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Besides their
major roles in
reabsorption and
secretion, cells of the
proximal tubule also
perform hydroxylation
of vitamin D and
release to the
capillaries. Moreover,
fibroblastic interstitial
cells in cortical areas
near the proximal
tubules produce
erythropoietin, the
growth factor secreted
in response to a
prolonged decrease in
local oxygen
concentration.
The loops of Henle and surrounding interstitial connective tissue are involved in further adjusting the
salt content of the filtrate. Cuboidal cells of the loops’ TALs actively transport sodium and chloride ions
out of the tubule against a concentration gradient into the hyaluronate-rich interstitium, making that
compartment hyperosmotic. This causes water to be withdrawn passively from the thin descending part
of the loop, thus concentrating the filtrate. The thin ascending limbs reabsorb sodium chloride (NaCl) but
are impermeable to water. The countercurrent flow of the filtrate (descending, then immediately
ascending) in the two parallel thin limbs establishes a gradient of osmolarity in the interstitium of the
medullary pyramids, an effect that is “multiplied” at deeper levels in the medulla. Countercurrent blood
flow in the descending and ascending loops of the vasa recta helps maintain the hyperosmotic
interstitium. The interstitial osmolarity at the pyramid tips is about four times that of the blood.
The ascending limb of the nephron is straight as it enters the cortex and forms the macula densa, and
then becomes tortuous as the distal convoluted tubule (DCT) (see Figure 19–2). Much less tubular
reabsorption occurs here than in the proximal tubule. The simple cuboidal cells of the distal tubules differ
from those of the proximal tubules in being smaller and having no brush border and more empty lumens
(Figure 19–9). Because distal tubule cells are flatter and smaller than those of the proximal tubule, more
nuclei are typically seen in sections of distal tubules than in those of proximal tubules (Figure 19–8). Cells
of the DCT also have fewer mitochondria than cells of proximal tubules, making them less acidophilic
(Figure 19–9). The rate of Na absorption here is regulated by aldosterone from the adrenal glands.
Decreased arterial pressure leads to increased autonomic stimulation to the JGA as a result of
baroreceptor function, including local baroreceptors in the afferent arteriole, possibly the JG cells
themselves. This causes the JG cells to release renin, an aspartyl protease, into the blood. There renin
cleaves the plasma protein angiotensinogen into the inactive decapeptide angiotensin I. Angiotensin-
converting enzyme (ACE) on lung capillaries clips this further to angiotensin II, a potent vasoconstrictor
that directly raises systemic blood pressure and stimulates the adrenals to secrete aldosterone.
Aldosterone promotes Na and water reabsorption in the distal convoluted and connecting tubules, which
raises bloodvolume to help increase blood pressure. The return of normal blood pressure turns off
secretion of renin by JG cells.
■ A single layer of small basal cells resting on a very thin basement membrane;
■ An intermediate region containing from one to several layers of more columnar cells; and
■ A superficial layer of very large, bulbous cells called umbrella cells that are occasionally bi- or
multinucleated and are highly differentiated to protect underlying cells against the cytotoxic effects of
hypertonic urine.
Most of the apical surface consists of asymmetric unit membranes in which regions of the outer lipid
layer appear ultrastructurally to be twice as thick as the inner leaflet. These regions are composed of lipid
rafts containing mostly integral membrane proteins called uroplakins that assemble into paracrystalline
arrays of stiffened plaques 16 nm in diameter. These membranous plaques are impermeable to water
and protect cytoplasm and underlying cells from the hyperosmotic effects of urine.
Urothelium is surrounded by a folded lamina propria and submucosa, followed by a dense sheath of
interwoven smooth muscle layers and adventitia (Figures 19–16 and 19–17). Urine is moved from the
renal pelvises to the bladder by peristaltic contractions of the ureters. The bladder’s lamina propria and
dense irregular connective tissue of the submucosa are highly vascularized. The bladder in an average
adult can hold 400 to 600 mL of urine, with the urge to empty appearing at about 150 to 200 mL. The
muscularis consists of three poorly delineated layers, collectively called the detrusor muscle, which
contract to empty the bladder (Figure 19–17). Three muscular layers are seen most distinctly at the neck
of the bladder near the urethra (Figure 19–17). The ureters pass through the wall of the bladder obliquely,
forming a valve that prevents the backflow of urine into the ureters as the bladder fills. All the urinary
passages are covered externally by an adventitial layer, except for the upper part of the bladder that is
covered by serous peritoneum.
