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    GANGGUAN FAAL

    GINJAL

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    Renal Physiology, Electrolytes and

    Renal Failure

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    FUNGSI GINJALMemertahan!an "#ME#S$ASIS

    1. Mempertahankan keseimbangan H2O

    2. Mengatur jumlah dan konsentrasi sebagian besarion CES

    3. Memelihara volume plasma

    4. eseimbangan asam!basa

    ". Memelihara osmolaritas

    #. Eliminasi sisa metabolisme tubuh

    $. Sekresi sen%a&a asing

    '. Membentuk hormon eritropoetin

    (. Sekresi renin

    1).Mengubah vit * menjadi bentuk akti+

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    %hat you need to !no&'

    Renal anatomy(ontrol o) *asculartone

    $u+ular )unction"andling Na-&ater"andling ., (I"andling acid

    Pathohysiology o)renal )ailure

    Electrolyte disordersAcid/0ase disorders%ater disorders

    (onduit-ouch e1ects#+struction e1ectsStones-R$A2iuretic e1ectsSurgical issues in renal)ailure atient

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    NEFR#N 3 satuan )ungsionalgin4al

    1 juta ne+ron , ginjal

    -e+ron adl satuan terkeil %ang mampumembtk urin

    Susunann%a didlm ginjal/ kortek dan medula 0iap ne+ron / komponen vaskular tubulus

    komponen vaskular/ rteriol a kapilerglomerolus arteriol e kapilerperitubulus venula

    omponen tubulus/ kapsula 5o&man tubproksimal lengkung Henle tub distal

    tub pengumpul

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    5 Proses em+entu!an urin

    67 Filtrasi glomerolus

    87 Rea+sor+si tu+ulus

    57 Se!resi tu+ulus

    1') liter 64$ galon7 8ltrat glomerolus ,hari

    1$'." lt diserap kembali

    1." lt dikeluarkan sebagai urin

    Setiap %ang di8ltrasi atau disekresi tetapitidak direabsorbsi akan dieksresikandalam urin

    6bedakan istilah eksresidan sekresi7

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    Physiology

    Liquids flow from high pressure low pressure

    Heart the driving force for urine flow

    Disruption of urine flow occurs if collecting

    system pressure rises above 30 cmH2

    !he collecting system runs from the renal

    pelvis to the bladder and is a dynamic structure

    designed to store and then to conduct urine tothe outside while maintaining a low and safe

    pressure"

    9aediatri:rolog%

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    Renal "emodynamic 2e9nitions

    Renal 0lood Flo& :R0F;

    ! blood to kidne%s per minute 612)) ml,min7

    Renal Plasma Flo& :RPF;

    ! plasma ;o& to kidne%s per minute 6#$) ml,min7 Glomerular Filtration Rate :GFR;

    ! volume o+ plasma 8ltered per minute b% theglomeruli 612" ml,min males< 1)) ml,min

    +emales7

    Filtration Fraction :FF;

    ! =>?/?9> 6about .1'!.227

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    GFR

    balane o+ h%drostati and onotipressures

    h%drostati pressure ontrolled b% relative

    toniit% o+ pre! and post!glomerulararterioles

    h%per!renin state &ill maintain =>? b% post!glomerular arteriolar onstrition

    =>? ma% be appro@imated b% reatininlearane< sine Cr 8ltered< not reabsorbedand minimall% sereted

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    (ontrol o) Renal Artery$one

    Aasoonstritors# Endothelin

    # angiotensin BB

    ! atrial natriureti peptide

    Aasodilators

    ! 9=E!2

    ! aet%lholine

    serotonin,brad%kinin 6-O mediated7

    gluoortioids

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    $u+ular Function

    maintain appropriate &ater< aid and

    eletrol%te balane using passive andative mehanisms

    reabsorb seletivel% up to ((D o+ theglomerular 8ltrate

    respond to endorine signals to makeneessar% hanges

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    0ubular Organiation

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    Pro

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    Loo o) "enle

    earl% &ater and urea permeabilit%

    derease urinar% alium

    in *B< the% have an anti!diuretieet

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    Loo 2iuretics

    +urosemide< etharini aid