o

|1.
Date

Figure 26-5 The Blood Supply to the Kidneys.

(a) A sectional view, showing major arteries and veins;
compare with figure 264. (b) Circulation in the renal Conical radiate vein
cortex- (() A llowchart of renal circulation. ATLAS:
Pl;iei 53(,c;6ia*( Cortical radiate artery

Arcuate artery

Arcuate vein

Juxi:.--: -
Cortical . e ah-a
radiate
veins
Cortical
radiale
arteries

lnlrlobar
arteries
Segmental
artery

Suprarenal
artry
Flenal
anery
Renal
vein

Pe':-tt-,:.
afteflole c3p 3:S
At erent
a*eriole Drs::

Renal -
iio: a
corpuscle

. ouc:
Fer:-,:-.:,
. ca:lrra:
:- Nephron
' lmp
(b) Corticai nephron

Renal cortex

Renal medulla -

lnner layer of -
Renal pyramid Prox.ma
fibrous capsule co.rcl! t:c
Peritubular t!brle rPa -
capillaries
Fenal sinus
Ccnnection to Glomerulus
minor calyx D,sra
Ad jpose tissue allli tr i.ia:
Minor calyx
in renal sinus
Major calyx
Fenal pelvi6
Hilum Hilur
Henal lobe
Benai papilla
Uretet Collecting
duct
Renal columns
- Peritubular
capiilaries
Nephron
Fibrous capsule toop

(c) Juxiamedullary nephron

 C)

D.ite tO .Teb . 2ot6

l\natori i. Ti* i G"1"1

: Fun4s, ukrnrcr qr.'{ - irnnc(nog ' d ,m ?ntdo*ho.r, Oioial

( Ltkrus, penqoluaur ?rodut :' 9,scr I mtrabolrr lrbui. i oorq6bdomi,'ulr I
'
urtlr vcna rencrtis
i] Etirtnast , {l,n dirchonqt of i\u," or:stt 1ot\vck lntz, fl.t 'u#}IJ
rena[tg

{ Horneostast. 1 reSut&si Lt<oimbangan vot{mt r lconssokztsi ?4t a - s{qm

, @n tall s
tI

I &otote) dtm damh 9 i , , ,.uu i a! .u.at vI \

| ,r",^^ a- lnlzrtobani Y. lnterlt,bani

0' jmlh unh
r,Dlrr" & telcaoan
,tq,
daah
-
sesoaikas

t(kr'si E?O * icnin

,
I t
v. arL,:akr
A - arcuat-ut

. Eonskari
Edlsitfl'ot a
\
[il;;- (Na+, ct-, r.*, &'*, Hn , Hcor- , ?oq'', a.
J
intrrlobc,{an!
t
v. lnterioh[ans /
Soqt- , M42+ ) "-t mcitiq , :bn C! L/a -LorhGqtis mdr'ata) raciu tcr

IT
l<or:

" 9{..bitirari pH damh -> konhol eVskresi +r+ & N6:ai-

@ uno arl"rto[ a(ern veorth
. kor,rr-rori nuln'en barhaqa tf
- *{RoM - --*r;"";,i;rub.,r"i_l
. 'Dlafop"ci .acun r olz*{ : , adrtf nratcanao , LLn -,*l:_-9
\I alomeillo
l\, .a
',- !- :
i

eks6qe5 666 notn'tr(

{?yt-1ey-- --)^--
-;
o) [RofVaVr : Njarvus tenalt's
-,n*I + hurinarius c)
' ( ureter )
I

be,tgg r,,b al: f4s nli-inorr' ur;,

( tJBrvrsr / M,r.-ruRtct )

xd,?,,l t fud)
) jatr.,r a. renaiir hinqqa .agcu malrng ! npfon

:' l-etat , - eTf,^na verl-cbra T, - Lr 6 [t.' :. ko#t +,rbol,

- refogcrrtonza! [cLntarr^ otot Punqqung * f:+arurt\ r - atur Lcohn @nrasr un'n d4n ubah ([au: 9 yrcssurt
Wt-)
J ql. sogmrcnal dtaft"s t,ap gtn3a-Q @ noJ.zn

drgoteksi 1fiL,asi , 3 r#l kolsuto 6b*sa t"* e'L stimr.rtasi Do\epasan ro.nto--a--) retensi Na{ t air

\a . phr. adigaca I
I
. NErrorrl
c. (tscra onoJG oua,,

r) rormajnq^ tdo^lasa). rnemh lcecok[atan, t l0crn { F'Scm t Zca, *n( fungsiona\ qi,rja-Q. C *n,t i.,tzec,l d["r
/ ' -::-- suafu o,nao Vg
l
P
J isog (O-? : izs-t1oqr ; o* ' t,t-,ofi i nr*p" taLscrnalzan reorua 6/aqs\ otqan kb )

