??? ????????? Regulation of urine formation of the kidney

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??? ????????? Regulation of urine formation of
the kidney

• ???????????????
• ???

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?????? regulation of urine formation

• ??????? ??????
• regulation of renal blood flow
  nervous and humonal control
• (??????) (???????)
• ?? ?? ??
• ?? ?? ?? ADH ??? ?????
• 
  Aldosterone
  parathyroid
• 
  
  hormone

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??????? antidiuretic hormone, ADH

• ???????(supraoptic nucleus)????(paraventricular
  nucleus)??ADH
• ?? ?????
• ????????(??????????)
• ??? ADH ??
• ?????
• ??????????
• The hypothalamus contains two types of
  neurons that synthesize ADH in the supraoptic
  nucleus and paraventricular nucleus.once ADH is
  synthesized,it is transported down the axons of
  the neurons to their tips,terminating in the
  posterior pituitary gland.

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• ??
• 1.????????????????????,????????????????(???)?
  ????
• The most important renal action of ADH is
  to increase the water permeability of the distal
  tubule,collecting tubule.This effect helps the
  body to conserve water in circumstances such as
  dehydration.
• 2.??????????????????????????
• ADH increases the urea permeability of
  collecting tubule in inner zone and decreases the
  blood flow in medulla.
• 3.?????????NaCl????,????????
• ADH increases the reabsorption of NaCl in
  thick segment of ascending limb and so leads to
  constriction of vasa recta.

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• (?)?????
• ADH?????????????????????
• ??????????? ?????cAMP ???
• ??????? ?????? ????? ??
• ??????????? ?
• ADH ,???????,
• ????? ?

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• ADH combines with the receptor in
  basolateral membrane and activated the adenylate
  cyclase,it produces cyclic adenosine
  monophosphate,which leads to activation of
  protein kinase in basolateral membrane,then the
  membrane protein is phosphorylated,so the
  configuration of membrane changes,this process
  increases the permeability to water by the open
  of water channel.

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• (?)ADH?????(the regulation of ADH secretion)
•   ??????????
  (the change of crystal osmotic
• 
  pressure)
• ??????
• effective stimuli
• ???????
• (the change of
  effective blood
• volume)

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• 1???????????
• ????,??????? 12??????
• ???() ?? ?? ??
• ???????????????
• ?????????? ??????? ???
• ????????????() ???? ????
• ????? ??ADH ???????????
• ?? ????? ,???? ?????
• The precise way that the osmotic concentration of
  the extracellular fluids
• controls ADH secretion is not clear.Yet somewhere
  in or near the
• hypothalamus are modified neuron receptors called
  osmoreceptors.when
• the extracellular fluid becomes too
  concentrated,fluid is pulled by osmosis
• out of the osmoreceptor cell,initiating
  appropriate nerve signals in the
• hypothalamus to cause additional ADH secretion.

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• ???water diuresis ????? ??
• ?1000ml??,?30?? ?? ,(1??????,23????)
• ?1000ml NS,?30?? ????

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• 2????????(???????)
• ????,????() ???????????
•  ??N,????
• ??,?????????????
• ??ADH ???????????? ???
• ?? ?? ?
• When blood volume increases because of excess
  transfuse, the volume
• receptor in endometrium of left atrium sends
  impulse through Vagus
• nerve to center and inhibit the release of ADH by
  Hypothalami-
• Pituitary posterior lobe system,so the water
  permeability in distal
• tubule and collecting tubule decreases,therefore
  the reaborption of
• water decreases and the urine volume increases.

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• 3?????
• ?AP () ????????? ?N
  
• ADH????? ??
• ????????? ADH ??
• ????? ADH ??
• ??????????????? ADH??
• ???? ???(diabetes insipidus)?
• When arterial pressure increases,pressorecepto in
  carotid sinus sends signals
• to hypothalamic nuclei through sinus nerve that
  decreases ADH
• secretion.ADH secretion can also be controlled by
  other stimuli such as pain
• and nervous mood.

