《生理学》CHAPTER8.EXCRETIONOFKIDNEY

1、Chapter 8 .excretion of kidney，department of physiology of sums Wang tinghuai，中山大学基础医学院生理学和王正会先生，第8章肾脏排泄，The latest information from who The inciii传染病没有充分控制引起泌尿科感染、急性肾炎、间质性肾炎、结核病的发病率水平。infectious diseases are not be controlled enough，So the incidence rate of infectious diseases，acute nephritis，inter

2、stitial nephritis，2 .严重的环境污染和生活毒素没有得到控制Heavy environment pollution and toxin are not be controlled enough . 3 .与遗传性疾病生育控制不足、多囊肾等先天性疾病的多发有关。birth control are not carried out effectively for preventing genetic disease . so The incidence rate of congenital diseases such as polycystic ks The 排泄气体将与物质代谢的

3、尾产品和不需要或不需要过剩的气体排出体外的过程the process that the cellular waste products or extra nutrients，minerals and water leaving the 调节细胞外液体的数量和血液的渗透压。regulation of extracel lular fluid and osmotic pressur in blood。体液中的某些重要成分(例如Na、k、HCO3-、Cl-reservation of important materials in body fluid such as Na、k、HCO3- and C

4、l-)肾小球过滤2。reabsorption in renal tubule and collect tubule 3。肾小管和集合管排泄(Excretion of Tubule and Collect Tubule)，非泌尿功能分泌生物活性物质肾脏分泌的活性物质：a .促红细胞生成素(erythropoietin，EPO)促进RBC生成。肾素调节醛固酮分泌调节血容量调节电解质浓度c .海德化VitD3钙代谢D. PGA输血管，第一节肾脏的结构和功能特性，肾小球肾小球(毛细血管球)1，肾小体renal corpuscle肾小囊，皮质肾单位：8590%，肾小球小，肾单位牙齿小A型根数肾单位：10

5、15%，肾小球大，进球第二，juxtamedullary nephron(a)肾脏的供血(renal blood supply) 1。丰富的成年人安静的时候，1200ml /min皮质(cortex) 94%外水(outer zone) 56%内水(inne) 2。毛细血管网肾A(renal artery)叶间A(interlobar arteries)弓A(arcuate arteries)小叶A(interlobular arteries)进球。毛细血管网(golmerular capillaries)球A(efferent arterioles)毛细管(peritubular capil

6、laries)小叶V(interlobular vein)肾脏内血流分布不均.皮质血流水质blood flow in the vasa recta of the renal medulla is very low compared with flow in the renal cortex皮质肾单位入口小a口径出口小a(电阻小) (电阻大的肾小球内压有利于过滤)(b)调节肾脏血流(regulation of blood flow in kidney)1。肾血流自调节自动重建灌注压2080 mmhg (2.70肾血流随着肾A压升高，80180mmHg(10.724Kpa)在一个水平上稳定肾脏血流

7、180mmHg(24Kpa) causing them to contract . this contraction per vents overdistention of the vessel and at the same time，by raising vascular reses Helps to prevents (反之亦然)、2。肾脏血流的神经和体液调节，肾脏n(源自T12 L2)进入交感神经系统，进行肾素分泌。n纤维对尿液生成的影响还没有确定。体位性肾血量的变化可能是反射性交感N兴奋引起的体液因素。肾上腺素(adnephrin)、脱甲肾上腺素(norepinephrine)、助推

8、器、血管紧张素肾血管收缩(angiotensin)The auto regulation mai The auto regulation运动或异常(如高温、出血缺氧时：通过神经、体液调节，减少血流，确保重要的器官血流供应)。During severe，acute disturbances such as hypertherm ia and hy poxia it ensures the blood flow of important organs by decreasing the renal blood food血浆(plasm)、过滤器(filtrate)、尿液成分的比较微穿刺技术(mic

9、ropuncture technique) 2。肾小球滤过率：单位时间(每分钟)两个肾脏产生的超滤液量。125ml/min/1.73 m2 1251440(24h)=180000 180 l/24h GFR=KF Puf(KF:过滤器系数，Puf:有效过滤器压力)，3。过滤器，第二，过滤膜及其通透性(the Glomerular capillary membrane and its permeability)，肾小球毛细管内皮细胞(Glomerular capillary endothelium)“分子量大小选取过滤器”(the filtr um of solutes is related to their size)，有效半径3.6nm不能过滤葡萄糖glucose(1