,) Sinus ronatr! : intrna-[ cavit5 b?-+.*)

dlm gmiaO ( dr-q0fsi J haq
r.q\q..
a. afureo r efirm
crrprfr\io.[ qinja-t , io q,ow) af ) t
'
.> hlortzkr rgnaLr ' baq. @ KonrPone.n varLula'- + +r.,;gnhubvlu5

rcddirh brou..rn tr grz.nalar @ Komuo,*. luht c + rLP + fli[ " rro .r

fr&dr.rlla rena[t! tdo 6-16 ?

b = lnvoq.msi baddq mnqka? t
k amrU rcnalts ghuttur ko.d.at / ln'crng,.rtar Q>-" n",l Popilla
" tcnhe aLo dr hinqqq I ne(on bM

rrun;ooL k- *. .inrs r.nol,\/

h6lo*na renal{q : jor.l.orhka\ pmfsah aht-arz1 11*,14
: ;) ./ &jr,nts BfL nefron brWg
. otoqen)lus^,ja
Lrlor rencr.l{i : I piumtct t tcol,rnna ren+t,\ & *** O,*\i*Oo L-.e t"p luar Lortelcs , Aua henle Vt&k
I
l" nr6stlta ftr reols }. ,sckretonic
i
/ "dismginq"
(diLs o{nor - cvg - shrrgecl drai''r c\. di-rLhs dt,n nrsq! gagilla lf/o nefron "7g!i;"arto'.i
fforq.) sqh$tlvsg
+ q -i
mayoc --
1.r\runqa,. cr\u< trinot- ' e W . dln Lo/.*s, .lrmpfng medlrtta ,
anm henlt

Pelvrrunat i qcrbu.q6,r e -3 -.- maiJor i#,T l#t;. tri"g hi"qqa m&{^ --+ kpiicr fedtubotr,tnua *Va.sa'
Lobr\us : \nrfton 'i I dubiug h\ebtilus Cdianto* 2 a . kod adtht*) . u-' nasLotar
baalcunq RECrh "
-r ... - Pt i,5,
meq-bnenkcsi 't-n (r"IiLtron) *.0
o

I
Glommlar capsule L)
capsular Glomsurur
tc"p"rr*-liooJ Podocyte
sprce capillary epithelium epithslium
Pores

Mffingial
cell
Efferent
aderiole Capillary
sdothelial
Di5lal cell
convolu'ted Dense
l!bule lay.'r

I-Macuta densa
t
[l Juxlaglomerular
II cells

l-
Juxtaglomsule
complex

Figure ?6-8 The Renal (orpuscle. (a) lmportanl structural features of a renal corpuxle- (b) This cross section throuqh a \c(11x1rl el llrr'
glomerulus shows the componenis of the filtration membrane of the nephron.

Proximal convoluted tubule Distal convoluted tubule

ReaDSo.otio" o'' \',4:e'. . Se3'e'o,' Jf o'.s ac ds.

rons. and ali drugs. toxrr.rs
organic nutner.rts . Var abie reabsorption of
'u,iater. sodiufil ions. and
calciur-.r ions lunder
lrornronal controiJ

Renal tubule
I
'-i
i; Collecting duct
Capsular space
Glomerulus
Efferent arteriole
Afferent arteriole Variable reabsorption
of water and
Glomerular capsule
reabsorption or
Ascending secretion of sodlunr.
Descending
limb of potassium, hydrogen.
limb of
loop ends and bicarbonate ions
loop begins

Production of filtrate Thick

Thin
descending ascending
limb linrb
I

I
I

Descending Ascending
llmb limb
KEY

Delivery of urine
Solutes to minor calyx
Fr ltrate Minor
Furlher reabsorption of $/ater calyx
Variabie
(descending limb) and both
reabsorption
cr secretiou
sodium and chloride
ions (ascending limb)
 @

Date it teb zoto

L) korp,.,s n'olph.a6'' ? nrciabot0 I otryc^o,c uasl< Dkr irn l.rs d eicr(t res, :

L to-2roiim Cdtana*cr) \;-URe^ { : t1q ptq bqk , orostiS r hasrl. pe.mecaha-i as -amiro

L, tapisan panzk^! = uPit"l sdaPrs gzp,^g . X,. C,zahniu-_ =D r Lsl y.mecahan

i\
lcrzahirin &sfat @ eal olnl sVeltld.

