regulation of:
water & electrolyte balances.
body fluid volume & osmolarity
acid-base balance.
arterial pressure.
Blood Clearance
EFFECTIVE
EFFICIENT
WHAT
HOW MUCH
PORE
PRESSURE
PACE
TIME
ENERGY
FILTRATION
Glomerulus
Na
K
Cl
Hydrogen
Glucose
Protein
Creatinine
Urea
STILL NEEDED
MORE TO BE
EXCRETED
Diffusion
Osmosis
Biochemistry
REABSORPTION
SECRETION
Peritubular I
Prox Tub..
Vasa recta
Loop Henle
Peritubular II
Distalis Tub.
EXCRETION
SELESAI
Ke Counter Current
Hydrostatic pressure:
The glomerular (high ~ 60 mmHg) => for filtration.
The peritubular (low ~ 13 mm Hg) => for reabsorption.
KEMBALI
Glomerular Filtration
Urine formation start with the filtration of plasma in the
glomeruli:
GFR determined by:
The balance of hydrostatic & colloid osmotic forces across the
glomerular membrane
The glomerular filtration coefficient (Kf)
Net Filtr.Pressure= PG - PB - G+ B.
GFR= Kf x Net Filtration Pressure
Macula densa
Juxtaglomerular cells
Proximal Na Cl
reabsorption
Renin
Angiotensin II
Efferent Arteriolar
resistance
KEMBALI
Afferent Arteriolar
resistance
Transport Maximum
Transport maximum for substances that are actively
reabsorbed:
Glucose
320 mg/min.
Phosphate
0.10 mM/min.
Sulfate
0.06 mM/min.
Amino acid
1.5 mM/min.
Uric acid
15 mg/min.
Lactate
75 mg/min
Plasma protein
30 mg/min
Constituent
Water
Sodium
Potasium
Chloride
Bicarbonate
Phosphate
Glucose
Urea
Uric acid
Creatinine**
Filtered
167.5 liters
24,000 mmoles
720 mmoles
19,500 mmoles
4,500 mmoles
6g
150 g
50 g
8g
1.5 g
Reabsorbed
166 liters
23,900 mmoles
630 mmoles
19,400 mmoles
4,498 mmoles
5g
150 g
25 g
7.2 g
0g
Excreted
1.5 liters
100 mmoles
90 mmoles
100 mmoles
2 mmoles
1g
0g
25 g
0.8 g
1.8 g
Reabsorption of glucose
Glucose is cotransport with sodium
across the luminal cell membrane
(uphill)
the energy from:
the sodium gradient, how?
the electrical gradient
Glucose Threshold
The ability to reabsorb is limited
At normal plasma glucose levels (6590 mg/dl) => completely reabsorb.
At 180-200 mg/dl => glucose first
appear in the urine (threshold).
Tubular transport maximum (Tm) for
glucose: the maximal rate of glucose
reabsorption.
Sodium (Na+):
Most filtered sodium is reabsorbed.
The proximal tubules: 70%.
The loop of Henle: 20%
The distal tub. and collecting duct: 9%
The quantity of Na+ excreted =>important
role in body sodium balance.
Countercurrent Mechanism
Loop of Henle (countercurrent multipliers) &
Vasa recta (countercurrent ex-changers)
Loops of Henle: establish an osmotic gradient
in the medulla.
The descending limb:
water permeable
The ascending limb:
Active sodium transport
Low water permeability
The vasa recta: remove water from the medulla.
Ke Slide 8
Ke Slide 4
RPF
1-Hematocrit
Excretion Rate = Ux x V
URETER:
* Muscular tubes
that extend
inferiorly from
the kidney.
* Begins as a
continuation of
pelvis renalis
through the hilus
Vesica Urinaria:
A hollow muscular
organ
Functions as
temporarily
storage reservoir
for urine
Urethra:
Extends from
collum vesicae to the
exterior.
MICTURITION
A complex act involving autonomic
and somatic nerves, spinal reflexes,
and higher brain centers.
