chapter 8 excretion of the kidneys major functions of the kidneys 1. regulation of: body fluid...
TRANSCRIPT
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Chapter 8 Excretion of the Kidneys
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Major Functions of the Kidneys
1. Regulation of: body fluid osmolarity and volume electrolyte balance acid-base balance blood pressure
2. Excretion of metabolic products foreign substances (pesticides, chemicals etc.) excess substance (water, etc)
3. Secretion of erythropoitin 1,25-dihydroxy vitamin D3 (vitamin D activation) renin prostaglandin
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Section 1 Characteristics of Renal Structure and Function
I. Physiological Anatomy of the Kidney
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1. Nephron and Collecting Duct
Nephron: The functional unit of the kidney
Each kidney is made up of about 1 million nephrons
Each nephrons has two major components:
1) A glomerulus
2) A long tube
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Cortical nephron
Juxtamedullary nephron
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Anatomy of Kidney Cortical nephron
80%-90% glomeruli in outer cortexglomeruli in outer cortex short loops of Henleshort loops of Henle
extend only short distance into medullaextend only short distance into medulla
blood flow through cortex is rapid cortical interstitial fluid 300 mOsmolar
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Anatomy of Kidney
Juxtamedullary nephron– glomeruli in inner part of cortexglomeruli in inner part of cortex – long loops of Henlelong loops of Henle
extend deeply into medulla.extend deeply into medulla.
– blood flow through vasa recta in medulla is slow
– medullary interstitial fluid is hyperosmotic – maintains osmolality, filtering blood and maint
aining acid-base balance
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2. The juxtaglomerular apparatusIncluding macula densa, extraglumerular mesangial cells, and juxtaglomerular (granular cells) cells
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3. Characteristics of the renal blood flow:
1, High blood flow. 1200 ml/min, or 21 percent of the cardiac output. 94% to the cortex
2, Two capillary beds
High hydrostatic pressure in glomerular capillary (about 60 mmHg) and low hydrostatic pressure in peritubular capillaries (about 13 mmHg)Vesa Recta
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Blood flow in kidneys and other organs
Organ Approx. blood flow(mg/min/g of tissue)
A-V O2 difference
(ml/L)
Kidney 4.00 12-15(depends on reabsorption of
Na+ )
Heart 0.80 96
Brain 0.50 48
Skeletal muscle (rest)
0.05 -
Skeletal muscle (max. exercise)
1.00 -
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Section 2 Function of Glomerular Filtration
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Functions of the Nephron
Filtration
Reabsorption Secretion
Excretion
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FiltrationFiltration
First step in urine formationBulk transport of fluid from blood to kidney
tubule– Isosmotic filtrate– Blood cells and proteins don’t filter
Result of hydraulic pressureGFR = 180 L/day
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Reabsorption
Process of returning filtered material to bloodstream
99% of what is filteredMay involve transport proteinsNormally glucose is totally reabsorbed
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Secretion
Material added to lumen of kidney from blood
Active transport (usually) of toxins and foreign substances– Saccharine ( 糖精)– Penicillin
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Excretion:
– Loss of fluid from body in form of urine
Amount = Amount + Amount -- Amount
of Solute Filtered Secreted Reabsorbed
Excreted
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Glomerular filtration
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– blood enters glomerular capillary
– filters out of renal corpuscle
• large proteins and cells stay behind
• everything else is filtered into nephron
• glomerular filtrate
– plasma like fluid
Glomerular filtration
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Factors that determining the glumerular filterability
Molecular weight Charges of the molecule
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Filtration Membrane–One layer of glomerular capillary cells.
–Fenestration, 70 – 90 nm, permeable to protein of small molecular
C: capillary
F: fenestration
BM: basal membrane
P podocytes
FS: filtration slit
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Filtration Membrane–Basement membrane(lamina densa)
–with the mesh of 2-8 nm diameter
C: capillary
F: fenestration
BM: basal membrane
P podocytes
FS: filtration slit
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Filtration Membrane–One layer of cells in Bowman’s capsule:
–Podocytes have foot like projections (pedicels) with filtration slits ( 滤过裂隙) in between
C: capillary
F: fenestration
BM: basal membrane
P podocytes
FS: filtration slit
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Stanton BA & Koeppen BM:
‘The Kidney’ in Physiology,
Ed. Berne & Levy, Mosby, 1998
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Dextran filterability
右旋糖苷
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Protein filtration:
influence of negative charge on glomerular wall
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Constituent Mol. Wt. Filteration ratio
Urea 60 1.00
Glucose 180 1.00
Inulin 5,500 1.00
Myoglobin 17,000 0.75
Hemoglobin 64,000 0.03
Serum albumin 69,000 0.01
Filterablility of plasma constituents vs. water
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Starling Forces Involved in Filtration:
What forces favor/oppose filtration?