\ ,;{'#' = peges_ii- --.7 ada pedflca{ Cffi"e r a, t-lric .ao&-5-' tJ;trrE-EaF ir ulang basa nihoqen n o1ul61i KNA

\\.yzrr/aot Jt
L Sgu stxnto,at >) @ antara t*tit".' !-rro/a^,) 4*o *qr(n.,
L r' Gtor-, vnirip arctin _-) br \ronfrol dr'anetzr krpri'o-r ?.

) altmn darah ta;u (t"t

i
L, hryir.. g\ornewtue ' ondoka..fl pnerwata + mgmbran tasc"ttS 3 ?-ro, e{..ca. e G*;a-Q, ( Pumb"nfrl','" L["' )
gg bs meltngtcupi >t uot1;G.

Proximal cglrvo juted luouie Distal ffivohted tubule @ trilkas,"

TKP l^ .) Kid6eg gamb drnding tcagtter qiomerutos (enaotol)

tToLolos
,;,ffIi'.i Bbod.
#-b.o* basat,:1
L> [61r5m : zpi \
Y1[' r.)''=., 't "edah \prr'.""' "
L absortsi nuki
\l i-t -)/podori{ '*,
dr cctiran {rr ii l.:i
'1,,1
t:: s-" I
L Ansrr. l,o'.\t
I.--- dasanclinc
if Colletirg drct +i

Esx
il *:i
,i: .e'
'L.gon boru. ,)grrrruobc( {hd HLO

eaf ta{nruk \^inn*o

& , -- tctp,lan galalinosa

*d^ BlhSgS e
4sTlolar ,

glilcogcoLao

il { l i Woata" skrubtuca.t J,-r^* durr^,

\\ atencl,n q {{ hc.m$at g.otttn
olasma,ktc .4lbumin
,/
-l iis \ I +dl(
'oanolrrlc' atbuoin g grot p6nra taio
{}. r9DM
X
I ['- ., cth ' DM qloruxutoro-{nh:
'
t}] * s.boq peng-' ginjol dgn atbominona car-'std b4 6t rwntaa Q @
Ndphron l6p .i 4,.
.f$ membrrn !asc& sht pc*nbmq qtomerlrlus ) qecmcabe( ttrd atbumio

7 TkD L'Iltru(us LonLothus Distaa ) evm thouqh uJzvran pod blrir X berubah

Lz diamghcr <'tgp x :r miEmvi(i

Lr f p6sesyftaQ: L!) Sekrest atch{ ion],&samr, obat,toksln 4 Sinjai lennra 2D -z;o[u dt fol.aJ- Cardto6 69arr3
,^.a^
G) Reobs seteLh-( Alit \- Cat{ zrZ hrftrr,z.si inko kagsota boornan :) Fl nnnt
f- ",{"
(9) sc\tLttf air &) pon,a\catan rrrin Lao% nqrltr 41* a.ekx,4.^ G\ k"p- penfubtilus
Fro"bs O nornol "ga
LrJru\.^^ot" anhaua a,aftrcn I a,efercn => frpp"*lrt ],'^lr,gto'^e., *L lr*t,
*'S'5*'* --/*
[eOO Fr(kari ,

c60nt/do\)
o*unt"- O fYlo,vuh. l*rwa .ogftr,t Tro u >I & @,uvr*r^4o eW '""/','n
?@ t0l$Eoqb*rlar-. modlf"d srabut aloF yolos @a-a$-renogcn
ftrin
y,?o e- @ gil gotLfon Ltu,as / nuanqth.Q e*qhaXlornt,tlar)
' '- -- / @ ReabsorQei
j "- ',,- =per,rioc{ahonse(elch{bohao}beroa"["r"t drtomen fubu{uEkemheti
\r. ylam* kagier 7erifub*rloe ---r t}Z}.o -7 )tg tresirL,,'tari)
1 sa\masang,a{ t-eu,h%6* --/ *^'lll,E/n". t*ri['tl^'*
\ rnhogto-=fgsi , S,qosiFosis , g-ngokong paosrf , U d, LBD-yh,; + =V
ssk*riatDtcfo (trt,gpqp;, toq.rl^,; L,^rl-;)
d ' "
Ga^t'ln
rzgutaci blood (too qramrru[,.,s,

I @ go'*i
I

l, lrUrfr, koletchv,.rs CCot(ecii.g duct) , ganinclohao szleLh( tohanr d. k p gartubotus ft tu-u, frbrlrs
L" qrtct kolrrno,1 - doo/o '4q
x rZ6tt*si
Lt afur [a&tr*) l.omposi.i 6p.lran * tentulron lroocmkrasi osorohlc

