urinary (นำเสนอข้อมูลจาก cd) physiology by jiradet
TRANSCRIPT
1
1502 504
CD
: Urinary
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1 2554
CD
3
Urinary
nephron
3
4
Anatomy Review
2
Early filtrate processing
20
Glomerular filtration
29
Late filtrate processing
37
5
Anatomy Review
Urinary System
1. Anatomy
2. Nephron
3.
Tubular epithelium
6
4. Juxtaglomerular
apparatus
epithelial cells
Epithelial Cells
3 squamous, cuboidal columnar
ureter) ,
urinary bladder)
urethra)
urine)
7
retroperitoneal
peritoneal cavity)
upper abdomen
Adrenal gland)
Perirenal fat capsule
Renal vein ,Renal hilium Inferior vena cava
8
continuously filter)
Renal vein Renal artery
Abdominal aorta
Segmental arteries Interlobar
arteries
3
renal cortex, renal medulla pelvis
9
1. Renal cortex nephron
(Nephron) cortex cortical nephrons
Nephron cortex medulla juxtamedullary
nephrons
Cortical nephrons
nephrons cortex loop of Henle
medulla
Juxtamedullary nephrons
nephrons glomeruli cortical/medullary juction
loop of Henle medulla
10
2. Renal medulla
renal pyramids
Renal pyramids
medulla
capillaries
Renal columns
renal cortex renal
pyramids medulla
Renal pelvis
renal sinus
ureter)
Renal sinus
renal pelvis artery
vein
Nephron overview
nephron)
11
associated blood vessels)
Nephron)
glomerulus
(renal tubule)
Nephron overview: Associated blood vessels
Interlobar artery
renal colums
segmental artery
arcuate artery
Arcuate artery
12
medulla-cortex junction arcuate veins
renal pyramids
cortical radiate arteries
Cortical radiate artery
arcuate artery
afferent arterioles
Afferent arteriole
cortical radiate artery
glomerulus
autoregulation
Glomerulus
afferent arterioles
efferent arterioles
glomerular capsule (Bowman's capsule)
Efferent arteriole
glomerulus
peritubular capillaries
Peritubular capillaries
13
efferent arteriole
renal cortex
Vasa recta
medulla
Cortical radiate vein
peritubular capillaries vasa recta
arcuate vein
Arcuate vein
medulla-cortex junction arcuate
arteries
renal pyramids
Interlobar veins
Interlobar vein
arcuate vein renal vein
Nephron overview: Tubular segments
14
(nephron)
Glomerular (Bowman's) Capsule
glomerulus
(Proximal convoluted tubule (PCT))
glomorular capsule loop of
Henle
Active 65%
U (Loop of Henle)
U descending ascending
limbs.
Descending loop of Henle (
Ascending loop of Henle (
Distal convoluted tubule (DCT))
juxtaglomerular apparatus
cortical collecting duct
Cortical collecting duct
15
distal convoluted tubules
nephrons
cortex
Medullary collecting duct
cortical collecting ducts
medulla
16
renal corpuscle
Glomorulus
afferent efferent arterioles
glomerular (Bowman's) capsule
Afferent arteriole
cortical radiate artery
glomerulus
autoregulation
Efferent arteriole
glomerulus
peritubular capillaries
Glomerular (Bowman's) Capsule
nephron glomerulus
Renal corpuscle
nephron glomerulus
glomerular capsule
Parietal layer
17
glomerular capsule glomerulus
Visceral layer (podocytes)
glomerular capsule
glomerulus
Capsular space
glomerular capsule
18
Renal corpuscle
glomerular
longitude)
Capillary endothelium
simple squamous cells
Fenestrations
,
19
20
renal corpuscle
basement membrane capillary endothelium
Basement membrane
epithelial cells
basement membrane podocytes
Podocyte
