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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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