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Glomerular filtration
• Mechanism: Bulk flow
• Direction of movement : From glomerular capillaries to capsule space
• Driving force: Pressure gradient (net filtration pressure, NFP)
• Types of pressure:
Favoring Force: Capillary Blood Pressure (BP), Opposing Force: Blood colloid osmotic pressure(COP) and Capsule Pressure (CP)
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Glomerular Filtration
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• Amount of filtrate produced in the kidneys each minute. 125mL/min = 180L/day
• Factors that alter filtration pressure change GFR. These include: – Increased renal blood flow -- Increased GFR– Decreased plasma protein -- Increased GFR. Causes
edema.– Hemorrhage -- Decreased capillary BP -- Decreased
GFR– Capsular pressure
Glomerular filtration rate (GFR)
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GFR regulation : Adjusting blood flow
• GFR is regulated by three mechanisms
1. Renal Autoregulation
2. Neural regulation
3. Hormonal regulation
All three mechanism adjust renal blood pressure and resulting blood flow
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ERPF: experimental renal plasma flow
GFR: glomerular filtration rate
1. Renal autoregulation
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Mechanism?
Myogenic MechanismTubuloglomerular feedback
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Blood Flow = Capillary Pressure / Flow resistance
1) Myogenic Mechanism of the autoregulation
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2) Tubuloglomerular feedback
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2. Neural regulation of GFR
• Sympathetic nerve fibers innervate afferent and efferent arteriole
• Normally sympathetic stimulation is low but can increase during hemorrhage and exercise
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3. Hormonal regulation of GFR
• Angiotensin II. • a potent vasoconstrictor. • Reduces GFR
• ANP (Atrial Natriuretic Peptide) • increases GFR by relaxing the afferent arteriole NO
• Endothelin• Prostaglandin E2
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Measuring GFR
• 125ml/min, 180L/day
• plasma clearance:
• The amount of a kind of substance present in urine
• The substance: filtered but neither reabsorbed nor secreted,
• If plasma conc. is 3mg/L then
3mg/L X 180/day = 540mg/day
(known) (unknown) (known)
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Renal handling of inulin 菊粉
Amount filtered = Amount excretedPin x GFR Uin x V
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Qualities of agents to measure GFR
Inulin: (Polysaccharide from Dahalia plant)• Freely filterable at glomerulus• Does not bind to plasma proteins• Biologically inert• Non-toxic, neither synthesized nor metabolized
in kidney• Neither absorbed nor secreted• Does not alter renal function• Can be accurately quantified• Low concentrations are enough (10-20 mg/100
ml plasma)
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Creatinine (肌氨酸酐) :
End product of muscle creatine (肌氨酸) metabolism
Used in clinical setting to measure GFR but less accurate than inulin method
Small amount secreted from the tubule
Qualities of agents to measure GFR
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Plasma creatinine level vs. GFR
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Section 3
Reabsorption and Secretion
Concept of Reabsorption and Secretion
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•GFR 125 ml/min (180L/day)
•(about 1% is excreted)
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Filtration, reabsoption, and excretion rates of substances by the kidneys
Filtered Reabsorbed Excreted Reabsorbed
(meq/24h) (meq/24h) (meq/24h) (%)
Glucose (g/day) 180 180 0 100
Bicarbonate (meq/day) 4,320 4,318 2 > 99.9
Sodium (meq/day) 25,560 25,410 150 99.4
Chloride (meq/day) 19,440 19,260 180 99.1
Water (l/day) 169 167.5 1.5 99.1
Urea (g/day) 48 24 24 50
Creatinine (g/day) 1.8 0 1.8 0
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Two pathways of the absorption:
Lumen
Plasma
Cells
Transcellular
Pathway
Paracellular
transport
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Mechanism of Transport
1, Primary Active Transport
2, Secondary Active Transport
3, Pinocytosis
4, Passive Transport
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Primary Active Transport
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Secondary active transport
Na+
glucose
Na+
H+
out in out in
co-transport counter-transport (symport) (antiport)
Co-transporters will move one moiety, e.g. glucose, in the same direction as the Na+.