Ke slide 4
Intracellular
40 %
Extracellular
20 %
(42 liter in 70 kg
(14 liter in 70 kg
young adult)
young adult)
Interstitial
15 %
(10.5 liter in 70 kg
young adult)
Plasma
5%
Transcellular
1-3 %
(3.5 liter in 70 kg
(Cerebrospinal)
young adult)
(Aqueous humor)
Plasma
(mEq/L)
142
4
5
2
153
103
25
17
8
153
Interstitial Fluid
(mEq/Kg H2O)
145
4
3
2
154
117
28
9
154
Intracellular
Fluid (mEq/Kg
H2O)
10
159
1
40
210
3
7
45
155
210
Prolonged
Heavy Exercise
2100
200
2300
?
200
?
350
350
100
100
1400
2300
350
650
5000
100
500
6600
Definition of Edema:
Starling Hypothesis
The balance of hydrostatic and oncotic pressures across the capillary endothelium
IF
): 0 mmHg
Acid-Base Balance
pH:
Symbol of H+ ion levels
pH = -log [H+]
H2CO3
HCO
pH pK log
S.pCO2
pH pK log
HCO
0,03xS.PCO
2
Henderson-Hasselbalch Equation
pH=pK + log kidneys
lungs
pH=pK + log [HCO3-]
PCO2
1.
6 ,1 log
pH
[ HCO
PCO
2.
[ H
]( nmol
[ HCO 3] 20
[ H 2CO 3] 1
3]
2
/ L ) 24 x
PCO
2 ( mmHg
HCO
3 mEq
)
/ L
7.60
25
7.10
80
7.50
30
7.00
100
7.40
40
6.90
125
7.30
50
6.80
160
ACID:
Result of metabolism and digestion
Consist of: volatile and nonvolatile
Volatile
HCl, H2SO4, HNO3, H3PO4, NH4+, H2CO3
H2CO3 (primary)<=>H20 + CO2
Eliminated as CO2 gas via lungs.
Nonvolatile:
Small amount.
Lactic acid, acetic acid
Removed via the kidney
Base :
Amphoteric Substance:
Can function as both an acid and a base.
Glycine( +H3N-CH2-COO-):
NaOH++H3N-CH2-COO-=>H2N-CH2-COO-Na+ + H2O
HCl + +H3N-CH2-COO- => Cl-+H3N-CH2-COOH
H CO <=> HCO - + H+
2 3
3
2. Protein :
NH + <=> NH + H+
4
3
Albumin; Globulin
Hemoglobin
3. Lung and Kidney
[H2CO3]<=>PaCO2 x (0.03)
PaCO2 :
Provides a measure of H2CO3
The respiratory component.
Normal:
PaCO2 = 40 mm Hg.
H2CO3 = 40 x 0.03 = 1.2 mEq/L
HCO3-=Metabolic component
Regulated by the kidney.
By modulating the rate of re-absorption
Normal Range:
PaCO2 = 38 to 42 mmHg
HCO3- = 22 to 26 mEq/L
pH = 7.38 to 7.42
HCO3- / H2CO3 = 20 : 1
Acid-base disturbance (blood):
Acidemia: pH< 7.38
Alkalemia: pH> 7.42
Acid-Base Disturbance
Simple :
Respiratory acidosis: PaCO2 high / HCO3normal or slightly high
Respiratory alkalosis: PaCO2 low /HCO3normal or low
Metabolic acidosis: HCO3- low / PaCO2 normal
or low
Metabolic alkalosis: HCO3- high / PaCO2
normal or high
Mixed / Combination:
(Respiratory + Metabolic)
Physiologic compensation
Primary disorder
Respiratory acidosis
Physiol. compensation
Kidney retention of HCO3; excretion of H+
Respiratory alkalosis Kidney excretion of
HCO3-; retention of H+
Metabolic acidosis
Lung excretion of H+
(CO2).
Metabolic alkalosis Lung possible retention of
H+ (CO2)
Exercise
pH = 7.33
PaCO2 = 50 mmHg
HCO3- =25.8 mEq/L
Answer:
Acidemia
Primary respiratory
Acute
pH = 7.55
PaCO2 = 30 mmHg
HCO3- = 23.4 mEq/L
Answer:
Alkalemia
Primary respiratory
Acute
Exercise
pH = 7.31
PaCO2 = 29.5 mmHg
HCO3- = 14.5 mEq/L
Answer:
Acidemia
Primary metabolic
Respiratory
compensation
pH = 7.59
PaCO2 = 46.5 mmHg
HCO3- = 45 mEq/L
Answer:
Alkalemia
Primary metabolic
Respiratory
compensation