肾脏--生理学--临床七年课件.ppt

UnitEightFormationandExcretionofUrine DepartmentofPhysiology ZhengzhouUniversityZhaoWenchao Kidneys 1 Produceurine 2 Endocrinefunction Renin EPO 3 Promotetransformationof25 OH VitD3to1 25 OH 2 VitD3 4 Glyconeogenesis 1 Produceurine 1 Eliminatewasteproductsofmetabolism foreigncompounds excesssubstances 2 Involvementinwaterandelectrolytesbalances 1 Functionalanatomyofkidneys 2 Formationofurine 3 Severaltechniquesinrenalresearch 4 Micturitionreflex 5 Regulationofurineproduction 1 Functionalanatomyofkidneys Nephron Collectingduct Juxtaglomerularapparatus Capillaries Bloodsupplyofkidneys Nephron Renalcorpuscle Renaltubule Glomerulus Bowman scapsule Renaltubule Proximaltubule ThinsegmentsofloopofHenle Distaltubule Proximalconvolutedtubule Thicksegmentofdescendinglimb Thinsegmentofdescendinglimb Thinsegmentofascendinglimb Distalconvolutedtubule Thicksegmentofascendinglimb Corticalnephron Medullarynephron Quantity Small Diameterofateriole Afferent Efferent Large Afferent Efferent LoopofHenle Short Long Capillariesderivedfromefferentateriole Peritubularcapillaries Peritubularcapillariesandvasarecta Formationofurine 1 Functionalanatomyofkidneys Nephron Collectingduct Juxtaglomerularapparatus Capillaries Bloodsupplyofkidneys Juxtaglomerularapparatus Juxtaglomerularcells Extraglomerularmesangialcells Maculadensa Secretionofrenin SenseNaCllevelintubularfluidandregulatesecretionofrenin 1 Functionalanatomyofkidneys Nephron Collectingduct Juxtaglomerularapparatus Capillaries Bloodsupplyofkidneys Bloodsupplyofkidneys 1 Largebloodflow 94 incortexand6 inmedulla 2 Twosetsofcapillaries 3 Highpressureinglomerularcapillaries 4 Lowpressureinperitubularcapillaries 5 U shapevasarecta 6 Autoregulation sympatheticandhumoralregulation BPincrease Myogenicactivityincrease Increaseresistance 80 160mmHg 1 Functionalanatomyofkidneys 2 Formationofurine 3 Severaltechniquesinrenalresearch 4 Micturitionreflex 5 Regulationofurineproduction 2 Formationofurine 2 1Glomerularfiltration 2 2Reabsorptioninrenaltubuleandcollectingduct 2 3Secretionbyrenaltubuleandcollectingduct 2 4Mechanismsofconcentratedanddilutedurine 2 1Glomerularfiltration Ultrafiltration Filtrationmembrane Endothelialcell Basementmembrane Footprocessofpodocyte Fenestration 70 90nm 2 8nm Filtrationslit coatedwithfiltrationslitmembraneincludingsmallslits Ultrafiltrate Proteinswithnegativecharge Mechanicalbarrier Chargebarrier Ultrafiltrate lackofproteinsandbloodcells Glomerularfiltrationrate GFR 125ml min Renalplasmaflow 660ml min Filtrationfraction 19 Bloodpressureinglomerulus PGC Colloidosmoticpressureinultrafiltrate pT Colloidosmoticpressureinglomerulus pGC HydrostaticpressureinBowman scapsule PT PGC pT PT pGC effectivefiltrationpressure EFP 45 0 10 25 10mmHg Filtrationequilibrium Increaseinrenalplasmaflow Characteristicsofglomerularfiltration Highbloodpressureincapillaries Lowpermeabilitytoproteins Gradualincreaseincolloidosmoticpressureinplasma HighhydrostaticpressureinBowman scapsule Factorsaffectingglomerularfiltration 1 Bloodpressureinglomerulus Arterialbloodpressure Afferentandefferentarteriole 2 Colloidosmoticpressureinplasma 3 PressureinBowman scapsule 4 Renalplasmaflow Filtrationequilibrium Increaseinrenalplasmaflow 2 Colloidosmoticpressureinplasma 3 PressureinBowman scapsule 4 Renalplasmaflow 5 Filtrationcoefficient Effectivepermeabilitycoefficient Surfacearea Regulationofglomerularfiltration 1 Autoregulation 2 Neuroregulation 3 Humoralregulation 1 Autoregulation Myogenicautoregulation Tubuloglomerularfeedback Tubuloglomerularfeedback RenalbloodfloworGFR Tubularfluidpassingthroughmaculadensa 1 Vasoconstrictionofafferentandefferentarterioles glomerulus 2 Decreaseofsurfaceareaoffiltrationmembrane 2 Neuroregulation Renalsympatheticnerve NE areceptor Bloodloss 3 Humoralregulation renin angiotensinogen angiotensin angiotensin angiotensin Renin