Renal Student Handout 2024-25 PDF

MPharm Programme A Renal - sFmportant ! Dr Praveen Bhugra PHA115 Slide 1 of 41 PHA115 Renal ...

MPharm Programme A Renal - sFmportant ! Dr Praveen Bhugra PHA115 Slide 1 of 41 PHA115 Renal  Learning Objectives From this lecture you should be able to:  Understand and explain briefly the organs and function of the urinary system  Understand and explain in detail the anatomy of kidney including location,⇌ internal and external structure, the blood and nerve supply and also the function of the kidney.  Understand and describe in detail the structure of the _ nephron and the organisation of its blood supply including its _ function  Understand and explain in detail the renal physiology including mechanism of urine formation, glomerular filtration, tubular reabsorption, tubular secretion and hormonal regulation and homeostasis Slide 2 of 41 PHA115 Renal  Urinary System > - c flecty duct ' Mcwncalya mosom calyα end pehcs Slide 3 of 41 PHA115 Renal  Urinary System 횡경막 석도부신 , 콩팥정맥 G sght louwer than left leof Tver s abdominal rorta 신장에혈액공급, 대동맥 하대정맥 : transfer crame to bladder reservoir forOrne renal LiCmvey Urine to exterior Slide 4 of 41 PHA115 Renal  Urinary System Are paired, bean-shaped organs Located along the back body wall below the diaphragm and adjacent to the vertebral column A Right kidney lower than the left because. liver occupies larger area above the kidney on the right side Slide 5 of 41 PHA115 Renal  hephron : 콩팥단위 , 오름생성에 중요한 역할 Structure of Kidney 콩팥단위, 오중행성에 중요한 역할 Ns eackkadnay of = millsons Naphrom ~ × _ 8-18 ← 2-3 outer layer of kadney _ → locm loug. 5 Tan width. 3 Cm thick. Slide 6 of 41 PHA115 Renal  Structure of Kidney Milius of rephon → suans collectarydict _ ~ ∞ θ \ Slide 7 of 41 MPharm PHA115 Renal  Blood and Nerve Supply Renal arteries deliver ~ 1/4 (1200 ml) of cardiac output to the kidneys each minute Arterial flow into and venous flow out of the kidneys follow similar paths Nerve supply is via sympathetic fibers from the renal plexus Slide 8 of 41 PHA115 Renal  Blood Supply of Kidney Slide 9 of 41 PHA115 Renal  ☆Renal Blood Supply 콩팔에서여과될혈액보 θ ) Slide 10 of 41 PHA115 Renal  Functions of the Kidney Removal of toxins, metabolic wastes, and excess ions from the blood Regulation of blood volume, chemical composition, and pH evhat Gluconeogenesis during prolonged fasting Endocrine functions :amportartprocess ∞ Renin: regulation of blood pressure and [ A kidney function 2 important Erythropoietin: regulation of RBC ornones n production oxygen sensr. s ~. Activation of vitamin D basiealy ~ Calcamlerd s. Slide 11 of 41 MPharm PHA115 Renal  Functions of the Kidney absptkreabsmptim. ∞ detect calein ⑦ cecd. 1,25 dihydroxycholecalciferol or 1,25-dihydrooxyvitamin D3 or calcitriol Slide 12 of 41 PHA115 Renal  Nephron Tkenaudcorpumbule ? Structural and functional units that form urine ~1 million per kidney Each nephron consists Renal corpuscle: an initial filtering < component Renal tubule: Extends from the renal corpuscle Slide 13 of 41 PHA115 Renal  Nephron ) Slide 14 of 41 PHA115 Renal  2ty Nephron concentraten gradient s nmedella. kidry of ☆ 10 ~ 15 % 」 of 80 % - 85% types 2 rephon Slide 15 of 41 PHA115 Renal A  Contical Nephon N. Nephron I suxtamedullaynephion Cortical nephrons make up about 80–85% of the 1 _ million microscopic nephrons 대부분 차지 Their renal corpuscles are located in the outer portion of the cortex, with short loops of Henle that penetrate only a small way into the medulla. YPCT 길다 재흥수 분미 기능 + & The ascending limbs of their loops of Henle consist of only a thick segment, lacking any thin portions. Nephrons with short loops receive their blood supply from peritubular capillaries that arise from efferent CVasa arterioles. mota Slide 16 of 41 PHA115 Renal  Nephron The other 15–20% of the nephrons are juxtamedullary nephrons. Their renal corpuscles lie deep in the cortex, close to the medulla, and they have long loops of Henle that extend into the deepest region of the medulla. The ascending limbs of their loops of Henle consist of both thin and thick segments. Nephrons with long loops receive their blood supply from the vasa recta that arise from peritubular ∞ capillaries before becoming peritubular venules … perctubular srasarecta. - peritubulea s venales. Slide 17 of 41 MPharm PHA115 Renal  Nephrons Slide 18 of 41 PHA115 Renal  Nephrons The distal convoluted tubules of several nephrons empty into a single collecting duct. Collecting ducts unite and converge into several hundred large papillary ducts which drain into the minor calyces, major calyces, renal pelvis, and ureters. Slide 19 of 41 PHA115 Renal  Functions of Nephron Slide 20 of 41 PHA115 Renal  Renal Corpuscle