The urethra is a tube that carries the urine from the bladder to the exterior (Figure 19–18). The urethral
mucosa has prominent longitudinal folds, giving it a distinctive appearance in cross section. In men, the
two ducts for sperm transport during ejaculation join the urethra at the prostate gland (see Chapter 21).
The male urethra is longer and consists of three segments:
- The prostatic urethra, 3 to 4 cm long, extends through the prostate gland and is lined by urothelium.
- The membranous urethra, a short segment, passes through an external sphincter of striated muscle and
is lined by stratified columnar and pseudostratified epithelium.
- The spongy urethra, about 15 cm in length, is enclosed within erectile tissue of the penis (see Chapter
21) and is lined by stratified columnar and pseudostratified columnar epithelium (Figure19–18), with
stratified squamous epithelium distally.
In women, the urethra is exclusively a urinary organ. The female urethra is a 4- to 5-cm-long tube, lined
initially with transitional epithelium, then by stratified squamous epithelium and Some areas of
pseudostratified columnar epithelium. The middle part of the female urethra is surrounded by the
external striated muscle sphincter.
Sumber :
Mescher A.L. 2013. Junqueira’s Basic Histology TEXT AND ATLAS THIRTEENTH EDITION. McGrawHill : New
York
Glomerular Filtration
1. Tubular reabsorption is a selective process that reclaims materials from tubular fluid and
returns them to the bloodstream. Reabsorbed substances include water, glucose, amino acids,
urea, and ions, such as sodium, chloride, potassium, bicarbonate, and phosphate
2. Some substances not needed by the body are removed from the blood and discharged into the
urine via tubular secretion. Included are ions (K+,H+, and NH4+), urea, creatinine, and certain drugs.
3. Reabsorption routes include both paracellular (between tubule cells) and transcellular (across
tubule cells) routes.
4. The maximum amount of a substance that can be reabsorbed perunit time is called the
transport maximum (Tm).
5. About 90% of water reabsorption is obligatory; it occurs via osmosis, together with
reabsorption of solutes, and is not hormonally regulated. The remaining 10% is facultative water
reabsorption, which varies according to body needs and is regulated by ADH.
6. Na+ ions are reabsorbed throughout the basolateral membrane via primary active transport.
7. In the proximal convoluted tubule, sodium ions are reabsorbed through the apical membranes
via Na+–glucose symporters and Na+/H+ antiporters; water is reabsorbed via osmosis; Cl-
,K+,Ca2+,Mg2+, and urea are reabsorbed via passive diffusion; and NH3 and NH4+ are secreted.
8. The loop of Henle reabsorbs 20–30% of the filtered Na+, K+,Ca2+,and HCO3-; 35% of the filtered
Cl-; and 15% of the filtered water.
9. The distal convoluted tubule reabsorbs sodium and chloride ions via Na+–Cl- symporters.
10. In the collecting duct, principal cells reabsorb Na and secrete
K ; intercalated cells reabsorb K and HCO3 and secrete H+.
+ -
11. Angiotensin II, aldosterone, antidiuretic hormone, atrial natriuretic peptide, and parathyroid
hormone regulate solute and water reabsorption
Sumber :
Tortora G.J & Derrickson B. 2009. PRINCIPLES OF ANATOMY AND PHYSYIOLOGY Twelfth Edition.
