利尿劑英文ppt課件(完整版)
【正文】 es (hypertension, heart failure, renal failure, and cirrhosis) 2 glomerulus Proximal convoluted tubule Distal convoluted tubule collecting duct Loop of Henle Thick ascending limb Thin descending limb filtration secretion excretion reabsorption Physiology of Kidneys Process of urine formation 180 L filtrate 12 L final urine 99% nephron renal corpuscle 3 Reabsorption of tubules and collecting tubes ? Proximal convoluted tubules ? NaHCO3 (Na+, HCO3) are reabsorbed ? epithelium is permeable to ions and water, and permit passive flow in either direction Na+ reabsorption is acpanied by passive absorption of water ? Carbonic anhydrase inhibitors (acetazolamide) reduce Na+H+ exchange, in turn, sodium reabsorption is decreased 4 interstitial fluid proximal tubule epithelial cell tubular lumen 1 2 3 4 5 6 7 Carbonic anhydrase inhibitors (acetazolamide) Na+K+ATPase Na+H+exchanger Carbonic anhydrase diffuses Na+HCO3 symporter basolateral membrane apical membrane bicarbonate Carbonic acid Carbon dioxide 5 Reabsorption of tubules and collecting tubes ? thick ascending limb of Henle’s Loop ? Na+/K+/2Cl cotransport system ? water is impermeable at this segment, tubular fluid is hypotonic with respect to plasma as it enters the distal convoluted tubule (diluted) ? inhibitors of Na+/K+/2Cl symporter block its function, increase excretion of Na+, K+, Cl, Mg2+, Ca2+ 6 1 2 4 5 3 apical membrane Basolateral membrane Na+/K+/2Cl cotransport system lumenpositive electrical potential H2O diluted Loop diuretics (furosemide) Na+K+ATPase interstitial fluid 7 dilution function and concentration function ? In the thick ascending limb, large amount of ions are reabsorbed, but water is impermeable at this segment, as a result, the tubular fluid bees dilute——dilution function ? At the same time, the reabsorption of ions at this limb produces a hypertonic renal medulla. When the urine pass through the collecting duct, the hypertonic interstitial fluid sucks water out of the tubules, thereby the tubular fluid bees concentration——concentration function 8 Reabsorption of tubules and collecting tubes ? Distal convoluted tubule ? Na+/Cl symporter ? both parathormone and calcitriol increase Ca2+ reabsorption ? further diluted ? this segment is in the cortical part, the hypertonic state of renal medulla is not affected 9 Cl thiazides apical membrane Basolateral membrane interstitial fluid H2O diluted Parathormone calcitriol Na+/Cl symporter 10 Reabsorption of tubules and collecting tubes ? late distal tubules and collecting tubules ? Na+/K+ exchange ? reabsorption of Na+ and its coupled secretion of K+ is regulated by aldosterone
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