URINARY SYSTEMURINARY SYSTEM

dr. ARLENDS CHRIS, M.Si.Fakultas Kedokteran

Universitas Tarumanagara Jakarta

Sistem ekskresi pada manusia dan vertebrata lainnya melibatkan organ paru-paru, kulit, ginjal, dan hati. Namun yang terpenting dari keempat organ tersebut adalah ginjal.

HOW THE KIDNEYS WORK The kidneys are two bean-shaped organs located toward the back of the body on either side of the spine near the waistline. They are about the size of a fist and are protected by other organs and two of the lower ribs. Normal functioning kidneys serve the body in several very important ways. They: Clean your blood and remove waste products Balance water and salt to control fluid in the body Control blood pressure Help make red blood cells and strong bones Control the amount of potassium, calcium, magnesium and phosphorus in the blood

IntroductionIntroduction

The urinary system comprises– 2 kidneys– 2 ureters– 1 bladder– 1 urethra

This system contributes to the maintenance of This system contributes to the maintenance of homeostasis by complex process that involves, homeostasis by complex process that involves, (nephron)(nephron)

Filtration of most small molecules from blood plasma to form an ultrafiltrate of plasma.

Selective reabsorption of most of the water and some other molecule from ultrafiltrate, leaving behind excess and water material to be excreted.

Secretion of some excretory products directly from blood into urine.

Maintenance of the acid-base balance by selective of H+ ions into the urine.

The kidney also participates in other homeostatic The kidney also participates in other homeostatic mechanisms either by production or by mechanisms either by production or by modification of various hormones:modification of various hormones:

Renin, is component of the renin-angiotensin-aldosteron mechanism which control blood pressure.

Erythropoietin, synthesised in the kidney, stimulated the production of erythrocytes in the bone marrow and thus regulated the oxygen-carrying capacity of the blood.

Vitamin D, which regulated calcium balance, is converted to an active form in the kidney.

The two kidney produce about 125 mL of filtrate per minute;

124 mL is absorbed in the organ

Only 1 mL is released into the ureter as urine

About 1500 mL of urine is formed every 24 h

IntroductionIntroduction

Urine kidney retroperitoneal

ureter

bladder anterior part of the pelvis

FOR MORE INFO...

Urine is produced in the kidneys and flows down the ureters to the bladder where it is stored until voided via the urethra.

The kidney possess a convex and a concave border, the latter of which is known as the hilum.

The cortical region is subdevided into the cortical labyrinth and the medullary rays.

The medulla is composed of 10-18 renal pyramids, each of whose apex is perforated by 15-20 papillary duct (of Bellini) at the area cribrosa. Each renal pyramid is said to constitute a lobe of the kidney. The region of the medulla between neighboring renal pyramid is occupied by cortical-like material known as renal columns (of Bertin). Each medullary ray is an extension of the renal medulla into the cortex, where it forms the core of kidney lobule.

Cortical Labyrinth

Medullary Rays

Medulla Zona Externa

Medulla Zona Interna

cortex

medulla

Medullary ray

Cortical labyrinth

Corpus malphigiTubulus contortus primusTubulus contortus secundusDuctus colligentes pars arcuata

Tubulus rectus primusTubulus rectus secundusDuctus colligentes pars rectus

Tubulus rectus primusThin limb of Henle’s loopTubulus rectus secundusDuctus colligentes pars rectus

Thin limb of Henle’s loopDuctus colligentes pars rectusDuctus papillaris Bellini

Zona eksterna

Zona interna

KIDNEY

Histologic organization of the kidney

Cortical Labyrinth

• Corpus Malpighi

• Tubulus Contortus Primus

• Tubulus Contortus Secundus

• Ductus Colligentes pars Arcuata

Medullary Rays

• Tubulus Rectus Primus

• Tubulus Rectus Secundus

• Ductus Colligentes pars Rectus

Medulla Zona Externa

• Tubulus Rectus Primus

• Ansa Henle Segmen Tipis

• Tubulus Rectus Secundus

• Ductus Colligentes pars Rectus

Medulla Zona Interna

• Ansa Henle Segmen Tipis

• Ductus Colligentes pars Rectus

• Ductus Papillaris Bellini

Classification by the functionsClassification by the functions• Functional filtration unit (nefron)