visceral layer glomerulus
capsule
cell body
Pedicels
foot process podocyte basement membrane
glomerular capillary
filtration membrane
Filtrations slits
pedicels filtration
membrane
fenestrated capillary endothelium, basement
membrane podocyte
21
filtration membrane
Filtration membrane
3
fenestrated capillary endothelium, basement
membrane filtration slits
pedicels podocytes
filtration membrane cross-section
Photomicrograph filtration membrane cross-
section
Podocyte
visceral layer glomerulus
capsule
Nucleus
22
Pedicel
foot process podocyte basement membrane
glomerular capillary
filtration membrane
Capsular space
glomerular capsule
filtrate)
Filtrations slits
pedicels filtration
membrane
Basement membrane
epithelial cells connective
tisssue cells
Capillary endothelium
simple squamous cells
Capillary fenestration
23
filtration membrane
capsular space
Proximal convoluted tubule (PCT)
Simple cuboidal cells PCT brush border cells
microvilli
24
PCT
glomerular capsule loop of Henle
65%
Brush border cells
epithelial cells PCT microvilli
Microvilli
plasma membrane
Lumen
Luminal membrane
plasma membrane tubular lumen
Tight junctions
Intersititial space
interstitium
25
Basolateral membrane
plasma membrane
interstitial space
Mitochondrion
organell cytoplasm ATP
metabolism
:
Solutes
(solvent)
(solution)
Squamous cells Thin loop of Henle
thin segment loop of Henle
Simple squamous epithelial cells
:
26
Thick ascending loop of Henle DCT
Cuboidal epithelium thick ascending loop of Henle
DCT
:
ascending limb NaCl
DCT ascending limb
Cuboidal epithelia
(renal tubule)
Ascending loop of Henle
medulla
renal cortex
27
DCT
juxtaglomerular apparatus cortical
collect duct
Glycoprotein
Photomicrograph Glomerulus Adjacent tubules
Photomicrograph glomerulus
glomerular capsule
Glomerular capsule
glomerulus
28
Parietal layer
glomerular capsule glomerulus
Visceral layer
glomerular capsule basement
membrane glomerulus
Distal convoluted tubule (DCT)
juxtaglomerular apparatus
cortical collecting duct
Proximal convoluted tubules (PCT)
glomorular capsule loop of
Henle
Active 65%
29
30
Juxtaglomerular apparatus
thick ascending loop of Henle DCT
afferent efferent arterioles
Thick ascending loop of Henle
U filtrate medulla
cortex
Efferent and Afferent arteriole
juxtaglomerular apparatus (JGA)
macula densa granular cells
Juxtaglomerular apparatus (JGA)
31
ascending loop of Henle
afferent arteriole
glomerulus
Granular cells
smooth muscle cells (modified)
autoregulation GFR blood regulation
rennin juxtaglomerular (JG)
cells
Macula densa cells
loop of Henle
juxtaglomerular apparatus
filtrate
32
Cortical collecting duct
Cuboidal cells cortical collecting duct 2
Principal cells intercalated cells
Cuboidal cells
(renal tubule)
Principal cells
(collecting duct)
aldersterone antidiuratic hormone
Na K ions
Intercalated cells
acid-base
regulation
:
Principal cells:
2) Intercalated cells: H+
33
-
34
Medullary collecting duct
Medullary collecting duct principal cells
Medullary collecting duct
cortical collecting duct medulla
urine
Principal cells
(collecting duct)
aldersterone antidiuratic hormone
Na K ions
:
Urea
nitrogenous waste
(urine)
35
36
Photomicrograph collecting ducts
Photomicrograph
(collecting ducts)
1.