angiotensinsystem RAS angiotensin Constrictafferentandefferentarterioles Afferentarteriole efferentarteriole Lowconcentration Highconcentration angiotensin Lowconcentration Mainlyconstrictefferentarteriole Renalbloodflowdecrease Glomerularpressureincrease angiotensin Highconcentration Constrictafferentandefferentarterioles Bloodloss 2 Formationofurine 2 1Glomerularfiltration 2 2Reabsorptioninrenaltubuleandcollectingduct 2 3Secretionbyrenaltubuleandcollectingduct 2 4Mechanismsofconcentratedanddilutedurine 2 2Reabsorptioninrenaltubuleandcollectingduct Transcellularpathway Paracellularpathway Na andCl H2O HCO3 K Glucose Ca2 Na andCl Proximaltubule LoopofHenle Distaltubule Collectingduct Filtration 500gNa Urine 3 5g Na andCl Proximaltubule Firsthalf Secondhalf Firsthalfofproximaltubule 65 FailtoreabsorbCl Apical Basolateral Firsthalfofproximaltubule Napump Na Na glucosecotransporter Na aminoacidcotransporter Na H exchanger Osmoticpressure H2O Promotereabsorptionbycapillaries Cl Cl Secondhalfofproximaltubule Transcellularpathway Paracellularpathway Apical Basolateral Napump Na Na H exchanger Na H Cl HCO3 Cl HCO3 exchanger CO2 K K Cl cotransporter Cl Na Na andCl Proximaltubule LoopofHenle Distaltubule Collectingduct Na andCl LoopofHenle Thicksegmentofdescendinglimb Thinsegmentofdescendinglimb Thinsegmentofascendinglimb Thicksegmentofascendinglimb PermeabletoH2ObutnotNaCl PermeabletoNaClbutnotH2O ImpermeabletoH2O Thicksegmentofascendinglimb Apical Basolateral Napump Na Na K 2Cl Na K 2Cl cotransporter Cl channel K channel Na Ca2 K ImpermeabletoH2O Na andCl Distaltubule Collectingduct Firsthalf Secondhalf Principlecell Intercalatedcell Apical Basolateral Napump Na Na Cl Na Cl cotransporter Na channel Na Cl Cl channel H2O Proximaltubule 65 Osmoticpressure Transcellularpathway Paracellularpathway Apical Basolateral Aquaporin Regulationbyvasopressinindistaltubuleandcollectingduct Proximaltubule 85 Thicksegmentofascendinglimb LoopofHenle Distaltubuleandcollectingduct HCO3 HCO3 Proximaltubule 85 Apical Basolateral Napump Na Na H exchanger Na H HCO3 CO2 CO2 H2O HCO3 CA CA Thicksegmentofascendinglimb LoopofHenle Distaltubuleandcollectingduct protonpump ReabsorptionofHCO3 keepacid basebalance K Proximaltubule 65 Thicksegmentofascendinglimb LoopofHenle Distaltubuleandcollectingduct K secretion Glucose OnlyinProximaltubule Apical Basolateral Na dependentglucosetransporter SGLT Glucosetransporter2 Renalthresholdforglucose Differentindifferentnephrons Maximalrateoftransportofglucose Tm G 250 500 200 400 Glucose mg min Plasmaglucose mg ml Ca2 Proximaltubule 70 Thicksegmentofascendinglimb LoopofHenle Distaltubuleandcollectingduct Apical Basolateral Ca2 Proximaltubule 70 Transcellularpathway Paracellularpathway 80 Solventdrag 溶剂拖曳 20 Ca2 Na Ca2 pump Na Ca2 exchanger Ca2 channel Ca2 FactorsaffectingCa2 reabsorption 1 Parathyroidhormone PTH 2 VitminD3 3 Ca2 levelinplasma 4 Extracellularfluid 5 pHofbodyfluid Solventdrag 溶剂拖曳 Summary Na andCl H2O HCO3 K Glucose Ca2 Proximaltubule LoopofHenle Distaltubuleandcollectingduct Proximaltubule Proximaltubule Proximaltubule Regulationofreabsorption 1 Constantfractionalreabsorption 2 Osmoticdiuresis Reabsorption GFR Glomerulotubularbalance 65 70 2 Formationofurine 2 1Glomerularfiltration 2 2Reabsorptioninrenaltubuleandcollectingduct 2 3Secretionbyrenaltubuleandcollectingduct 2 4Mechanismsofconcentratedanddilutedurine 2 3Secretionbyrenaltubuleandcollectingduct H K NH3 H Proximaltubule Distaltubuleandcollectingduct Na H exchanger Protonpump Protonpump H K ATPase Na H exchanger FactorsaffectingH secretion 1 pHinbody 2 K levelinplasma Apical Basolateral Na H exchanger H Na Na K exchanger K Na NH3 Proximaltubule Collectingduct Glutamine 2NH4 2HCO3 NH3 H NH3 Proximaltubule Apical Basolateral NH4 HCO3 NH3 H Na H exchanger H Na NH4 NH3 Collectingduct Apical Basolateral NH4 HCO3 NH3 H Na H exchanger