Glomerular (Bowman’s) capsule and glomerulus _ Slide 21 of 41 PHA115 Renal  Renal Corpuscle Glomerular (Bowman’s) capsule and glomerulus Slide 22 of 41 PHA115 Renal  Glomerular Filtration Slide 23 of 41 PHA115 Renal  Glomerular Filtration Total Amount Amount in Amount returned to Amount in 180 L of in blood/d Urine (/day) filtrate (/day) Plasma (Reabsorbed) Water (passive) 3L 180 L 178-179 L 1-2 L Protein (active) 200 g 2g 1.9 g 0.1 g Glucose 3g 162 g 162 g 0g (active) 24 g 30 g Urea (passive) 1g 40 g (about 1/2) (about 1/2) 1.6 g 0g Creatinine 0.03 g 1.6 g (none (all filtered) reabsorbed) Slide 24 of 41 PHA115 Renal  Glomerular Filtration Net filtration pressure = 55-30-15=10mmHg Slide 25 of 41 PHA115 Renal  AA ☆Glomerular Filtration Regulation glomnltutea. eak _ ∞ reducepresswe _ _ - As _ Slide 26 of 41 PHA115 Renal  Glomerular Filtration Regulation Two hormones contribute to regulation of GFR Angiotensin II is a potent vasoconstrictor of both afferent and efferent arterioles (reduces GFR). A sudden large increase in BP stretches the cardiac atria and releases atrial natriuretic peptide (ANP). ANP causes the glomerulus to relax, increasing the surface area for filtration Slide 27 of 41 PHA115 Renal  Glomerular Filtration Regulation Slide 28 of 41 PHA115 Renal  falterout - s reabsorption. Reabsorption Routes Tubule Peritubular Fluid in cell capillary tubule lumen Na+ Na+ Na+ Paracellular reabsorption ATP ADP Na+ Na+ geset Na+ Na+ Key: Transcellular Diffusion reabsorption Basolateral Active transport membrane Sodium–potassium pump (Na+/K+ ATPase) Tight junction Apical membrane Interstitial fluid Slide 29 of 41 PHA115 Renal  Reabsorption in PCT Other Na+ symporters in the PCT follow similar way HPO42- (phosphate), SO42- (sulfate) ions Fluid in Proximal Peritubular all amino acids and tubule lumen convoluted tubule cell capillary lactic acid ATP Na+ Na+ ADP 2 Na+ Na+ Key: Na+–glucose symporter Glucose Glucose Glucose Glucose facilitated diffusion transporter Diffusion Tight junction Interstitial Sodium–potassium pump fluid Brush border (microvilli) Slide 30 of 41 PHA115 Renal  Reabsorption in PCT Na+ reabsorption and H+ secretion via secondary active transport through apical membrane CO2=Carbon dioxide H2CO3=carbonic acid CA=carbonic anhydrase H (Us : bacor bonate. Slide 31 of 41 PHA115 Renal  Reabsorption in PCT HCO3 reabsorption CO2=Carbon dioxide H2CO3=carbonic acid CA=carbonic anhydrase Slide 32 of 41 PHA115 Renal  Reabsorption in PCT Passive reabsorption in second half of the PCT Slide 33 of 41 PHA115 Renal  Reabsorption in Thick ascending limb of ~ Loop of Henle _ Reabsorbs 15% of filtered water;20-30% filtered Na+ and K+; 35% of filtered Cl-;10-20% of filtered HCO3- and variable amount of filtered Ca2+ and Mg2+ Slide 34 of 41 PHA115 Renal  Reabsorption in Distal convoluted tubule and in collecting duct Reabsorption of Na+ and secretion of K+; Slide 35 of 41 PHA115 Renal  Hormones and Homeostasis Five hormones affect the extent of Na+, Cl–, Ca2+, and water reabsorption as well as K+ secretion by the renal tubules. These hormones, all of which are key to maintaining homeostasis of not only renal blood flow and B.P., but systemic blood flow and B.P., are: angiotensin II antidiuretic hormone (ADH) aldosterone atrial natriuretic peptide (ANP) parathyroid hormone (PTH) Slide 36 of 41 PHA115 Renal  Hormones and Homeostasis Slide 37 of 41 PHA115 Renal  Hormones and Homeostasis Antidiuretic hormone (ADH) is released by the posterior pituitary in response to low blood flow in this part of the brain. ADH affects facultative water reabsorption by increasing the water permeability of principal cells in the last part of the distal convoluted tubule and throughout the collecting duct. In the absence of ADH, the apical membranes of principal cells are almost impermeable to water Slide 38 of 41 PHA115 Renal  Hormones and Homeostasis Parathyroid hormone (PTH) is released by the parathyroid gland. Stimulates cells in early distal convoluted to reabsorb Ca2+ into the blood Inhibits HPO42- (phosphate) reabsorption in proximal convoluted tubule thereby promoting phosphate excretion Slide 39 of 41 PHA115 Renal  Summary of filtration, reabsorption and secretion in nephron and collecting duct Slide 40 of 41 PHA115 Renal  Further Reading refer to the following textbooks Ross and Wilson Anatomy and Physiology in Health and illness 13th Edition Gerard J. Tortora and Byran H. Derrickson Principles of Anatomy and Physiology 13th Edition Frederic H. Martini Fundamentals of Anatomy & Physiology 7th Edition Lauralee Sherwood Human Physiology From Cells to Systems 7th Edition Robert G. Carroll Elsevier’s Integrated Physiology Slide 41 of 41 PHA115 Renal