Renal Urinary System PDF

The Renal urinary System General Sensory System Ajou University School of Medicine Physiology Eun Joo Baik MD PhD [email protected] 1 The Renal urinary System Ajou University School of...

The Renal urinary System General Sensory System Ajou University School of Medicine Physiology Eun Joo Baik MD PhD [email protected] 1 The Renal urinary System Ajou University School of Medicine Physiology Eun Joo Baik MD PhD [email protected] 2  Objectives 1. 체액 구성과 구획 The Composition and Compartment of the body fluid 2. 신장구조 Structure of the kidney 3. 소변 형성 Urine Formation; 사구체여과와 세뇨관 운반 Glomerular filtration and tubular transports 4. 체삼투압 조절 Renal regulation of body osmotic pressure 5. 세포외액, NaCl, 혈압조절 Renal regulation of extracellular fluid volume, NaCl, and Blood pressure 6. 산염기조절 Renal regulation of Acid-Base balance 3  The Sea in our body 내 몸 속의 바다 해수의 아이’ 이가라시 다이스케 ‘내안의 바다콩팥’ Homer W Smith ‘From fish to Philosopher’ Internal Homeostasis 4 1. Composition and Compartment of the Body Fluid Water intake and output 5 1. Composition and Compartment of the Body Fluid Osmolarity Na+ concentration Hypernatremia/hyponatremia  2. Structure of the Kidney 1. Regulation of body osmotic pressure and body fluid volume 2. Balancing the electrolytes Na+, K+, Cl-, HCO3-, H+, Ca++ and PO43- 3. Acid-Base balance; pH7.4  0.5 4. Excretion of metabolites (urea, creatinine, drug) 5. Production and secretion of hormones renin (cf. hypertention) calcitriol (cf. abnormal bone) erythropoietin (cf. anemia) - Retroperitoneal organ - 1 million nephrons (about 150 g)/each kidney 7  Nephrons(네프론) renal corpuscle(신소체) + renal tubule(세뇨관) Cortical (superficial) nephron Juxtamedullary nephron 8 Structure of the Nephron 1) Renal corpuscle: Glomerulus (신소체, 사구체, 토리)+bowman’s capsule 사구체(토리)낭(보우만낭) 2) Renal tubule 세뇨관 9  Structure of the Nephron 신소체 근위세뇨관 헨레고리 원위세뇨관 집합관 Renal corpuscle Proximal tubule Loop of Henle Distal tubule Collecting duct system 신소체: 사구체(glomerulus,토리) 보우만낭(Bowman’s capsule) 여과( filtration) 10  Glomerular Filtration 사구체 여과 - Glomerulus + Bowman＇s capsule - Podocyte: epithelial cells covering capillaries * Filtration barrier 1) Endothelium (capillary) 2) Basement membrane 3) Epithelium (podocyte) 11 Juxtaglomerular apparatus (complex); 토리곁장치 - GFR 결정에 주요한 피드백 기전 (tubuloglomerular feedback mechanism) - GFR Glomerular filtration Rate; 사구체여과율 - GFR Autoregulation 사구체여과율 자동조절 Juxtaglomerular apparatus 1) Macular densa: thick ascending limb, epithelial cell, densly packed 2) Juxtaglomerular cells: SMC (renin-producing granular cells), EGM (extraglomerular mesangial cells) -- “tubuloglomerular feedback mechanism” 12  3. Urine formation (1) Glomerular filtration 사구체 여과 GFR 180L/day (2) Tubular Reabsorption (3) Tubular Secretion (4) Urinary Excretion Urine Output 1.5-1.8L 13 (1) 사구체 여과 Glomerular filtration ; 혈구성분과 단백질을 제외하고 모두 여과 Glycosuria 당뇨 Proteinuia 단백뇨 14  Determination of GFR 사구체여과율=Kf X (여과 압력, Effective filtration pressure EFP) EFP = PGC – PBS – GC GFP = Kf (PGC - PBS - GC ) 125ml/min180L/24h 99% Reabsorption Daily urine output 0.5-1.5L Regulatory mechanism: capillary constriction 모세혈관 수축 Afferent a. constriction >> GFR 감소 Efferent a. constriction>> GFR 증가 Precapillary sphincter - Hydrostatic gradient 정수압 차이 15 - Colloid osmotic pressure gradient 교질성 삼투압 차이 Autoregulation (자동조절)of GFR and RBF Constant GFR and RBF to variable changes of the renal arterial pressure (90-190 mmHg), Mechanism: 1) Myogenic 2) Tubuloglomerular feedback * Arteriolar resistance : afferent arteriole is the major site of autoregulation 16 Regulation of GFR and RBF 17 (Relationship of the endothelial cell and the vascular smooth muscle Renin-Angiontensin-Angiotensin System (RASS) 