(2)Dysfunction of renal tubules The secretion and reabsorption function are very important for maintain the homeostasis of internal environment Principal influencing factors O Renal tubular EC (may impaired by ischemia hypoxia, infection and toxins) 180Ld 2 Neuro-humoral factors (Aldosterone, ADH, ANP, PTH etc.) B Concentration and flow rate of the initial urine (ANP: atrium natriuretic peptide; PTH: parathyroid hormone) 1.5Ld 11
11 (2) Dysfunction of renal tubules The secretion and reabsorption function are very important for maintain the homeostasis of internal environment l ) Principal influencing factors ① Renal tubular EC (may impaired by ischemia, hypoxia, infection and toxins) ② Neuro-humoral factors (Aldosterone, ADH, ANP, PTH etc.) ③ Concentration and flow rate of the initial urine (ANP: atrium natriuretic peptide; PTH: parathyroid hormone) 180L/d 99% 1.5L/d
2) Types of renal tubular dysfunction O Dysfunction of reabsorption Proximal convoluted tubule: glucosuria, phosphuria aminoaciduria, Na and h,o retention renal tubular acidosis 2 Dysfunction of concentration and dilution Henle's (medullary) loop and collecting tubule polyuria, Isosthenuria(isotonic), Hyposthenuria(hypotonic) (3 Acid-base Disturbances Proximal tubule(secrete H, NH4, NH3; reabsorb HCO3) Medullary loop(reabsorb b HCO3 and NH3 Distal tubule(secrete H) 12
12 ① Dysfunction of reabsorption Proximal convoluted tubule: glucosuria, phosphuria, aminoaciduria, Na+ and H2O retention, renal tubular acidosis ③ Acid-base Disturbances Proximal tubule (secrete H+ , NH4 + , NH3 ; reabsorb HCO3 – ); Medullary loop (reabsorb b HCO3 – and NH3 ) Distal tubule (secrete H+ ) ② Dysfunction of concentration and dilution Henle’s (medullary) loop and collecting tubule: polyuria, Isosthenuria (isotonic), Hyposthenuria (hypotonic) 2) Types of renal tubular dysfunction
(3)Dysfunction of renal endocrine (1 Increased secretion of rennin Renin↑ (2 Declined Kallikrein-kinin system(KKs) Kinin√ Increased secretion of endothelin ET↑ 4 Inadequate synthesis of prostaglandins from arachidonic acid PGE、I Renal Hypertension 13
13 Renal Hypertension (3) Dysfunction of renal endocrine ① Increased secretion of rennin Renin ③ Increased secretion of endothelin ET ② Declined Kallikrein-kinin system (KKS) Kinin ④ Inadequate synthesis of prostaglandins from arachidonic acid PGE2 , I2
6 Decreased eryhropoietin--EPO (90%o formed in kidney) Renal aneamia 6 Decreased 1-a-hydroxylase 1,25-(OH2D O Weakened inactivation to PTH PIH个 Renal osteodystrophy 8 Weakened inactivation to gastrin-HC个 ULceration 14
14 EPO HCI 1,25-(OH)2 - D3 PTH Renal aneamia Ulceration Renal osteodystrophy ⑤ Decreased eryhropoietin ⑥ Decreased 1-a-hydroxylase ⑦ Weakened inactivation to PTH ⑧ Weakened inactivation to gastrin (90% formed in kidney)
Section 2 Acute renal Failure 15
15 Section 2. Acute Renal Failure