$"rt * uc(ume unn abhir. @)-@ *@ 'V EkeLreti tn'n

- p",rgalri.a. bairan I dc lul,oir kir dlm t^n,'r
 @

Date tt tcb 2Ot6

ko,1,-,s rn,^ipl" ia6'' l{o Tnnsport * Z mclabotrt forqc.nic pastt pq Uq hrs dir[cshres,:
Medrmifr
L t<l - 2to ijrr)
( bn, lons Urea
, rnostig ; harrl pgmerahar: as .Gmino
. Na,al < K-, H', CA] 'vVater l
t?
,
lcreohhin ps@t @ eal oLot sLeleia{
ta?isan
1- f c" , .,r
-
Po,t Urob;iinogen

\ v.so_,'.
HCC Bilip"bin rr viqng ba:a nihagen polekoi trNA
Wastes
I
Crealinine
L, SEL MxAN6tA M","boti,", Ammonia 't+ro^x1*
L v 6t*n", o'':"t" Organi{ aclds and bares
\ - Ar:aO a( d5
Proteinl

L, h0,,..
Miscellaneous
NPurofiansilil10rs 3 ?*ro, c\.r.ca. e Gi^;a-a- ( P"mb"nlrko" L[..o )
iACl, NE, t, dopamine)
Histam:nr

@) tritt'"sr"
--? 1-Kp tT.rLuLs konlortus Pok-etmaA / P.. convo[,rled - fub,.,b ) "l Bbod Kdd6ral Barrio. K-- clmdio6 tcagiter qtomerr.rtus Cena*oi)

L, [a?ts"o '. egifel schpu tubs + milcrpvr'li basatr]

\ :J-t,='* 1

*--
'.'tot'
L, absorLsi nuFn'en orna-nrlc
, bnt , 4(r ' Frot'Pttsrnq (Trrada)
-)/Podos;L
'-,-, [ra'' "

d.r caiun +t)t ula, G;:-\ calrz.o perifubokr J

'L.qon botot ,)qrrncabo{ {hd HLO & u -- t.,g,!on ge.lalioosa asslolql ,
ttarr]c: tcubaid' i +ht! : q'o?nq lda q
[nsa. [,a,nk 7a[ te(nrut \.ionga t<ghqzn qlil@vateio
( 'o
dasa.aig *ct- , w.w rrht 61,o. **^ s?ntvtn'*t --'-;,).!)f *,r,
\-\ Vft\o ^,,t'P ,,J*;:-,
osczndtna,
oscendtngn rl \U"7
\lb,{" 7 yemenlod tu (ur
yemenlod T(.,
t(nd a-tr
ar. o{or.aul".otbr*in
g[ar.a,k)c.a(bu,min
*tT;rJ'" .oenolale,atb,
.^on^t^t,,,,r{,,,-r^
g
'/
-^, ptf;rna
'oenolale'atburnin
o g.ot ^,{.1^,,,,^
ic.,n
I vu,.o rEv
x.vo
vlt'rtcr( J tu
I .rcth'DM'qloruxutoru$tir
.L+t i" * s"bas peng-' 6iniol dgn atbom(nonh car-,so,cl bg 6," n..rlltao Q @

-a-bmr barcrq sht mo*nbmq gtarrrzrutus ) pmcabel thd atbumfo

1
L: TfD L-Iirbotus Lontortus U\ta-A ) e-vcn thouqh irt uran ?or{ ea1r1.cr x brubah

L: d{arnsLo. < TEP 1 :A niLmrnli

b3?*r"ru,lr,.Q., fu) leLrosf crth( tonr,&saml,obat,tokan '7$in16\tm'ma 2o'L,o[b &totd GrdfacOotpc't

u) Rzobs seteuh'f Mit \- Ca"{ rZ U^ lrrfi'ttras; into hfsota $oonran ;) H nnAl

z f-
(3) Frabs sctekt'f atr &) paora\catao trrin Lao'6 n@ff. {h* a.efeczt, \ k"?- pentubulus
Onr.ro\, W "qa
LrJrn\,^^la,t antara a,otr^ e a.o-fercn => ,{ppo*tu, }vxhglor'.eru
[Q,O *L L*t', ._ frtkasi ,

*#',:^t"t'* -/ "'"%a us,Ft1^)

**,int.- () llllabu(a, Ar*o ,@pft{,t -ftsD u6 > I & @,uu*rnto tuW
Wl +@ Ma$Etoatr*.tar. modlf"d ombur alol- Tolos @a-a\:.,"aga
E?D e- @ &,t gotL{sr,n (tbds / nuanq,\ul otrfianlown1ar) ! 't / @ Freabso*ei