18 Aldosterone 알도스테론; - C-21 corticosteroid, the major mineralocorticoid - Produced by adrenal gland a. Physiological actions (a) Conservation of Na+ Aldosterone regulates the total body Na+ content, while ADH regulates the plasma Na+ concentration (b) Excretion of K+ b. Regulation of Aldosterone secretion (a) ACTH (b)  plasma K+ (c) Angiotensin II (d)  plasma Na+ Adrenocorticotropic hormone K+ reabsorption and resecretion 19  Links with Vasopressin and RAAS Atrial natriuretic peptide 심방나트륨이뇨 텝티드 Antidiuretic Hormone 항이뇨호르몬 20  3. Urine Formation 소변 형성 (2) Renal tubular transport 세뇨관 운반 21 1) Reabsorption of glucose and Amino acid 22 2) Excretion of Para-aminohippurate PAH and Penicillin 23 (3) Tubular Transports along the tubules Reabsorption in the Proximal tubule - 67% reabsorbed; Na+, Cl-, K+ and other solutes. - all of glucose and amino acids filtered - Based on Basolateral Na +-K + ATPase 24 Transport in the Henle’s loop (1) Thin descending LH (DLH) - highly permeable to water - low permeability to NaCl and urea - 15-20 % of filtered water reabsorption (2) Ascending LH (ALH) - impermeable to water; diluting segment - Na-K-2Cl cotransporter - permeable to urea - important for concentrating the urine 25 Transport in the Distal and Collecting tubules - 7% of filtrate absorbed - Secretion of K+ and H+ - Water reabsorption by ADH ( 8% to 17% ); Antidiuretic Hormone 항이뇨호르몬 vasopressin (1) Early segment of the distal tubule - Na active transport : regulated by aldosterone - Cl passive transport - impermeable to water and urea (2) Late segment of the distal tubule and CD - Two type of cells ① Principal cell: reabsorb Na and secrete K ② Intercalated cell: Acid-Base 26 27  Objectives 1. The Composition and Compartment of the body fluid 2. Structure of the kidney 3. Urine Formation 요형성; Glomerular filtration and tubular transports 4. Renal regulation of body osmotic pressure 5. Renal regulation of extracellular fluid volume, NaCl, and Blood pressure 6. Renal regulation of Acid-Base balance 28  4. Renal regulation of body osmotic pressure : Urine Concentration and Dilution 신장에 의한 삼투압 조절; 뇨의 농축과 희석 Diluted or concentrated urine 50 - 1,200 Osm/L Maximal concentrating ability: 1200 mOsm/L Obligatory urine volume = 0.5 L Concentration mechanism ; countercurrent multiplier 와 ADH a. descending limb of the loop of Henle(DLH) b. thin and thick segments of the ascending limb of the loop of Henle c. medullary interstitium; Hyperosmolarity d. distal convoluted tubule e. collecting duct f. vasa recta, which are vascular elements of the juxtaglomerular nephrons 29 Countercurrent multiplier system 30  Renal Osmoregulation 신장에 의한 삼투압 조절 원리 1. Separation of Solute and Water 2. High Medullary osmotic pressure: NaCl and urea Recycling 3. Countercurrent Structure 4. Regulation of water reabsorption by ADH (Antidiuretic hormone, 항이뇨호르몬) 31 Regulation of the body osmotic pressure by ADH 32 Disorders of urine concentration 소변 농축 이상상태 a. Difficulties of ADH Production and release ; central diabetes insipidus b. Abnormal renal concentration c. Nephrogenic diabetes incipidus Cf. Diabetes Mellitus 33  5. Renal regulation of ECF volume, NaCl and Blood pressure A. Concept of Effective Circulating Volume (ECV) 유효 순환 용적 개념 B. Monitoring ECV; atria and Kidney C. Regulation by Sympathetic n., Renin-angiotensin system, Aldosterone, and Atrial natriuretic peptide (1) Renal Na+ excretion - Constant body Na+ concentration though variable Na+ ingestion and loss - Renal Na+: freely filtered, reabsorbed, but not secreted ; Sodium reabsorption is more important. (2) Pressure natriuresis and pressure diuresis - pressure natriuresis : blood pressure  --- sodium excretion  - pressure diuresis : blood