Jon Wiley & Sons, Inc : Hoboken
Sumber :
Fulop T. 2016 Acute Pyelonephritis. Viewed 24 Januari 2017. From <
http://emedicine.medscape.com/article/245559-overview >
4. Diagnosis DD scenario
Sign and symptom Pyelonephritis akut Pyelonephritis urolithiasis Cystisis (Female)
kronis
Demam 39.4oC + disertai menggigil
Nyeri costovertebral + + + +
angle
Leukositosis +
Eritrosituria/hematuria + + +
Leukosituria
Leukosit cast
Riwayat nyeri + + +
suprapubic
Riwayat Diabetes (komplikasi)
Melitus
Riwayat hipertensi + +
Lainnya Nausea & vomit, Nausea & vomit , Positif batu, tanda Malaise, pyuria,
anorexia, lethargy, pyuria, radang proteinuria
perubahan status azotemia,
mental, susah
makan, pyuria,
bacteriuria, NGAL +
Sumber :
Lohr J.W. 2015. Chronic Pyelonephritis. Viewed 24 Januari 2017. From <
http://emedicine.medscape.com/article/245464-overview >
Fulop T. 2016 Acute Pyelonephritis. Viewed 24 Januari 2017. From <
http://emedicine.medscape.com/article/245559-overview >
Syakh S.M. 2016. Pediatric Urolithiasis. Viewed 24 januari 2017. From <
http://emedicine.medscape.com/article/983884-overview >
Brusch J.L. 2016. Cystisis in Females. Viewed 24 januari 2017. From <
http://emedicine.medscape.com/article/233101-overview >
Sumber :
http://www.kki.go.id/assets/data/arsip/SKDI_Perkonsil,_11_maret_13.pdf
Terapi ditujukan untuk mencegah terjadinya kerusakan ginjal yang lebih parah dan memperbaiki
kondisi pasien, yaitu berupa terapi suportif dan pemberian antibiotika. Antibiotika yang
dipergunakan pada keadaan ini adalah yang bersifat bakterisidal, dan berspektrum luas, yang
secara farmakologis mampu mengadakan penetrasi ke jaringan ginjal dan kadarnya didalam urine
cukup tinggi. Golongan obat-obat ni adalah: aminoglikosida yang dikombinasikan dengan
aminopenisilin (ampisilin atau amoksisilin), aminopenisilin dikombinasi dengan asam klavulanat
atau sulbaktam, karboksipenisilin, sefalosporin, atau fluoroquinolone.
Sumber :
Kee, Joyce Le Fever. 2010. Pedoman Pemeriksaan Laboratorium dan Diagnostik. EGC : Jakarta.
ISK Atas
Sumber :
Sumber :
Purnomo, Basuki B. 2009. Dasar-dasar urologi edisi kedua. FK Univ. Brawijaya : Malang.
Sumber :
Tortora G.J & Derrickson B. 2009. PRINCIPLES OF ANATOMY AND PHYSYIOLOGY Twelfth Edition.
Jon Wiley & Sons, Inc : Hoboken
The erythrocyte sedimentation rate (ESR) determination is a commonly performed laboratory test
with a time-honored role.
Sedimentation of red cells in this system is affected by forces both for and against sedimentation. The
forces resisting sedimentation are the negative charge on the red cell surface (causing red cells to repel
each other (zeta potential)), the up flow of plasma displaced by falling red cells, and the rigidity of red
cells. The forces accelerating sedimentation are anemia and plasma proteins. Plasma proteins bind to red
cell membranes thereby reducing the zeta potential thus allowing rouleaux formation to occur. The
degree to which proteins reduce the zeta potential can be rated on a scale of 1-10: fibrinogen 10, beta-
globulin 5, alpha globulin 2, gamma globulin 2, and albumin 1.
Any condition that elevates fibrinogen (e.g., pregnancy, diabetes mellitus, end-stage renal failure,
heart disease, collagen vascular diseases, malignancy) may also elevate the ESR. Anemia and macrocytosis
increase the ESR. In anemia, with the hematocrit reduced, the velocity of the upward flow of plasma is
altered so that red blood cell aggregates fall faster. Macrocytic red cells with a smaller surface-to-volume
ratio also settle more rapidly. A decreased ESR is associated with a number of blood diseases in which red
blood cells have an irregular or smaller shape that causes slower settling.
Sumber :
Hameed M.A & Waqas Sobia. 2016. Physiological Basis and Clinical Utility of Erythrocyte
Sedimentation Rate. Vol 22 no 2. Viewed 24 Januari 2016. From <
http://www.pjms.com.pk/issues/aprjun06/article/cme.html >
Hematuria
Sumber :
Sudoyono et al. 2014. Buku Ajar Ilmu Pentakit Dalam Edisi 6 jilid 1. InternaPublishing : Jakarta