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????????(Aldosterone)

• ????????????
• ??????????
• ?????Na??????,????
• K????Na?K???
• Aldosterone,secreted by the zona glomerulose
  cells of the adrenal cortex,is an
• important regulator of sodium reabsorption and
  potassium secretion by the
• renal tubules.The primary site of aldosterone
  action is on the principal cells
• of the cortical collecting tubule.the mechanism
  by which aldosterone increase
• sodium reabsorption while at the same time
  increasing potassium secretion is
• stimulating the sodium-potassium ATPase pump on
  the basolateral side of
• the cortical collecting tubule membrane.

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• (?)????
• ?????????????????? ???????
• ??????????? ???? ???????
• ???????? ??mRNA??? ???
• ????????Na ???
• ???? ????????ATP
  ????Na
• ??????Na ???
• ??????(?Na) ????????? K????
• ???(?K)
• Aldosterone diffuses readily to the interior of
  the tubulaar epithelial
• cells and combines with a highly specific
  cytoplasmic receptor
• protein,then the aldosterone-receptor complex
  diffuses into the
• nucleus where it may undergo further
  alterations,finally inducing one
• or more specific portions of the DNA to form one
  or more types of
• messenger RNA related to the process of sodium
  and potassium
• transport.

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• (?????ANP)28??????
• 
  ????Na??
• 
  ?(-),????
• 
  ?????
• ???(Cardionatrin)(-) aldosterone ??
• ADH
• ????
• ??????????
• The function of cardionatrin is to promote the
  secretion of
• sodium and water by kidney .the cardionatrin can
  reduce
• the release of aldosterone?ADH and renin.

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• (?)??????????????????????K??Na??
• ????????(ACTH)?????????????????
• Potassium ion concentration and the renin-
• angiotensin system are by far the most potent in
• regulating aldosterone secretion.

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• 1. ????????????
• (renin-angiotensin-aldosterone system, RAAS)
• RAA???
• ??????
• ?????
• ?,????
• ??????
• ?????
• ?????
• ?????

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• ??? ????????? ?????
• ??? ???? ?? ???
• cirrhosis of liver secondary aldosteronism
  
• Edema?Hydroperitonia tissue fluid
  blood
• volume renin aldosterone

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• 2.?K??Na??
• ??K Na ????????????
• ????? ?Na?K
• ??K Na ????? ?Na?K????
• ????????K???????,K???0.51.0 mmol/L ???
  (???Kgt Na)
• Increased potassium ion concentration in the
  extracellular fluid greatly
• increases aldosterone secretion.a small
  percentage increase in potassium
• concentration can cause a severalfold increase in
  aldosterone secretion.

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????????(parathyroid hormone,PTH) ???

• ????????
• ??1.???????????Ca2????,???Ca2?? ?
• 2.??????????????,???????????
• 3.???????Na?K?HCO3-?????????
• PTH is secrected by parathyroid glands.PTH
  provides a powerful
• mechanism for controlling extracellular calcium
  and phosphate
• concentrations by regulating intestinal
  reabsorption,renal
• excretion,and exchange between the extracellular
  fluid and bone of
• these ions.PTH decreases calcium excretion and
  increases phosphate
• excretion by the kidneys.moreover,it increases
  the rate of
• reabsorption of magnesium ions and hydrogen ions
  while it decreases
• the reabsorption of sodium,potassium,and amino
  acid ions.

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??? ?????plasma clearance

• ???????(use of clearance methods to quantify
  kidney function)
• 1.????????(Urine concentration test and Urine
  dilution test )???????
• 2.??????(excretion test of phenolsulfonphthalein)
  ???????
• 3.???????(plasma clearance test)?????????????

