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1、肾脏泌尿功能的调节,1,第三节 肾脏泌尿功能的调节 Regulation of urine formation of the kidney,肾脏泌尿功能的调节,2,尿生成的调节 regulation of urine formation,肾血流量的调节神经体液调节 regulation of renal blood flow nervous and humonal control (对滤过的调节)(对重吸收和分泌) 自身 神经 体液 调节 调节 调节 ADH 醛固酮 甲状旁腺素 Aldosterone parathyroid hormone,肾脏泌尿功能的调节,3,肾脏泌尿功能的调节,4,一、
2、抗利尿激素 antidiuretic hormone, ADH,合成部位：视上核(supraoptic nucleus)、室旁核(paraventricular nucleus)合成ADH 运输： 丘脑垂体束 贮存释放：神经垂体（贮存于膨大神经末梢中） 前激素 ADH 九肽 蛋白水解酶 靶器官：远曲小管集合管 The hypothalamus contains two types of neurons that synthesize ADH in the supraoptic nucleus and paraventricular nucleus.once ADH is synthesized
3、,it is transported down the axons of the neurons to their tips,terminating in the posterior pituitary gland.,肾脏泌尿功能的调节,5,作用： 1.提高远曲小管和集合管上皮细胞对水的通透性，促进水的重吸收尿液浓缩、尿量减少（抗利尿）主要作用。 The most important renal action of ADH is to increase the water permeability of the distal tubule,collecting tubule.This effe
4、ct helps the body to conserve water in circumstances such as dehydration. 2.增加内髓部集合管对尿素的通透性并减少肾髓质的血流量。 ADH increases the urea permeability of collecting tubule in inner zone and decreases the blood flow in medulla. 3.促进髓绊升支粗段对NaCl的重吸收，使直小血管收缩。 ADH increases the reabsorption of NaCl in thick segment
5、of ascending limb and so leads to constriction of vasa recta.,肾脏泌尿功能的调节,6,（一）、作用机理： ADH与远曲小管、集合管上皮细胞管周膜上受体结合 激活膜内的腺苷酸环化酶 上皮细胞中cAMP 管腔膜 中蛋白激酶激活 膜蛋白磷酸化 膜构型改变 水通 道开放管腔膜对水通透性 。 ADH ，水通道小泡内移， 对水通透性 。,肾脏泌尿功能的调节,7,ADH combines with the receptor in basolateral membrane and activated the adenylate cyclase,it
6、 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.,肾脏泌尿功能的调节,8,（二）ADH分泌的调节(the
7、 regulation of ADH secretion) 血浆晶体渗透压的改变 (the change of crystal osmotic pressure) 有效刺激因素 effective stimuli 循环血量的改变 (the change of effective blood volume),肾脏泌尿功能的调节,9,1、血浆晶体渗透压的改变 特点：敏感，晶体渗透压改变 12%时即有反应。 电解质(+) 有效 尿素 无效 感受器：位于视上核及其附近区域。 大量出汗、腹泻、失水 血浆晶体渗透压 视上核 及其周围区域渗透压感受器(+) 神经垂体 膨大神经 末梢去极化 释放ADH 远曲小
8、管、集合管对水通 透性 对水重吸收 ，尿液浓缩 尿量减少。 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 pul
9、led by osmosis out of the osmoreceptor cell,initiating appropriate nerve signals in the hypothalamus to cause additional ADH secretion.,肾脏泌尿功能的调节,10,水利尿water diuresis 大量饮清水 尿量 饮1000ml清水，隔30分钟 尿量 ，（1小时末达高峰，23小时恢复） 饮1000ml NS，隔30分钟 变化不大,肾脏泌尿功能的调节,11,2、循环血量的改变（容量感受器途径） 过度输液，血量过多(+) 左心房内膜下容量感受器 迷走N，传入冲动
10、 中枢，间接抑制下丘脑垂体后叶系统 释放ADH 远曲小管集合管对水通透性 对水重 吸收 尿量 。 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 permeabi
11、lity in distal tubule and collecting tubule decreases,therefore the reaborption of water decreases and the urine volume increases.,肾脏泌尿功能的调节,12,3、其它因素 AP (+) 颈动脉窦压力感受器 窦N ADH反射性释放 尿量 痛刺激、情绪紧张 ADH 尿量 弱冷刺激 ADH 尿量 下丘脑病变累及视上核、室旁核 ADH合成 释放障碍 尿崩症(diabetes insipidus)。 When arterial pressure increases,press
12、orecepto 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.,肾脏泌尿功能的调节,13,二、醛固酮的作用（Aldosterone）,分泌部位：肾上腺皮质球状带 靶器官：远曲小管集合管 作用：促进对Na+的主动重吸收，同时促进 K+的排出保Na+排K+作用。 Aldos
13、terone,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 incr
14、ease 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.,肾脏泌尿功能的调节,14,（一）作用机制： 醛固酮进入远曲小管集合管的上皮细胞后 与胞浆受体结合 形成激素胞浆受体复合物 通过核膜 与核中受体结合 激素核受体复合物 促进mRNA的合成 醛固酮 促进小管上皮细胞
15、Na+ 泵运转 诱导蛋白 促进生化氧化提供ATP 促进加强Na+ 增加管腔膜对Na+ 通透性 的主动重吸收(保Na+) 造成小管腔内负电位 K+被分泌到 小管液（排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 i
16、t 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.,肾脏泌尿功能的调节,15,（心房利尿肽ANP）28个氨基酸残基 集合管对Na+重吸 收(-)，使出入球 小动脉舒张 心钠素（Cardionatrin）(-) aldosterone 释放 ADH 肾素分泌 作用：促进肾脏排钠排水 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.,肾脏泌尿功能的调节,16,肾脏泌尿功能的调节,17,（二）醛固酮分泌
