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Renal Physiology April 2011
Renal Physiology April 2011
Mohan
Renal Physiology
April, 2011
J. Mohan, PhD.
Lecturer,
Physiology Unit,
Faculty of Medical Sciences,
U.W.I., St Augustine.
References:
Koeppen B.E. & Stanton B.A. (2010). Berne & Levy Physiology.
6th Edition. Mosby, Elsevier.
Physiology Objectives
Today’s Topics
• Solute and water transport along the nephron.
– Proximal Tubule
• Na+ Reabsorption.
• Water Reabsorption.
• Protein Reabsorption.
• Secretion of Organic Anions & Cations.
– Henle’s Loop
– Glomerular
filtration
– Tubular
reabsorption
– Secretion
Proximal Tubule
• reabsorbs :
• Ist half of PT
– Na-H+ anti-port
• active transport of Na+ at basolateral membrane via
Na+,K+-ATPase Na+ enters cell & H+ leaves at
apical membrane
– HCO3- transporters
• CO2 + H2O ↔ H2CO3 ↔ HCO3- + H+
• HCO3- leaves the cell at basolateral membrane
• Ist half of PT
• Na+ entry to PT cell coupled to entry of organic solutes
– Na+ enters proximal cells via several symporter
mechanisms, including Na+-glucose, Na+-amino acid,
Na+-Pi, & Na+-lactate
– glucose and other organic solutes that enter the cell with
Na+ leave the cell across the basolateral membrane via
passive transport mechanisms
– Na+-glucose symporter
• active tranport of Na+ at basolateral membrane via Na+/K+-
ATPase
• Na+ enters PT cell at apical membrane with glucose
• glucose leave the cell at basolateral membrane
• more water than Cl- is reabsorbed in the first half of the PT,
the [Cl-] in tubular fluid rises along the length of the PT
• Transcellular
– Na+ enters the cell across the apical membrane primarily
via the parallel operation of an Na+-H+ antiporter and one
or more Cl - - anion antiporters
– because the secreted H+ and anion combine in the
tubular fluid and reenter the cell, operation of the Na+-H+
and Cl- -anion anti-porters is equivalent to uptake of NaCl
from tubular fluid into the cell
–Na+ leaves the cell via Na+,K+-ATPase, and Cl- leaves
the cell and enters the blood via a K+-Cl- symporter in the
basolateral membrane
• in the 2nd half of the proximal tubule, some Na+ and Cl- are
reabsorbed across the tight junctions via passive diffusion
Na+ Reabsorption in PT
Summary
Water Reabsorption
• PT reabsorbs 67% of filtered water
Water Reabsorption
Water Reabsorption
• driving force for H20 reabsorption
– transtubular osmotic gradient established by reabsorption
of solute (e.g., NaCl, Na+-glucose)
– reabsorption of Na+ along with organic solutes, HCO3-&
Cl- from tubular fluid lateral intercellular spaces
osmolality of the tubular fluid and the osmolality of
the lateral intercellular space
Water Reabsorption
Protein Reabsorption
• peptide hormones, small proteins & small amounts of large
proteins e.g. albumin are filtered by the glomerulus
Protein Reabsorption
• proteins undergo endocytosis either intact or after being
partially degraded by enzymes on the surface of proximal
tubule cells
– Na+/K+ATPase
• Apical membrane
– OA-s are transported across the apical membrane by OAT4 & by MRP2
(multidrug resistance-associated protein 2)
– Na+/K+ATPase
– 4 pathways : passive diffusion & 3 uniporters (OCT1, OCT2, &
OCT3)
• Apical membrane
– OC+s leave the cell across the apical membrane in exchange for
H+ by 2 OC+ - H+ antiporters (OCTN1, OCTN2 & MDR1)
Today’s Topics
• Solute and water transport along the nephron.
– Proximal Tubule
• Na+ Reabsorption.
• Water Reabsorption.
• Protein Reabsorption.
• Secretion of Organic Anions & Cations.