2. 3 renal cortex, renal medulla renal
pelvis
3. (nephron)
4.
epithelial cells
37
Early filtrate processing
filtrate)
filtrate
1. passive active
reabsorbtion) (secretion)
2. filtrate processing
38
3. countercurrent multiplier
medullary osmotic gradient
nephron
passive transport
primary active transport
secondary active transport
osmolarity
Passive Transport
Primary active transport
ATP carrier molecule
Secondary active transport
concentration gradient
concentration gradient
membrane
concentration gradient primary active
transport
39
cotransport
Osmolarity
reabsorption)
glomerulus
reabsorption)
(reabsorption pathways)
2 tubular cell barrier
Transcellular pathway
luminal basolateral membranes
Paracellular pathway
tight junctions
Transcellular pathway
40
Peritubular capillary
Tubular cell
Interstitial space
Basolateral membrane
Luminal membrane
Paracelluar pathway
Peritubular capillary
Tubular cell
Tight junction
Interstitial space
Lateral intercellular space
41
Reabsorption Overview:
lumen tight junctions
tubule interstitial space
Decrease the osmolarity of the interstitium
intersitium tubule
dehydration
Increase the osmolarity of the interstitium
tight junction
interstitium
plasma membrane
Reabsorption Overview: Interstitial Osmolarity
osmolarity interstitium
sodium ion interstitium
sodium interstitium
osmolarity
tubule tight junction plasma membrane
interstitium
osmolarity
42
interstitium
interstitial osmolarity
Reabsorption Overview: Membrane Activity
sodium ion
basolateral transport
luminal membrane?
sodium ions
filtrate lumial membrane
Sodium ions filtrate
intracellular
sodium ions basolateral membrane
reabsorption ions luminal membrane
43
Reabsorption Overview:
basolateral transport sodium ions
2
Interstitial osmolarity tubular
lumen
2. sodium ions
luminal membrane
Sodium ion transport
PCT Basalateral membrane: Active
2
Na+
Na+-K+ ion pumps Na+ K+
Interstitial fluid
1. Na+
44
2. osmolarity interstitial fluid
PCT Basolateral membrane: Diffusion
Potassium ion channel K+ interstitium
Diffusion
K+ K+
Glucose carrier molecules glucose
facilitated diffusion
Glucose
45
PCT Luminal membrane activity
Luminal membrane
Na+-H+ countertransport Na+-glucose cotransport
carrier carrier molecules
Na+-K+ ATPase
ion pumps Basolateral membrane
H+ countertransport molecule
Na+
Countertransport molecules
concentration gradient
primary active transport pumps basolateral
membrane
cotransport molecule
Na+ Cotransport
molecule concentration gradient
primary active transport pumps basolateral
membrane
transport
carriers
Transport maximum (Tm)
46
Hyperglycemia
Hyperglycemia
(diabetes mellitus)
cotransport molecules
filtrate
Cotransporters
cotransport molecules comformation
Glucose
glucose Tm
glucose
Glucose
PCT loop of Henle
Tubular cells cotransport carriers
cotransport carriers
glucose
Glucose reabsorption analogy
47
Normal sugar rate
PCT
glucose,
Increase sugar rate
hyperglycemia (diabetes
mellitus)
glucose transport maximum
Tm)
PCT Paracellular Pathway
tight junction PCT (tight)
PCT tight junction concentration
gradient
Na+ Cl- K+ solvent drag
Osmolarity filtrate interstitial fluid
equilibrium
48
PCT
PCT
1. Na+-K+ ATPase ion pumps
Na+ interstitium
2. H+ ions filtrate
3. transport molecules
filtrate cytosol
4. bulk flow interstitium
peritubular capillaries
:
65%
(filtrate)
glucose 100%
49
Thin Descending Loop of Henle
cuboidal epithelial cells simple
squamous epithelial cells
(membrane) NaCl
channels transporter molecules
:
osmolarity filtrate
Ascending Loop of Henle: Luminal
Membrane
tight junction glycoprotein
converting luminal membrane
Luminal membranes:
microvilli
2. ion channels secondary active
transport carriers
Carrier molecule K+, 2Cl- Na+
50
K+ K+
filtrate interstitium
Cl- Na+ basolateral membrane
interstitium
Ascending Loop of Henle: Basolateral
Membranes
Basolateral membranes ascending loop of Henle
Na+-K+ ATPase ion pumps K+
channels PCT
Chlorid channel Cl- Na+
equilibrium
luminal filtrate interstitial fluid
Osmotic gradient interstitial fluid tubular filtrate
200 mmole
Ascending Loop
ascending limb of loop of Henle
1. Filtrate
51
2. Interstitial osmolarity 200 mmole filtrate
3. osmolarity cortex
(medullary osmotic gradient)
Loop of Henle: A Countercurrent Multiplier
osmotic gradient countercurrent
multiplier loop of Henle 2
acending limbs descing limbs
interstitial osmolarity gradient
medulla
medullary gradient
ascending limb NaCl interstitium
interstitium
loop
52
descending limb loop
NaCl ascending limb
filtrate
Medullary interstitium
300-1200 mmole
cortical loop of Henle
100 mmole
200 mmole
interstitial fluid
53
The Vasa Recta: A Countercurrent Exchanger
Vasa recta medullary cells
medullary osmotic
gradient
vasa recta
countercurrent exchange
descending vasa recta loop
interstitium NaCl
2. ascending loop
NaCl interstitium
medulla
osmotic
gradient
-
1. 65% filtrate)
PCT Active Passive
2. filtrate descending loop of Henle
54
3. Filtrate ascending loop of Henle
4. NaCl ascending
descending limb loop of Henle osmotic gradient
medulla
5. Vasa recta medull
osmotic gradient
55
Glomerular filtration
3 :
(filtration) reabsorption)
(secretion)
(filtration membrane) glomerular capsule
1. 3
2. filtration membrane)
3.
glomerulus (glomerular filtrate)
4. glomerulue
(glomerular filtration)
1. nephron)
2. hydrostatic pressure
3. osmotic pressure
(nephron)
56
glomerulus
renal tubule)
Hydrostatic Pressure
Osmotic Pressure
(solution) (solute)
Renal Process
Filtration)
(solute) glomerulus capsular space
(Reabsorption)
(filtrate)
peritubular capillaries
(Secretion)
peritubular capillaries
tubular cells filtrate
57
1. (filtration membrane)
2.
3.
glomerulus
glomerular capsule
Filtration Membrane glomerulus (Glomerular
Filtration)
(filtration membrane) 3
1. Fenestred glomerular endothelium
2. Basement membrane
3. Filtration slits
Filtration slits pedicels podocyted
58
glomerulus bulk flow
hydrostatic pressure
(solute)
Glomerular filtrate
capsular space glomerular
filtrate
glomerular filtrate
59
Organic molecules = Glucose, Amino acids
Nitrogenous waste = Urea, Uric acids, Creatinine
Ions = Sodium, Potassium, Chloride
Water
glomerular filtrate
(Filtration Membrane)
(
60
filtrate
“hematuria”)
1. Glomerular hydrostatic pressure (blood pressure)
= 60 mmHg
2. Capsular hydrostatic pressure = 15 mmHg
3. Glomerular osmotic pressure = 28 mmHg
4. : 60 mmHg – (15 mmHg + 28 mmHg) =
17 mmHg
61
60) touchdown
2 (15 28)
60
glomerulus hydrostatic
pressure
Glomerulus (Glomerular Filtration Rate: GFR)
62
(net filtration pressure)
GFR
GFR
autoregulation
GFR
63
Autoregulation GFR
1. Systemic pressure : 120 mmHg