pressure  --- urine volume  34 Response against changing body fluid volume 체액량변화에 대한 반응 35 6. Renal regulation of Acid-Base balance 1) Production of CO2 and body buffer system 2) Excretion of CO2 by Respiration; Respiratory compensation 3) Renal H+ secretion and HCO3- reabsorption; Renal Compensation Normal pH 7.4 Acidosis 산증 Alkalosis 알카리증 Respiratory and Renal Compensation 36 From Slideplayer.com Hemoglobin buffer in RBC From Slideplayer.com 37 1) Respiratory regulation of Acid-Base Balance : Regulation of PCO2 by Respiration Chemoreceptor : CO2 , Oxygen , pH → Hyperventilation → Hypoventilation 2) Renal regulation of Acid-Base Balance 1) Reabsorption of filtered HCO3- 2) Secretion of noncarbonic acid 3) Production of new HCO3- 38  Renal Regulation of Acid-Base Balance Kidney regulate extracellular fluid H+ through 1) Reabsorption of filtered HCO3- 2) Secretion of H+ 3) Production of new HCO3- Acidosis and Alkalosis; Intercalated cell H+ secreting cell, HCO3- secreting cell 39  Disorders of Acid-Base Balance 호흡성(Respiratory) 대사성(Metabolic) 산증(Acidosis) 알카리증(Alkalosis) 산증(Acidosis) 알카리증(Alkalosis) Pco2 ↑ Pco2↓ 지 hypercapnia hypocapnia [HCO3-] ↓ [HCO3-] ↑ 표 hypercarbia hypocarbia Noncarbonic 원 Noncarbonic acid hypoventilation hyperventilation Acid accumulation 인 Reduced production in ECF [HCO3-]↑: renal 보 reabsorption↑ Pco2↓ Pco2↑ [HCO3-]↓ 상 [H+]↓: renal Renal compensation Renal Compensation excretion↑ CO2 결핍 당뇨병 강염기 과잉 IncreasedCO2 고지대 오랜 생활 뇨독증 HCl소실 병 만성폐질환 불안 히스테리 젖산증 K+결핍 인 호흡중추마비 아스피린중독 설사 NaHCO3 투여 뇌염 세뇨관 질환 지속되는 구토 치 hypoventilation bicarbonate 40 O2 투입 normal saline 투여 료 (vinyl pack) 투입 Introduction of the Nervous System How to Feel 41  Somatic sensation and Special Sensory System 일반(체성) 및 특수감각생리 Somatic(General) sensation Touch, Temperature, Pain, Proprioception, Vibration, Pressure Special sensation Vision Audition Gustation and Olfaction Equilibrium Receptors- Sensory tracts – Thalamus – Sensory Cortex 42 Types of Sensory Receptors; Transducer Exteroceptor Interoceptor Mechanoreceptor Chemoreceptor 43 The somatosensory system 체성 감각계 Sensing the outside world Sensory receptor 감각수용기; receptor potential>action potential Primary afferent neuron >> spinal cord >> brain Sensation 감각 Perception 감각인지 Touch, Vibration, Proprioception vs Pain, Thermal Sensation 44 The somatosensory system 1) Dorsal column-medial lemniscus system Touch 촉각 Vibration 진동감 Proprioception 위치감 2) Spinothalamic system Pain 통각 Temperature 온도감 Primary sensory neuron 일차감각신경세포 Nerve fibers Abeta, Adelta, C fiber Thalamus 시상 Sensory Cortex 감각피질 45 Receptor Potential vs Action Potential 수용기전압과 활동전위 46 Receptor adaptation 수용기 적응 1) Rapidly adapting 2) Slowly adapting 47  Sensory Coding 1. Intensity 2. Stimulus duration 3. Stimulus direction 4. Receptive fields (수용야) 5. Surround inhibition. 48 Thermoreceptors Nociceptors - Noxious stimuli - Free nerve ending - Afferent nerve; A or C fiber - Polymodal nociceptors 49  Pathways of somatic sensory system 1. Dorsal Columns system 2. Anterolateral system: spinothalamic tract From basicmedical key 50 Dermatomes 피부절 - a "segmental field" of the skin - 31 paired spinal nerve Trigeminal nerve 51 Thalamus 시상 Station for all kinds of sensation but, olfaction Lateral geniculate ganglia Medial geniculate ganglia 브레인월드 52 Cerebral Cortex 대뇌감각피질 Postcentral gyrus Broadmann area 3,2,1 Homunculus Homunculus Study Querie Illustration by Allan Ajifo 53 Neural Plasticity 신경 가소성 54  Sensory Adaptation vs Sensitization 감각순응 vs 감각 감작 1) Slow vs Rapidly 2) No adaptation 3) Sensitization vs Central Sensitization 55 Endogenous Analgesic System 내인성 오피오이드 시스템 Periaqueductal gray Raphe Magnus nucleus A pain inhibitory complex in the spinal cord Quell 2021 56