肾脏泌尿功能的调节

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1、第三节肾脏泌尿功能的调节Regulationofurineformationofthekidney中山大学基础医学院生理学教研室王庭槐尿生成的调节regulationofurineformation肾血流量的调节神经—体液调节regulationofrenalbloodflownervousandhumonalcontrol(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Aldosteroneparathyroidhormone一、抗利尿激素antidiuretichor

2、mone,ADH合成部位：视上核(supraopticnucleus)、室旁核(paraventricularnucleus)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ThehypothalamuscontainstwotypesofneuronsthatsynthesizeADHinthesupraopticnucleusandparaventricularnucleus.onceADHissynthesized,itistr

3、ansporteddowntheaxonsoftheneuronstotheirtips,terminatingintheposteriorpituitarygland.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]。ThemostimportantrenalactionofADHistoincreasethewaterpermeabilityofthedistaltubule,collectingtubule.Thiseffecthelpst

4、hebodytoconservewaterincircumstancessuchasdehydration.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。ADHincreasestheureapermeabilityofcollectingtubuleininnerzoneanddecreasesthebloodflowinmedulla.3.促进髓绊升支粗段对NaCl的重吸收，使直小血管收缩。ADHincreasesthereabsorptionofNaClinthicksegmentofa

5、scendinglimbandsoleadstoconstrictionofvasarecta.（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。ADHcombineswiththereceptorinbasolateralmembraneandactivatedtheadenylatecyclase,itproducescyclicadeno

6、sinemonophosphate,whichleadstoactivationofproteinkinaseinbasolateralmembrane,thenthemembraneproteinisphosphorylated,sotheconfigurationofmembranechanges,thisprocessincreasesthepermeabilitytowaterbytheopenofwaterchannel.（二）ADH分泌的调节(theregulationofADHsecret

7、ion)血浆晶体渗透压的改变(thechangeofcrystalosmoticpressure)有效刺激因素effectivestimuli循环血量的改变(thechangeofeffectivebloodvolume)1、血浆晶体渗透压的改变特点：敏感，晶体渗透压改变1～2%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远曲小管、集合管对水通透性对水重吸收，尿液浓缩尿量减少

8、。TheprecisewaythattheosmoticconcentrationoftheextracellularfluidscontrolsADHsecretionisnotclear.Yetsomewhereinornearthehypothalamusaremodifiedneuronreceptorscalledosmoreceptors.whentheextracellularfluidbecomestooconcentrat