'Y*."i*^'ilI::r,":TH"^-i^rl:::ff"
xsz\masonq,ar ,-"*w^-)
\ ,^*n*=f1<i , pd,ostl, *^'r+a,rL/ur". + *'\j['t/^'*
$qosrForis , p-r,r.1otong U a, Bo-t/u,i +
sdcrzsigftolcl. (tL1 ,foep), tttlrll^;n)
"
rcLnilhn
L'-r/-;)
reguta.i blood (too 4rawuru(o, "'
1f, luUur* Ieolalchvus Ccottecting d.uct ) "*' . ganindohao selerchf tohqn
r d. kug garitubulus ft lrmun frbrlrs

L' a?it l l.oturnnor - Boo/o '4q * $'flv*i

L7 6\u1 [dl{7u() itornposist ccLi!-an :" knfukan iaooqrehzq( oJo}ohlc

{"^l
i uir{,rt trno akl'r-. 6-@ n@ ,V fkrLresi
v
c.nn

uar-an ba.han - di lubuh br dlm unlr

@

Region Length Diameter Primary Fun<tion Histological characteristi(s

t*::*:
NEPHRON

i 50-250 pm 150-250 irnr Filtralion oi plasma Glomerulus (capillary knot),

Capsular " (spherical) mesangial cells, and dense layer,
space enclosed by the glomerular
Uapsular capsule; visceral epithelium
epithelium - i (podocytes) and capsular
epithelium separated by
Capillaries capsular space
oi glomerulus
Visceral
epithelium

Renal tubule
;l:rrnal cortvciuted '14 mnr 60 pnr Reabsorption o{ rons, Cuboidal cells with microvii i
-,.r.rie lPC i) organic molecules,
vitamins, water; secretion
of drugs, toxins, acids
tulicrovilli

l.:-"oirrcr: loop Squamous or low cuboidal cetis

1 5 ir.m Descending limb: reabsorption
of water from tubular fluid
30 pm fucendin g limb: reabsorption
of ions; assists in creation of a
concentration gradient
in the medulla

Diiiai .on,loiLrted trrbLrle iDCT' 30-50 pm Reabsorption of sodium ions Cuboidal cells with few
and calcium ions; secretion if any microvilli
of acids, ammonia, drugs,
toxins

COTTECTING SYSTEM ,-
ioltcc:.rrrq duct 'I
5 mm 50-i 00 pm Reabsorption of water, Cuboldai to colun nar cel,:
sodium ions; secretion or
'-a.. reabsorption of bicarbonate tatic &lood)
: ions or hydroqen ions rcross capillary
;e layer.

r.:p larv ciuai 5mm 10G-200 pm Conduction of tubular fluid Columnar cells r,ransport, including
to minor calyx; contributes
! It (glucose, amino
to concentration gradient ,; (glucose, ions), and
of the medulla :with secretion of H')
: or osmosis (water)
with sodium ions
ions. lipid-soluble materlals, water
Secretion: HYdrogen ions,
ammonium ions. creatinine,
drugs, and toxins (as at DCT)
water Reabsorption" Sodium and Active transport via Nar-K./2 Cl*
I'lt.lllrron loop Reabsorption ol 25o/o of the
(45 Udai) and 20-25% of the chloride ions transporter
sodium and chloride ions present in Water Osmosis
the original filtrate; creation of the
concenlration gradient in the medulla
I )i\l.al convoluted Reabsorption of a variable amount Reabsorption" Sodium and Cotransport
ttrbule (DCT) of watei (usually 5%, or 9 Uday),
- chloride ions
lOl stimulation, and a Sodium ions (variable) Countertransport with Potassium
unOer
ions; aldosterone-regulated
variable amount of sodium ions,
stimulation Calcium ions (variable) Carrier-mediated transPort
under aldosterone
stimulated by ParathYroid
hormone and calotriol
Water (variable) Osmosis; ADH regulated
Secretion'. Hydrogen ions, Countertransport with
ammonium ions sodium ions
Creatinine, drugs, toxtns C arrier-mediated transport

Reabsorption of a variable amount of
Collecting system
water (usually 9.3%, or 16.8 UdaY)
under ADH stimulation, and a
variable amount o{ sodium ions.
under aldosterone stimulation
Peritubular caPillaries Redistribution of water and solutes
reabsorbed in the cortex
Vatarecta Redistribution of water and solutes
reabsorbed in the medulla and
stabilization of the concentration
gradient of the medulla
Reabsorption: Sodium ions (variable) Countertransport with Potassium
or hydrogen ions; aldosterone-
reoulated
Bicarbonate ions (variable) Diifusion, generated within tubular cells
Water (variable) Osmosis; ADH*egulated
Urea (distal portions only) Diffusion
Seffetron: Potassium and Carrier-mediated transPort
hydrogen ions (variable)
Return of water and solutes osmosis and diffusion
to the general circulation
Return of water and solutes to Osmosis and diffusion
the general circulation
 Region Length Diameter Primary Fun(tion Histological Characteristics
NEPHRON