Counter-transporters will move one moiety, e.g. H+, in the opposite direction to the Na+.
Tubular
lumenTubular Cell
Interstitial
Fluid
Tubular
lumenTubular Cell
Interstitial
Fluid
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Passive TransportDiffusion
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Pinocytosis
proximal tubule reabsorb large molecules such as proteins
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1. Transportation of Sodium, Water and Chloride
(1) in proximal tubule, including– proximal convoluted tubule – thick descending segment of the loop
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In proximal tubleIn proximal tuble Reabsorb about 65 percent of the filtered sodium, chloride, bica
rbonate, and potassium and essentially all the filtered glucose and amino acids.
Secrete organic acids, bases, and hydrogen ions into the tubular lumen.
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Reabsorption in proximal tubule
The sodium-potassium ATPase:– major force for reabsorption of so
dium, chloride and water
In the first half of the proximal tubule,– sodium is reabsorbed by co-transp
ort along with glucose, amino acids, and other solutes.
– HCO3- is preferentially reabsorbed
with the secretion of H+
– Cl- is not reabsorbed
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Reabsorption in proximal tubule (cont.)
In the second half of the proximal tubule– sodium reabsorbed mainly with chl
oride ions. Concentration of chloride at the s
econd half of the proximal tubule (around 140mEq/L) – interstitial fluid about 105 mEq/L
The higher chloride concentration favors the diffusion of this ion – Na+ is passively reabsorbed down t
he electronic gradient
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(2) Sodium and water transport in the loop of Henle
Constitution of the loop of Henle– the thin descending segme
nt – the thin ascending segment– the thick ascending segme
nt.
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(2.1) Sodium and water transport in the loop of Henle –the descending loop of Henle
High permeable to water and moderately permeable to most solutes
Has few mitochondria and little or no active reabsorption.
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(2) Sodium and water transport in the loop of Henle-thick ascending loop of Henle
Reabsorbs – about 25% of the
filtered loads of sodium, chloride, and potassium,
– large amounts of calcium, bicarbonate, and magnesium.
Secretes hydrogen ions into the tubule
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Mechanism of sodium, chloride, and potassium
transport in the thick ascending loop of Henle
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2. Glucose Reabsorption
Reabsorbed along with Na+ in the early portion of the proximal tubule. – by secondary active transport.
Essentially all of the glucose is reabsorbed– and no more than a few milligrams appear
in the urine per 24 hours.
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2. Glucose Reabsorption (continued)
The amount reabsorbed is proportionate to the amount filtered – When the transport maximum of glucose (Tm
G) is exceed, the amount of glucose in the urine rises
– The TmG is about 375 mg/min in men and 300 mg/min in women.
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GLUCOSE REABSORPTION HAS A TUBULAR MAXIMUM
Renal threshold (300mg/100 ml)
Plasma Concentration of Glucose
GlucoseReabsorbedmg/min
Filtered Excreted
Reabsorbed
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The renal threshold for glucose
The plasma level at which the glucose first appears in the urine.
– 200 mg/dl of arterial plasma,
– 180 mg/dl of venous blood
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Top: Relationship between the plasma level (P) and excretion (UV) of glucose and inulin
Bottom: Relationship between the plasma glucose level (PG) and a
mount of glucose reabsorbed (TG).
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3. Hydrogen Secretion and Bicarbonate Reabsorption
(1) Hydrogen secretion through secondary Active Transport
– Mainly at the proximal tubules, loop of Henle, and early distal tubule
– More than 90 percent of the bicarbonate is reabsorbed (passively ) in this manner
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Secondary Active Transport
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3. Hydrogen Secretion and Bicarbonate Reabsorption (cont.)
(2) Primary active transport of hydrogen– Beginning in the late distal tubules and contin
uing through the reminder of the tubular system
– Occurs at the luminal membrane of the tubular cell
– Transported directly by a specific protein, a hydrogen-transporting ATPase (proton pump).
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Primary Active Transport
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Hydrogen Secretion—through proton pump
Accounts for only about 5 percent of the total hydrogen ion secreted
Important in forming a maximally acidic urine. – Hydrogen ion concentration can be increased as
much as 900-fold in the collecting tubules. (Why?…)
Decreases the pH of the tubular fluid to about 4.5, which is the lower limit of pH that can be achieved in normal kidneys
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4. Ammonia (氨 ) Buffer System
Excretion of excess hydrogen ions Generation of new bicarbonate
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Production and secretion of ammonium ion (NH4
+) by proximal tubular cells.