• Corpus Malphigi (renal corpuscle)

• Ductus : TC I, TR I, thin limb of Henle’s loop,

TR II, TC II.• Excretion unit (≠ nefron)

•Collecting tubules : D. Colligentes pars arcuata,

D. Colligentes pars rectus,

D. Papillaris Bellini.

The Human Kidney contains approximately one-four million nephrons.Classification of the nephrons:

• According to location of

Corpus Malphigi

•Nephron Juxtamedullar (±

1/7 nephrons)

this nephron have loop of long henle.

•Nephron

Capsuler/superficial

• Parts of The loop of Henle

• Long nephron

• Short nephron

CORPUS MALPHIGI

• Glomerulus• Capsula Bowman

• Pars Parietal• Pars Visceral

• Vascular Pole• Urinary Pole

GLOMERULUS

• Pars Visceralis cell

Bowman Capsula.

• Podocytes cell

• Capillary endothelium

• Intraglomerular

mesangial cell

(fagositosis)

APPARATUS JUXTAGLOMERULUS (VASCULER POLE)

1. Juxtaglomerular cellsare specialised smooth cells of the wall of the afferent arteriol modifications as granuler mioepiteloid cell cytoplasm contains immature and mature membran-bound granules of the enzyme renin.

2. Macula densabetween afferent and efferent arteriole, the cell of macula densa are taller and have larger more prominent nuclei which are situated towards the luminal surface.

3. Lacis cells/extraglomerular mesangial cellagranuler juxtaglomerular cell.

Juxtaglomerular apparatus

Juxtaglomerular apparatusBlood pressure control system

Ciri-ciri mikroskopik saluran:Ciri-ciri mikroskopik saluran:TUBULUS CONTORTUS PRIMUS

- Berkelok-kelok- Epitel Selapis kubis - Aspek sangat asidofil- Batas sel tak jelas- Letak inti berjauhan- Brush Border - Mitokhodria

TUBULUS RECTUS PRIMUS

- Hampir sama Tubulus Contortus I- Tidak berkelok-kelok- Epitel Selapis kubis - Aspek asidofil- Batas sel tak jelas- Letak inti berjauhan- Brush Border - Mitokhodria

ANSA HENLE SEGMEN TIPIS

-Epitel Selapis Gepeng-Inti menonjol ke lumen-Bentuk lebih tebal dari endotel-Sedikit brush border-Sitoplasma kurang asidofil-Lumennya lebar

TUBULUS RECTUS SECUNDUS

- Tidak berkelok-kelok- Epitel selapis kubis- Inti berdekatan- Sitoplasma sedikit asidofil- Tak ada brush border- Mitokhondria

TUBULUS CONTORTUS SECUNDUS

- Kurang berkelok- Epitel selapis kubis- Inti banyak berdekatan- Batas sel tdk jelas- Sitoplasma bergranuler- Kurang asidofil- Brush border - Sedikit mitokhondria

DUCTUS COLLIGENTES

- Epitel selapis kubis- torak tinggi- Sitoplasma bening- Apical sel terdapat cuticula - Batas sel jelas

TCP(Tubulus Contortus Primus)

TRP(Tubulus

Rectus Primus)

PI(Pars

Intermedia)

TRS(Tubulus Tectus

Secundus)

TCS(Tubulus Contortus Secundus)

DC(Ductus Colligentes)

Epitel Selapis torak rendah/kubus

Selapis kubus

Selapis gepeng

Epitel selapis kubus(inti berdekatan)

Epitel selapis kubus(inti berdekatan)

Epitel selapis kubus-torak

Sitoplasma Bergranuler, sangat asidofil

Bergranuler, asidofil

Kurang asidofil, sedikit

Sedikit asidofil Kurang asidofil Bening, kurang sekali asidofil

Batas sel Tidak jelas Tidak jelas Tidak jelas Tidak jelas Tidak jelas Jelas

Brushborder (+) (+) (-) MC tapi(+) Sedikit pd

ME(Bailey, 17Th

Ed)