'l5S-250 pm
Renal corpuscle
Capsular
150-250 pm Filtration of plasma Glomerulus (capillary knot),
(spherical)
space mesangial cells, and dense layeq
enclosed by the glomerular
Capsular -:.' capsule; visceral epithelium
,.ollhelium
(podocytes) and capsular
Capillaries epithelium separated by
ot glomerulus \ capsular space
y;"s.;d _)
:! lrel Lltr

Renal tubule
: .,. ..1 atrt,,C tieCl 14 mm 60 pm Reabsorption of ions,
ir. .:,.i ri l Cuboidal cells with microvilti
organiC molecules,
vitamins, water; secretion
of drugs. toxins, acids
i.lrcrov rlli -....-.......-

| ,urun.ry I,rblr, 26 4 Hcnal Structures and Their Function

GGneral Functaoc
r,,rrl ,,'r1l..rlr. Filtration of plasma; generates
approximately 180 Uday of
filtrate similar in composition to
blood plasma without plasma
proteins
t r,,,.ln.rl r ortvolulr,<l Reabsorption of 60-70% of the
trrlrill, (l't I) water ('108-1 16Udayl,
99-1 00% of the organic
substrates, and 60-70% of
the sodium and chloride
ions in the original filtrate
I'jr,pltron loop Reabsorption oI 25% of the water
(45 Uday) and 20-25% of the
sodium and chloride ions present in
the original filtrate; creation of the
concentration gradient in the medulla
l)i,,lnl convoluted Reabsorption of a variable amount
tulrtrle (DCT) of water (usually 5%, or 9 Uday),
under ADH stimulation, and a
variable amount of sodium ions,
under aldosterone stimulation
Collecting system Reabsorption of a variable amount of
water (usually 9.3o/o, or 16.8 Uday)
under ADH stimulation, and a
variable amount of sodium ions,
under aldosterone stimulation
Peritubular capillaries Redistribution of water and solutes
reabsorbed in the cortex
Va5a re(ta Redistribution of water and solutes
reabsorbed in the medulla and
stabilization of the concentration
gradient of the medulla
Specific Functions
Filtration of watet inorganic ind
organic solutes from plasma;
retention of plasma proteins and
blood cells
Active reabsorptlon: glucose,
other simple sugars, amino acids,
vitamins, ions (including sodium,
potassium, calcium, magnesium,
phosphate, and bicarbonate)
Passive reabsorption: urea, chloride
ions, lipid-soluble materials, water
Secretlon: Hydrogen ions,
ammonium ions, creatinine,
drugs, and toxins (as at DCT)
Reabsorption: Sodium and
chloride ions
Water
Reabsorption'. Sodium and
chloride ions
Sodium ions (variable)
Calcium ions (variable)
Water (variable)
Secretion'. Hydrogen ions,
ammonrum rons
Creatinine, drugs, toxins
Reabsorption: Sodium ions (variable)
Bicarbonate ions (variable)
Water (variable)
Urea (distal portions only)
Secretrbn: Potassium and
hydrogen ions (variable)
Return of water and solutes
to the general circulation
Return of water and solutes to
the general circulation
Mechanisms
Glomerular hydrostatic (blood)
pressure working across capillary
endothelium, dense layer,
and filtration slits
Canier-mediated transport, including
facilitated transport (glucose, amrno
acids), cotransport (glucose, ions), and
countertransport (with secretion of H r)
Diffusion (solutes) or osmosis (water)
Countertransport with sodium ions
Active transport via Na'-K /2 Cl
transporter
Osmosis
Cotransport
Countertransport with potassium
ions; aldosterone-regulated
Carrier-mediated transport
stimulated by parathyroid
hormone and calcitriol
Osmosis; ADH regulated
Countertransport with
sodium ions
Carrier-mediated transport
Countertransport with potassium
or hydrogen ions; aldosterone-
regulated
Diffusion, generated within tubular cells
Osmosis; ADH-regulated
Diff usion
Carrier-mediated transport
Osmosis and diffusion
Osmosis and diffusion
 @

Date

KONTRDL AFK
--.--^..---.:.
@ Aoro<equLasi (wto,o'ne niryn&c)
G saa* b? (btmd ?cessure) \ : t . Aifo;la;i a- aferen
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lapiter gloaerrtbe

3. lcoFstnlci a-eQrn
Lrroo.t.g,t' ; @nstnki a.aferal \ 6fn

@ Qqdarr rlormona.( ( avbrequtasr , nLt@a,,1e+d)fif#"