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4. Ammonia Buffer System (continued)
For each molecule of glutamine metabolized – two NH4
+ ions are secreted into the urine
– two HCO3- ions are reabsorbed into the
blood.
The HCO3- generated by this process
constitutes new bicarbonate.
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Buffering of hydrogen ion secretion by ammonia (NH3) in the collecting tubule.
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Ammonia Buffer System (continued)
Renal ammonium-ammonia buffer system is subject to physiological control.
Increase in extracellular fluid hydrogen ion concentration stimulates renal glutamine metabolism
– increase the formation of NH4+ and new bicarbonate
to be used in hydrogen ion buffering
Decrease in hydrogen ion concentration has the opposite effect.
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Ammonia Buffer System (continued)
with chronic acidosis, the dominant mechanism by which acid is eliminated of NH4
+
– the most important mechanism for generating new bicarbonate during chronic acidosis
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5. Potassium reabsorption and secretion
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Mechanisms of potassium secretion and sodium reabsorption by the principle cells of the late distal and collecting tubules.
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6. Control of Calcium Excretion by the Kidneys
Calcium is both filtered and reabsorbed in the kidneys but not secreted
Only about 50% of the plasma calcium is ionized, with the remainder being bound to the plasma proteins.
Calcium excretion is adjusted to meet the body’s needs.
Parathyroid hormone (PTH) increases calcium reabsorption in the thick ascending lops of Henle and distal tubules, and reduces urinary excretion of calcium
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An Overview of Urine
Formation
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Section 4. Urine Concentration and Dilution
Importance: maintaince of the water balance in the body– When there is excess water in the body
the kidney can excrete urine with an osmolarity as low as 50 mOsm/liter
– When there is a deficient of waterthe kidney can excrete urine with a concentration of
about 1200 to 1400 mOsm/liter
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The basic requirements for forming
a concentrated or diluted urinethe controlled secretion of antidiuretic hormone (AD
H)– regulates the permeability of the distal tubules and collect
ing ducts to water
a high osmolarity of the renal medullary interstitial fluid– provides the osmotic gradient necessary for water reabso
rption to occur in the presence of high level of ADH
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I The Counter-Current Mechanism Produces a Hyperosmotic Renal Med
ullary Interstitium
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Hyperosmotic Gradient in the Renal Medulla Interstitium
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Countercurrent Multiplication and Concentration of Urine
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Countercurrent Multiplication and Concentration of Urine
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Figure 26.13c
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I.II. Counter-current Exchange in the Vasa Recta Preserves Hyperosmolarity of the Renal medulla
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The vasa recta trap salt and urea within the interstitial fluid but transport water out of the renal medulla
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III. Role of the Distal Tubule and Collecting Ducts in Forming Concentrated or Diluted urine
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Figure 26.15a, b
The Effects of ADH on the distal collecting duct and Collecting Ducts
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The Role of ADH
• makes the wall of the collecting duct more permeable to water
• Mechanism?
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Water reabsorption - 1Obligatory water reabsorption:
• Using sodium and other solutes.
• Water follows solute to the interstitial fluid (transcellular and paracellular pathway).
• Largely influenced by sodium reabsorption
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Obligatory water reabsorption
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Facultative ( 特许的) water reabsorption:
• Occurs mostly in collecting ducts
• Through the water poles (channel)
• Regulated by the ADH
Water reabsorption - 2
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Facultative water reabsorption
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A Summary of Renal Function
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Regulation of the Urine Formation
I. Autoregulation of the renal reabsorption
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Solute Diuresis
• = osmotic diuresis
• large amounts of a poorly reabsorbed solute such as glucose, mannitol ( 甘露醇) , or urea
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Osmotic DiuresisOsmotic DiuresisNormal PersonWater restricted
Normal person Mannitol InfusionWater Restricted
Urine Flow LowUosm 1200
Urine Flow HighUosm 400
H20
H20
H20
H20
H20
H20
Cortex
MedullaM
Na
Na
Na
Na
Na
M M M M
M
M
M
M
M
Na
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Osmotic DiuresisOsmotic Diuresis
Poorly reabsorbed Osmolyte
H20 H20 H20
Na Na Na
H20H20H20
Na Na Na
HypotonicSaline
Osmolyte = glucose, mannitol, urea
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2. Glomerulotubular Balance
Concept: The constant fraction (about 65% - 70%) of the filtered Na+ and water are reabsorbed in the proximal tubule, despite variation of GFR.