(-) (-) (-), tapi terdapat kutikula

Basal striation

(+) (+) Sedikit

(+)Paling sedikit

(+)Sedikit

(+)Sedikit

(-)

Bentuk sayatan

Berkelok Tidak berkelok

Tidak berkelok

Tidak berkelok Berkelok Tidak berkelok, kecuali pd pars arcuata

Saluran apakah ini?………Sebutkan ciri-cirinya?………

Azan x 750

A small number of dark intercalated cells (with microvilous)

Proximal tubule

Distal tubule

Supporting tissue

Ductus Papillaris Bellini(The largest of the collecting ducts)

Calyx Minor

Transitional Epithelium

Smooth Muscle

Comparison of epithelial structure in different parts of the renal tubule

Summary diagram of activities of different parts of the tubule

Vaskularisasi ginjal.A. Renalis

A. Interlobaris

A. Arcuata

A. Interlobularis

A. Intralobularis

Vasa Afferent

Vasa Afferrent

Glomerulus

Vasa EfferentBercabang menjadi Plexus Peritubular dan plexus kapiler

di medullaPlexus Peritubuler Venae V. Stellata V. Interlobularis V. Arcuata V. Interlobaris V. Renalis

SISTEM LIMFATIK GINJAL

• Sistem superficial

(dimana cabang kapiler limfe terdapat pd kapsul ginjal dan berhubungan dengan pembuluh ginjal)

• Sistem Profunda

Terletak pada jaringan kelenjar.

Dalam glomerulus tidak ada pembuluh limfe

PERSARAFAN GINJAL

Saraf tak bermielin Berasal dari Plexus Celiaca…, Nervus Th X – XII & LI mengikuti pembuluh darah dan berakhir pd arteriole glomerulus.

Serat saraf sensoris bermielin berjalan menuju kapsul, otot polos pelvis dan Tunika adventisia dari pembuluh darah ginjal.

Saraf memasuki ginjal melalui Hilus.

Tn. Mukosa- Epitel

- Lm. Propria- Tn. Musk. Muk.Tn. Sub MukosaTn. Musc

Tn. Adv

URETER

Transisional, sel payung, krustaJaringan ikat tipis-

Tidak jelas2/3 proksimal: long, sirk.1/3 distal: long,sir,long

Fibroelastika.Pembuluh drh ++

VESIKA URINARIA

Transisional, sel payung, krusta+ (tipis)-

Tidak jelasDlm: Long.Tengah: Sirk.Luar: long.

FibroelastikaBg. Dorsal: tn serosa

bladder

ureter

Tn. MucosaEpitel

M. BasalisLm. PropriaTn. Musc.muc

Tn. Musc.

Tn. Adv

URETHRA PRIA : + 15-20 CM

P. Prostatica3-4 cmTransisional

TipisJI jarang & p.d.

--

Fibromusculer

-

Tn. submucosa

P. Membranacea1 cmBerlapis – bertingkat torak

+JI Jarang

--

Fibromusculerm. Sph Urethrae (otot lurik)

-

P. Cavernosa15 cmBerlps torak-bertingkat

+JI JarangLapisan otot<<Lacunae venae, fibroelastik, o. polos long & sirkLacunae venae, long & sirkuler.

JI fibrosa = Tn. albuginea

P. Navicularis

Berlapis gepeng

+JI Jarang

--

-

-

Ductus EjaculatoriusUrethra Pars Prostatica

Kelenjar Prostat

Urethra Pars Membranacea

URETHRA PARS MEMBRANACEA

Urethra pars cavernosa

URETHRA WANITA : + 4 CM

Tn Mucosa:- Epitel transisional (dekat VU), berlapis torak – bertingkat torak – berlapis gepeng (distal).- Lm. Propria : JI. Jarang, plexus venae- Tn. Musc. Mucosa : -Tn submucosa: -Tn Muscularis: Longitudinal, sirculer

otot sphingster urethraeTn. Adventitia: -

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