' has,1 lrzbe.adr,tr sr,,sgensi grolern , enderung rn.nc.i{c air te lihtban agpmkus /csraltomeota.
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gumbatan @ a'rcnahs / hqian"ng
[64lc'r o,,b
/-\ ; laAcdr'Jxr4nl
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d"lt'lot l tsrnmH, X- Stimulasi tg_fqgbfugy!* d ioervaEi simgratis 1"ea^i a" tU-

' dftrbrlkoo coican @ aroai tubutos I olrtz;t tzsrslensi ahean a. % Lonscnkusi osmohk calran fubuler @ qqtq!6( &n'*':i:l:'2
catcan sqanjcmg ,retrcn & 'condoclf

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lxb4asq p^-kri, nrto.* @ a . af-r-a egl tanstnksi

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pnqorutri ^1 L-i:-q @,1 iL rr peru6. {c\., a.rltx csia6 dr' [r,,ar Lieatz.,r rrufo,zqr:lr.si , rntka,rLlire

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-t x 0thasi . ar<on crabrcao \ 1/ LFG 5asuai perub kL. a.len k5.

maLa J weLanisilre rzgutasi 91 ahn dr&tctr(&an

@ Podorit fo v Lonkakh't minp abuo qlut @ta: llh1tsi qr'XX

fita,rer. -)
@
Mefibantu memprMiki

ffi ;isii.ffi#

geCorA
han teLih
di c6E

ct)

I
I
oleh tubukcs
(t
mengikuti
pasif),

*--l*
Vasopresrn Haus I Vasokonstriksi
_t afteriol
i

I
I Reabsorpsi H2O
oleh lubulus ginlal

"Faktor lain yang berkaitan

dengan keseimbangan
cairan juga meriimbulkan
respons-respons ini.

Gambar 14*tE
Sistem renin-angiotensin-aldoJteron'(SRAA). Ginjal mengeluarkan hormon renin sebagai respons terhadap r.o NS,
volume CES. dan tekanan darah arteri. Renin mengaktifkan angiotensinogen. suatu protein plasma yang dr h.rh,
rrrenjadi angiotensin l. Angiotensin I diubah menjadi angiotensin ll oleh angrotensin-conveiting enzylne drqrod,-rrr dr
'

paru. Angiotensin ll merangsang korteks adrenal untuk mengeluarkan hormon aldosteron, yang merangsa*q Ua+
oteh ginlat. Rentesi Na' yang teriadi menimbulkan efek osmotik yang menahan lebih banyak HrO di CES. Be{S!
t(onservasi Na'dan H.O membantu mengoreksi rangsangan semula yang mengaktifkan sistem hormon ini. rxs 3 lrg.,
rrremitiki efek lain yang membantu mengoreksi rangsangan semula, misalnya dengan mendorong

E-ft.k primer AbIqtDTENStN 1 :

O dr.nO P.".Jrittr, sa\ rNa+ {1a1r1,.
e &\^ $ - konshrtcsi a{enbt e|cran => "r GFR s Filtohbn rates d[m ormLran tum.ira?
7 tse

- shmutasi reabs. loo l\la+ !' l[,D @ 11.P / @ p*^ pemharra N-lat-kr ATPcree
kt dlm memt'ran b,so tatera^e4iko
i. kote{cliws

@ 6l.r,rgcarunol { eHmutasi scrresi alclost:stzo J L'orietr

v
akcaterari mabc tuo. @ i-fD g baq.pgrizic,q sist, koltLtivus

eCNS St"sunsasi ha"s

2 - cefusLan gclegosan AD( Lt\nh Diurenc l-io.no,nL ) 1vo.r1x..,n
3. n} lonus nroton\c simpa.hs :) moNlrJa s. 6aio\-c\ar vzoA
i vmous "uu,-i )
s V
jr
stimotasi vaso ko nstn lcsi
pori(e.r d G.d,* oirtp,rt [cu.r^rr rq)

O ?^.hit , g"''f- Q VasoLoosknlcsi sirgkat n

,fffi\ arfanbta. P
s$'nqter (ubo+du =) d teJ.. **d.,1;,Y:|.,

r- Eunc\ameni-n\! o( AnaFomg \ Phryroiagg i{arh',i { tUath - 3th"6 ?.crrror,

j - hetotoq, fi16nvsra L Slr',i.oora /,ih cd. Crngc,g" L.am(n.\ -,EGC 7o\L
 @

)1. .