– Henle’s Loop
Henle's Loop
• Henle's loop (LoH) reabsorbs approximately 25% of the
filtered NaCl and 15% of the filtered water (See Tables 33-4 &
33-5)
Henle's Loop
• thin ascending limb reabsorbs NaCl by a passive mechanism
– Na+/K+ATPase
– K+ - Cl- symporter
– HCO3- ?
• Apical membrane
Henle's Loop
Summary
Today’s Topics
• Solute and water transport along the nephron.
– Proximal Tubule
• Na+ Reabsorption.
• Water Reabsorption.
• Protein Reabsorption.
• Secretion of Organic Anions & Cations.
– Henle’s Loop
• Basolateral membrane
– Na+/K+ATPase
– Cl- channels
• Apical membrane
– Na+Cl- symporter
– intercalated cells
• secrete either H+ or HCO3- ( acid-base balance)
• reabsorb K+
Cl-
Principal cells
• Basolateral membrane
– Na+,K+-ATPase
– K+ channels
– AQP 3&4
• Apical membrane
– epithelial Na+-selective channels (ENaCs)
– K+ channels
– AQP2
• H20 reabsorbtion
– water reabsorption is mediated by the AQP2 water
channel located in the apical plasma membrane & by
AQP3 and AQP4 located in the basolateral membrane of
principal cells
• K+ secretion
– K+ is secreted from blood into tubular fluid by principal
cells in two steps :
– (1) uptake of K+ across the basolateral membrane is
mediated by the action of Na+,K+-ATPase
– (2) K+ leaves the cell via passive diffusion
• K+ channels
• K+ diffuses down its concentration gradient through apical cell
membrane K+ channels into tubular fluid
• although the negative potential inside the cells tends to retain
K+ within the cell, the electrochemical gradient across the
apical membrane favors secretion of K+ from the cell into
tubular fluid
Cl-
– Basolateral membrane
• HCO3- (passive diffusion)
– Apical membrane
• H+ leaves the cell
• H+-K+-ATPase mediates K+ reabsorbtion
Today’s Topics
• Solute and water transport along the nephron.
– Proximal Tubule
• Na+ Reabsorption.
• Water Reabsorption.
• Protein Reabsorption.
• Secretion of Organic Anions & Cations.
– Henle’s Loop
NaCl reabsorption
• hormones
– angiotensin II, aldosterone, NE, Epi, natriuretic peptides,
and uroguanylin, dopamine & adrenomedullin
• Starling forces
• Glomerulotubular balance
H20
• ADH (direct)
NaCl reabsorption
Angiotensin II
• Major Stimulus
– renin
• Site of Action
– PT, thick ALoH, DT/CD
• Effect on Transport
– reabsorption of NaCl & H20
NaCl reabsorption
Aldosterone
• Major Stimulus
– AgII, plasma [K+]
• Site of Action
– thick ALoH, DT/CD
• Effect on Transport
– reabsorption of NaCl & H20
– secretion of K+
• Site of Action
– Medullary CD
• Effects
– reabsorption of NaCl & H20 excretion
– ADH-stimulated water reabsorption across the collecting
duct
– secretion of ADH from the posterior pituitary
• Site of Action
– PT, thickALoH, DT/CD
• Effects
– reabsorption of NaCl & H20
• Site of Action
– DT/CD
• Effects
– reabsorption of H20
G-T Balance
Glomerulotubular (G-T) balance
G-T Balance
• spontaneous changes in GFR markedly alter the filtered load
of Na+ (filtered load = GFR × [Na+] in the filtered fluid)
G-T Balance
• when body Na+ balance is normal (i.e., ECF volume is
normal), G-T balance refers to the fact that reabsorption of
Na+ & water increases in proportion to the increase in GFR
and filtered load of Na+
G-T Balance
• 2nd mechanism
G-T Balance
Summary of G-T balance
• in GFR
G-T Balance
Summary of GT-balance
• in GFR
– FF π pc reabsorbtion in PT
– filtered glucose & aa reabsorbtion Na+ in PT