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Patofsiologi

ginjalDr Putra Hendra

SpPD

UNIBA

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Structure of kidney & Urinary system

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Nephron1. Glomerulus : highly permeable

H2O,electrolytes filtration size + charge

2. Proximal convoluted tuules !P"#$:

reabsorb H2O

Na+, K+, H+, Cl

%. oop of 'enle :

- function as PCT

- escening !no H2O"

- ascening H2O

(. )istal convoluted tuules !)"#$ :

- #losterone epenent

- Na+ reabsorption

- K+ e$cretion

- %ynthesis - carbonic anhyraseH+ & pH ' electrolytes

*. "ollectin+ ducts :

- #(H !antiiuretic hormone" H2O

reabsorption

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Physiology/Pathophysiology

1. Filtration

. !ea"sorption/#ata"olis$

%. Se&retion

'. ()&retion

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Diseases o* the +idney

,lo$eruli,lo$erulonephritis

Pri$ary

Se&ondary

#hroni&

-u"ulointerstitiu$A&ute tu"ular ne&rosis

PyelonephritisA&ute

&hroni&

essels

Nephros&lerosis

Benign

alignant

Urinary o"stru&tion

Stones

Hydronephrosis

#ysti& diseases o* the+idney

#ongenital 0 dou"le ureter

-u$ors

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1. ,ater alance

Osmoreceptor !hypothalamus"

#(H, )asopressin !Pituitary"

Collecting uct

#bsorption of H2O

-unction of idney

2. /cid0ase alance

Carbonic anhyrase !(istal tubules"

Carbonic aci-bicarbonate buffer system

H+ e$cretion

Na+ reabsorption

H2O e$cretion

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%. xcretion of aste product

- #ci - base - H2O

- creatinine

- *etabolites

loo pressure . /enin

*. 'ematolo+y - erythropoeitin

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Diseases o* the +idney

,lo$eruli,lo$erulonephritis

Pri$ary

Se&ondary

#hroni&

-u"ulointerstitiu$A&ute tu"ular ne&rosis

PyelonephritisA&ute

&hroni&

esselsNephros&lerosis

Benign

alignant

Urinary o"stru&tion

Stones

Hydronephrosis

#ysti& diseases o* the+idney

-u$ors

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Stages o* +idney diseaseNF/ D23I

1. Asy$pto$ati& urinary a"nor$alities0GFR > 90 ml/min

4>156 $l/s7

2 Mild CRF: GFR60-89 ml/min418156 $l/s7

3 Moderate CRF: GFR 30-59 ml/min

495681 $l/s7

4 Severe CRF: GFR15-29 49568956 $l/s7

5 Approa&hing (S!D0 GFR ! 15 ml/min 4:

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#hroni& idney DiseaseClinical Manifestations

Urinary system

Polyuria!esults *ro$ ina"ility o* +idneys to

&on&entrate urine

2&&urs $ost o*ten at night

Spe&if& gra;ity f)ed around 1.919

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#hroni& idney DiseaseClinical Manifestations

Urinary system

OliguriaOccurs as CKD worsens

AnuriaUrine output

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