2. Glomerular hydrostatic pressure
3. afferent arteriole
4. : GFR = 125 ml/
autoregulation
1. Systemic pressure : 140 mmHg
2. Glomerular hydrostatic pressure
3. afferent arteriole
4. : GFR = 146 ml/
autoregulation (afferent arterilole
1. Systemic pressure : 140 mmHg
2. Glomerular hydrostatic pressure
3. afferent arteriole
4. : GFR = 125 ml/
autoregulation
1. Systemic pressure : 100 mmHg
2. Glomerular hydrostatic pressure
3. afferent arteriole
64
4. : GFR = 104 ml/
autoregulation (afferent arterilole
1. Systemic pressure : 100 mmHg
2. Glomerular hydrostatic pressure
3. afferent arteriole
4. : GFR = 125 ml/
65
GFR: Myogenic Mechanism
blood
flow
blood flow
autoregulation myogenic mechanism
arteriole reflexive
vasoconstriction
glomerular blood flow
GFR: Tubuloglomerular mechanism
66
macula densa cells juxtaglomerular
apparatus NaCl filtrate
terminal portion ascending loop of Henle
High Flow:
high filtrate flow rate macula densa
vasoconstrictor
afferent arteriole
vasoconstrictor:
1. GFR
2. Tubular filtrate flow
3. Na+ Cl-
Low Flow:
low flow rate macula densa:
1. vasoconstrictor
2. granular cells rennin
67
GFR: Sympathetic
sympathetic
sympathetic
autoregulation
sympathetic
1.
2. GFR
Emergency
sympathetic
arteriole
GFR filtrate flow
68
1. Glomerular filtrate
filtration
membreane
2. (net filtration pressure)
glomerular hydrostatic pressure capsular
hydrostatic pressure glomerular osmotic pressure
3.
autoregulation GFR
4.
sympathetic autoregulation
Late Filtrate Processing
filtrate DCT collecting duct
1. aldosterone
2. ADH
69
3. medullary osmotic gradient
1.
2.
3. osmolarity
4. medullary osmotic gradient
Late Filtrate Processing Analogy
early tubular segment
early tubular segment
later tubular segment
1.
2.
70
CCD: H+
cortical collecting duct principle cells
intercalated cells
Intercalated cells H+ filtrate
Principle cells
CCD: Aldosterone
Principal cells NaCl
aldosterone ADH
Aldosterone Na+-K+ ATPase ion pump
luminal Na+, K+ channels
71
Aldosterone: Adrenal gland
1. Aldosterone Na+-K+ ATPase ion pump
luminal Na+, K+ channels
2. basolateral K+ channels K+ filtrate
interstitium
3. Aldosterone DCT
4. interstitial osmolarity
72
CCD: Antidiuretic Hormone
Principle cells ADH
ADH: Pituitary gland
ADH (posterior pituitary)
Water channels
interstitial osmolarity
osmolarity
Dehydration Overhydration
Dehydration
dehydration
ADH
73
Overhydartion
overhydration ADH
medullary collecting duct
: Medullary Collecting Duct
74
medullary collecting duct
125 ml/ glomerular filtrate 6 ml/ (5%)
ADH collecting duct
Medullary osmotic gradient
75
Osmotic gradient filtrate
medullary collecting duct
ADH
ADH
Normal hydration
1. ADH Water channels
2. ADH urea medullary collecting
duct
3. Urea 40% interstitial osmolarity
4. Urea loop of Henle collecting
ducts
5. 2 body osmolarity
(600 mOsm)
Under hydration
1. ADH
2. filtrate
3. 1400
mOsm
Over hydration
76
1. ADH
2. Filtrate osmolarity
3.
4. osmolarity 100 mOsm
77
95% 125 ml/ filtrate
medullary collecting duct
Final volume of urine
Normal: ADH level Normal
0.9 % filtrate 1.10 ml/ 1.5
Dehydration: ADH level High
0.2 % filtrate 0.24 ml/ 0.4
Overhydration: ADH level Low
12.5 % filtrate 16.0 ml/ 22.5
78
1. Late filtrate processing
2. Late filtrate processing
aldosterone antidiuratic
3. Medullary osmotic gradient ADH
4. 99% glomerular filtrate