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• ???????????????????
• ?????? ?????1.030
• Urine concentration test mainly quantifies the
  reabsorption to
• water of renal tubule.
• ??????????????????
• ??????????11.5L,????lt1.003
• Urine dilution test mainly quantifies the
  dilution degree of
• urine .
• ??????????????????
• 0. 6??1ml????15?? ??????25??
• 2?? ??????60??
• ??15?? lt12
• 2?? lt40

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• ???????????
• ???????(plasma clearance. C)?????????(??????)
  ?????????????????????,??????????????????,?????????
  ??(ml /min),????????????????
• UV U????????
• C V?????
• P P????????? 
• ????????????????????
• The plasma clearance of a substance is the volume
  of plasma that is
• completely cleared of the substance by the
  kidneys per unit time.this
• provides a useful way of quantitating the
  effectiveness with which the
• kidneys excrete various substances.

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• 1.??????????????????????
• ??inulin???,???????????,?????????????????????
• UV 1ml /min125mg /100ml
• C??
  125ml /min
• P 1mg
  /100ml
• Inulin clearance can bu used to estimate
  GFR.inulin is freely filtered
• and is not reabsorbed or secreted by the renal
  tubules,the rate at
• which that inulin is excreted in the urine(UV)
  is equal to the
• filtration rate of the substance by the
  kidneys(GFRp),the
• GFR,therefore,can be calculated as the clearance
  of the inulin.

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• 2.???????(estimation of renal plasma flow)
• ???diodrast???????(PAH)?????,?????????????(???????
  )?
• ??????????????,???????????0,??????????????(UV),??
  ????????????????,?????????????????????
• Theorectically,if a substance is completely
  cleared from the lasma,the
• clearance rate of that substance is equal to the
  total renal plasma
• flow,in other words,the amount of the substance
  delivered to the
• kidneys in the blood would be equal to the amount
  excreted in the
• urine.Thus,renal plasma flow could be calculated
  as RPFUV/p.

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• UV XP X???????????
• UV
• X C
• P
• ??,???C???????????,?????????
• ????C ??????????
• ??? ?????
• ???55,???? 100
• 
  55

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• 3.?????????
• ????C gt 125ml/min ????????????
• If plasma clearance of a substance is more
• than 125ml/min,it must be secreted by the
• renal tubule.

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??? ????(micturition)

• ?????(ureter)???
• ???????(pelvis)??????????(autorhythmicity),???
  ??????3?/min,?????23cm/s?
• ???????,????,?????
• ????,????,????????
• ????,????????(bladder)?

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????????????

• ?N pelvic nerves ???? ???N
  S24
• ??N ??N Hypogastric nerves ???? ??N L15
• ??N pudendal nerve ???? ??N
  S24?
• 
  ????
•  

???? ????
?N ?????? ???????????????? ???
??N ?????? ?????????????? ?? ????
??N ?????? ???????? ???? (????????)
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??????(micturition reflex)

• ???????gt400ml?????
• ?????700ml?,???35cmH2O,???(detrusor muscles)?
  
• ?????,??????
• ????70 cmH2O?
• ????,?????
• Intravesical pressure
• evidently increases
• when the urine
• volume is more than
• 400 millilitre.

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• ????micturition reflex
• ?????????
• ???? ???? ?????? ?N
  ???????
• 400500ml ???? ????
  ??????
•  
• ?????? ??
• When urine volume in bladder is more than 400500
  millilitre,it leads
• to a stretch reflex initiated by sensory stretch
  receptors in the bladder
• wall,especially by the receptors in the posterior
  urethra when this
• area begins to fill with urine at the higher
  bladder pressures.sensory
• signal from the bladder stretch receptors are
  pelvic nerves and the
• reflexively back again to the bladder through the
  parasympathetic
• nerve fibers by way of these same nerves,so the
  detrusor muscles
• contracts and the intersphincter relaxes.

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• ???????injury of Lumbosacral spinal cord
• ??anesthesia
• ??tumor
  ???retention of
• ???big Calculus urine
•  
• ????(???????????????) ???
• 
  Urinary
  incontinence
•  
• ??????????????
  ????enuresis
• 
  during
  nighttime