Importance: To prevent overloading of the distal tubular segments when GFR increases.
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Glomerulotubular balance: Glomerulotubular balance: MechanismsMechanisms
Glomerulotubular balance: Glomerulotubular balance: MechanismsMechanisms
GFR increase independent of the glomerular plasma flow (GPF)
The peritubular capillary colloid osmotic pressure increase and the hydrostatic pressure decrease
The reabsorption of water in proximal tubule increase
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II Nervous Regulation
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INNERVATION OF THE KIDNEYINNERVATION OF THE KIDNEY
Nerves from the renal plexus (sympathetic nerve) enter kidney at the hilusinnervate smooth muscle of afferent & efferent arteriolesregulates blood pressure & distribution throughout kidney
Effect: (1) Reduce the GPF and GFR through contracting the afferent and efferent artery (α receptor)
(2) Increase the Na+ reabsorption in the proximal tubules (β receptor)
(3) Increase the release of renin (β receptor)
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III. Humoral Regulation
1. Antidiuretic Hormone (ADH)
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• Retention of Water is controlled by ADH:– Anti Diuretic Hormone
– ADH Release Is Controlled By:• Decrease in Blood Volume
• Decrease in Blood Pressure
• Increase in extracellular fluid (ECF) osmolarity
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Secretion of ADH
Increased osmolarity
ADH
Post. Pituitary
Urge to drinkSTIMULUS
cAMP+
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2. Aldosterone
• Sodium Balance Is Controlled By Aldosterone
– Aldosterone:
• Steroid hormone • Synthesized in Adrenal Cortex
• Causes reabsorbtion of Na+ and H2O in DCT & CD
– Also, K+ secretion
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Effect of Aldeosterone to make the kidneys retain
Na+ and water reabsorption and K+ secretion.– Acting on the principal cell
s of the cortical collecting duct.
– stimulating the Na+ - K+ ATPase pump
– increases the Na+ permeability of the luminal side of the membrane.
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Rennin-Angiotensin-Aldosterone System
Fall in NaCl, extracellular fluid volume, arterial blood pressure
JuxtaglomerularApparatus
ReninLiver
Angiotensinogen
+
Angiotensin I Angiotensin II Aldosterone
Lungs
ConvertingEnzyme
AdrenalCortex
IncreasedSodiumReabsorption
HelpsCorrectAngioten
sinase A
Angiotension III
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Regulation of the Renin Secretion:Renal Mechanism:
1) Tension of the afferent artery (stretch receptor)
2) Macula densa (content of the Na+ ion in the distal convoluted tubule)
Nervous Mechanism:
Sympathetic nerve
Humoral Mechanism:
E, NE, PGE2, PGI2
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3. Atrial natriuretic peptide (ANP)
• released by atrium in response to atrial stretching due to increased blood volume
• promotes increased sodium excretion (natriuresis) and water excretion (diuresis) in urine by
• inhibiting Na+ and water reabsorption
• inhibitiing ADH secretion
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2934
Renal Response to
Hemorrhage
aldosterone
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IV MicturitionOnce urine enters the renal pelvis, it flows through the ureters and enters
the bladder, where urine is stored.
Micturition is the process of emptying the urinary bladder.
Two processes are involved:
(1) The bladder fills progressively until the tension in its wall rises above a threshold level, and then
(2) A nervous reflex called the micturition reflex occurs that empties the bladder.
The micturition reflex is an automatic spinal cord reflex; however, it can be inhibited or facilitated by centers in the brainstem and cerebral cortex.
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stretchreceptors
Urine Micturition
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•1) APs generated by stretch receptors
•2) reflex arc generates APs that
•3) stimulate smooth muscle lining bladder
•4) relax internal urethral sphincter (IUS)
•5) stretch receptors also send APs to Pons
•6) if it is o.k. to urinate
–APs from Pons excite smooth muscle of bladder and relax IUS
–relax external urethral sphincter
•7) if not o.k.
–APs from Pons keep EUS contracted
stretchreceptors
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• Decline in the number of functional nephrons
• Reduction of GFR
• Reduced sensitivity to ADH
• Problems with the micturition reflex
V Changes with aging include:
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