H Na NH4 NH4 NH3 H Regulationofacid basebalancebyrenaltubuleandcollectingduct 1 SecretionofH 2 ReabsorptionofHCO3 3 SecretionofNH3 PromotesecretionofH ProductionofHCO3 Acidosis K Distaltubule Collectingduct Apical Basolateral Na pump Na K K K Na channel Na FactorsaffectingK secretion 1 Tubularflowrate 2 Cl levelintubularfluid Apical Basolateral K Cl K Cl cotransporter FactorsaffectingK secretion 1 Tubularflowrate 2 Cl levelintubularfluid 3 Aldosteron Apical Basolateral Na pump Na K Na channel Na IncreasetheamountofNa channel IncreasetheproductionofATP IncreasetheactivityofNa pump FactorsaffectingK secretion 1 Tubularflowrate 2 Cl levelintubularfluid 3 Aldosteron Apical Basolateral Na pump Na K Na channel Na 4 IntakeofK IncreasetheamountofK channel Increaseproductionofaldosteron IncreasetheactivityofNa pump 2 Formationofurine 2 1Glomerularfiltration 2 2Reabsorptioninrenaltubuleandcollectingduct 2 3Secretionbyrenaltubuleandcollectingduct 2 4Mechanismsofconcentratedanddilutedurine 2 4Mechanismsofconcentratedanddilutedurine Hyperosmoticrenalmedulla Permeabilityofcollectingducttowater Howhyperosmoticpressureisproduced Vasopressin Cortex Outermedulla Innermedulla Outermedulla Thicksegmentofascendinglimb ActivetransportofNaClandisnotpremeabletoH2O Thicksegmentofascendinglimb Hypoosmotic Outermedullalimb Hyperosmotic Cortex Outermedulla Innermedulla Innermedulla NaClandUrea NaCl Thinsegmentofdescendinglimb Thinsegmentofascendinglimb PermeabletoH2ObutnotNaCl PermeabletoNaClbutnotH2O Innermedulla NaClandUrea Urea Thinsegmentofascendinglimb Distalconvolutedtubule corticalandoutermedullarycollectingduct Permeabletourea ImpermeabletoureawithactivetransportofNaCl Innermedullarycollectingduct Permeabletourea Cortex Outermedulla Innermedulla Urearecycling Innermedulla NaClandUrea Outermedulla NaCl CapillariesininnermedullatakeawayNaClandurea U shapevasarecta PermeabletoH2Oandsolutes Distalconvolutedtubuleandcollectingduct PermeabilitytoH2Oisregulatedbyvasopressin Inthepresenceofvasopressin Intheabsenceofvasopressin PermeabilitytoH2O PermeabletoH2O ImpermeabletoH2O Cortex Outermedulla Innermedulla Inthepresenceofvasopressin PermeabletoH2O concentratedurea Intheabsenceofvasopressin impermeabletoH2O ActivetransportofNaCl Dilutedurea 1 Functionalanatomyofkidneys 2 Formationofurine 3 Severaltechniquesinrenalresearch 4 Micturitionreflex 5 Regulationofurineproduction 3 Severaltechniquesinrenalresearch Renalplasmaflow 660ml min GFR 125ml min Clearance Cx Levelinplasma Px Levelinurine Ux Urinevolume V Cx Ux V Px Measurementrenalplasmaflow RPF Ux V Cx Px Ux V RPF Px RPF Ux V Px RPF Ux V Px PAHanddiodrast 90 Measurementrenalplasmaflow RPF RPF Ux V Px 0 9 RPF Ux V Px 0 9 Renalbloodflow MeasurementofGFR Ux V Inulin Filtratedbyglomerulus secretion Reabsorption GFR Px Rx Sx 0 0 Ux V GFR Px GFR Ux V Px Filtrationfraction Presumptionoffunctionsofrenaltubuleandcollectingduct Inthepresenceofreabsorption Clearance GFR Inthepresenceofsecretion Clearance GFR 1 Functionalanatomyofkidneys 2 Formationofurine 3 Severaltechniquesinrenalresearch 4 Micturitionreflex 5 Regulationofurineproduction 4 Micturitionreflex Detrusormuscle Internalurethralmuscle Externalurethralmuscle Receptorsinbladder Receptorsinposteriorurethra Sympatheticandpelvicnerve Pudendalverve Pelvicnerve Bladder Nourine 0 Pressure 30 50ml 5 10cmofwater 200 300ml Increaseslightly Stressrelaxation 300 400ml Increasesignificantly Micturitionreflex Receptorsinbladder Activation Pelvicnerve Micturitioncenterinsacralsegmentsofcord Micturitioncenterincerebralcortexandbrainstem Pelvicnerve Contractionofdetrusormuscle Relaxationofinternalurethralmuscle Urineenterposteriorurethra Relaxationofexternalurethralmuscle 1 Functionalanatomyofkidneys 2 Formationofurine 3 Severaltechniquesinrenalresearch 4 Micturitionreflex 5 Regulationofurineproduction 5 Regulationofurineproduction 5 1Neu