Dare l2 . Feb . 2016

= PentaLL 6o*wlu, =
?at-oqenrri.'
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gr\c.s

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G lcjar tm anhbodfglzredar dlm drh bz.x dgn annqen@g{oorerulos b:ffiI1*
D ti0onh
t-tttormot't\
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cast5

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iahemia
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^l tiltr Aso l Asro

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tpe 2 =) GrcurtaHaq Immune @mplex Qgocihbn L> nlaLmdopr\ : grnja0 crd&rt men:barar-r rynnr.{raan
kortee tanrpalc

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L- anr'qeJZ;q;7 . .Jr^ DNA (stE) / Lr milcorkotrr! : miLraskog chg : 0toeha-- rhinlbecar , hipexelolnr,
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'p \>as cv;ot.oq
- 6N Vnn*r 1 , 6N prolrfcctif dtps aLot ( nDD -pasa tu

" QN cresa.olic l rapid\ prcgressive TRPON)

" 6N mzmbeoosa C MG N) ROMA NJEFROTI

' Minina.( changr ch'rar< Cuco) f flft(t ,) ciri i- etLcrminunh nar(

. Focal co4mtat"Q 6tornerulosclerosrr CfsGS) higeatLominznr tq

" 6N membran,Xqrll5lf Z. oQd.h^ Aaasa:cca

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a\Z P(r' rtuPto

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thh -ihto
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f Lklainao ) baswnt marbmne dtsgart
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+
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Dr-gr. , f:) Bonnn \c,.ririrrr di . S?Fo ?o e NU O -roobt e !q Med. (mor v,dtcx, " [\rep!roh-< vs lVef hn'hr \nd Erolunecl tiearl4
fO i?D (q'"i*l Hixrknri ) 9*t' n4 O, tu.l-ubc b9 USMuE i\h\ar Cnq . 6lonreruiooephrrh! l\kfin'h, lynritt,.u * U!qLE
@ Ro'bbint I Co{no falholoqic ba$ oe D,vox. gthea 1,. t\ .- Nlphoh? ,,
o
No.

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o) dfdahutri inf skcgtokotros p-'trenr\rhlcus 6rup LUdq ?A
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us qdlor nt(ffbogtnit< --+ 9o% Scrotige t2 , 4 ,
U
I

L, !r* pu*. tg rltm ptcq.nolis QN*^ R

f Vaiun-As/ Y
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krinqrhs . gotain M . gotein kahbn,k , (AP,fr

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.

[-; tr y"u-o3aA gioct-ocma / i.pnh'go . 49 . ncuraminfJacr . EPS 13

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j

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' |- 7Z

dqn anh'6tn gtomerutus norma{.

f* tr1"r!i -/ @ f-wp& A! icut'dens \ lP 57.,5O)Uow rouncu[ @ c. qernbenfulrao [<omp\cbs lmun in st']v atlatq. antibodi aotir]rzptokokos

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lpnqfuria norrul aross h(metun'^
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on'tl'qr :trr4to z/bhmhBi}'r--,

ic'ftIcci Lortrt la) :) @ nruim ganas I murim qrrgur

#;tr;;s7xt")yrgp "1te"4 f,b*
Jr. tonsi&raii ini @ g.ecico rig,. , - pandanqon Lab*r
sbnoq n1! btm i"tcl
I sant?ui
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- saidt tcrqtr"\rr ?arah
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irrfoLsi ( @.nnahc 1 irpefu) - porub skaius nrqta'l

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Jgn>dt\oha lcm grodo{tri anHbodit dmun botu6 arattv
ry X e[rna gulrnor"r. J q1t:
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@ fu*s : { - {-s nm )nvdal lukak d&i.i %omlztatc i.mnqa .) g1\'Aon spsifuk ')q umunt 6tcln :

- rna\a{rt * ng,Ln abdomina{ - (er,, u n**

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; potdn pnqikat g{arnio dqo ekso-B ) 6,lL
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* NAPt7: Nethritr'u - asgoctatcd sheptoVoroJ Ttaroio rateploe ?tarmin
 I

(to)

Date 2, . ELb . z016

, hipe.tgn., ,
Lrauro (n'ut'l
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.' 3 d**.a =) onscL ) ahprrcaQ ,) Urinan*tcrt:s sllo abnonna-Q i slkr r' hernahrnh. U ;;,
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Or
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r* atobat hemottsrs RbC 16g *"tnroy' 6erobmn hsa( qtomerulus & il,ttotonapLEMENEMrA
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ko"rplelcs imun bzwirLr.rtari
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I
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. skep\'a
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>i @ Pati hari c"tth Fqil hciur , Q ,-o5 ' ASO Cflntr' Strepratiicdn 0) 1$Ur*^@@ go,^@.ir6,tr
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