Hormones and renal system

You need to understand it well with all related details in order to apply in clinical practice!
However, this is for your reference only to simplify your study for the quiz and for the USMLE later.
Please note, that some of the hormones will be cover later in the endocrine module (highlighted in yellow)
so it is not part of the renal module.

Hormones secreting from the renal system

Hormone Site of Site of action Signal to activate Effects and clinical
secretion secretion significance
Renin Juxtaglome- Convert • Decrease in renal • Main regulator of
rular Angiotensinogen blood pressure blood pressure
apparatus, (synthesized in the • Increase • B-blockers induce
specifically liver) to Angiotensin I sympathetic tone decrease in blood
from JG cells (B1 receptor) pressure by inhibiting
(modified • Decrease in Na B1 receptors within
smooth load sensing by juxtaglomerular
muscle of macula densa apparatus and
afferent (NaCl sensors at decrease renin release
arteriole) DCT)
Erythropoietin Interstitial Bone marrow hypoxia • Stimulate RBC
cells of proliferation
peritubular • Additional
capillary bed supplementation of
this hormone may be
given in chronic kidney
diseases
Vitamin D proximal 1µhydrogenase will be Parathyroid hormone PTH • Hypoparathyroidism
(not a hormone but convoluted activated by PTH to requires
produced from the tubule cells convert 25-OH vitamin supplementation of D2
kidney) (PCT) D (produced in the (the active form) due
liver) to 1,25-OH to loss/deficiency of
vitamin (active form of PTH
Vit. D is calciferol)
Prostaglandins PGs Two types: Afferent arterioles Ischemia • Cause vasodilatation
(protective paracrine PGE2 from within the glomeruli Mechanical trauma of afferent arterioles
secretion for the medulla and And any condition causing a to increase renal blood
kidney) PGI2 from decrease in arterial blood flow (RBF) and
glomeruli volume and vasoconstriction glomerular filtration
rate (GFR)
• NSAIDs can affect
renal function
(especially in the
presence of decrease
in RBF) by blocking the
protective effect of
renal PGs and
decrease GFR leading
to acute renal failure
Dopamine PCT cells Interlobular arteries Low blood pressure Dose-dependent:
(endogenous renal Afferent arterioles • Low dose: increase
dopamine) RBF, little change in
GFR
• High dose:
vasoconstriction and
decrease GFR
• Maintain natriuresis
(Na excretion through
urine)
Use in renal failure with shock in
low dose
 Hormones secreting outside the renal system
Hormone Site of Site of action in the Signal to activate Effects and clinical
secretion renal system secretion significance
ANP and BNP ANP: atria • Vascular • Increase in body • Vascular smooth
(Natriuretic BNP: smooth fluid volume muscle relaxation via
hormones) ventricles muscles (volume cGMP leading to
• Afferent and overload) increase GFR
efferent • high blood • Afferent arteriolar
arterioles pressure dilatation
(detected by • Efferent arteriolar
arterial constriction
baroreceptors) • Maintain natriuresis
ADH (Vasopressin) Hypothala- Principal cells at • Low blood • Regulate osmolarity
mus (stored collecting ducts pressure • H2O reabsorption
in the • Angiotensin II (retention)
posterior release
pituitary
gland)
PTH Parathyroid PCT and DCT cells Hypocalcemia • Decrease PO4
gland Increase plasma PO4 reabsorption
Decrease in D3 • Increase Ca
reabsorption (which
lead to increase in
plasma Ca)
• Increase D3 production
• Chronic renal failure
associated with
secondary
hyperparathyroidism
Catecholamines Autonomic PCT and DCT and JG • Low blood • Na+ reabsorption
(dopamine, nervous cells pressure (retention)
epinephrine and system (detected by • Activation of renin
norepinephrine) (ANS) arterial angiotensin system
endings at baroreceptors)
the kidney
Angiotensin II Plasma (as a PCT and DCT cells • Low blood • Efferent arteriolar
result of pressure vasoconstriction
conversion
• Hyponatremia • Increase GFR
of
Angiotensin I (low Na+ level) • Na+ reabsorption
by ACE in the • Renin release (retention)
lung) • Smooth muscle cell
vasoconstriction to
increase BP
• Release of aldosterone
• Stimulate
hypothalamus and
lead to thirst sensation

Aldosterone Adrenal Principal cells in the • Low blood Mainly regulate extracellular fluid
cortex collecting tubules on the pressure volume and Na+ content by:
(secretion Na+/K+ ATPase pump • Hyperkalemia • Increase Na+
stimulated (Increase in reabsorption
by plasma K+) • H2O reabsorption
Angiotensin
• Angiotensin II (indirect action due to
II)
release Na+ reabsorption)
• Increase K+ secretion
• Increase H+ secretion