Principles of Renal Physiology. 4th Edition

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1 Principles of Renal Physiology 4th Edition

2 Principles of Renal Physiology 4th Edition Chris Lote Professor of Experimental Nephrology, University of Birmingham, UK SPRINGER SCIENCE+BUSINESS MEDIA, B.V.

3 A c.i.p. Catalogue record for this book is available from the Library of Congress ISBN ISBN (ebook) DOI / Prin led on acid-free paper AII Rights Reserved Fourth Edition 2000 Springer Science+Business Media Dordrecht Originally published by Kluwer Academic Publishers in 2000 No part of the material protected by this copyright notice may be reproduced in any form or by any means, electronic or mechanical, including photocopying, record ing or by any other information storage and retrieval system, without written permission from the copyright owner.

4 Contents Preface Terminology and abbreviations 1 The body fluids 1.1 Introduction 1.2 Body water 1.3 Body fluid osmolality 1.4 Distribution of ions across biological membranes 1.5 Fluid exchanges between body compartments 1.6 Fluid exchanges between the body and the external environment 1.7 Ionic composition of the body fluids 1.8 Ion exchanges between the body and the external environment 1.9 Body fluid compartments: methods of measurement Further reading Problems 2 Essential anatomy of the kidney 2.1 Introduction 2.2 General morphology and cellular organization 2.3 Blood supply and vascular structure within the kidney 2.4 Renal lymphatic drainage 2.5 Juxtaglomerular apparatus Further reading 3 Glomerular filtration 3.1 The filter 3.2 Glomerular filtration process 3.3 Composition of the glomerular filtrate 3.4 Filtration fraction 3.5 Tubulo-glomerular feedback Further reading Problems ix x v

5 vi Contents 4 Tubular transport Introduction Primary and secondary active transport Ion channels, uniporters and facilitated diffusion Para cellular movement Water absorption Fractional excretion and fractional reabsorption 52 Further reading 52 5 The proximal tubule Morphology of proximal tubule cells Proximal tubular handling of sodium Uptake of NaCl and water into peritubular capillaries Relationship of proximal tubular reabsorption to glomerular filtration rate Proximal tubular reabsorption of other solutes Secretory processes in the proximal tubule 66 Further reading 68 Problem 69 6 The loop of Henle, distal tubule and collecting duct The loop of Henle Collecting tubules Importance of urea in countercurrent multiplication Further requirements of the countercurrent multiplication mechanism: the vasa recta Long and short loops of Henle Regulation of urine concentration Other hormones affecting distal nephron transport processes 84 Further reading 84 7 Renal blood flow and glomerular filtration rate Measurement of renal blood flow and glomerular filtration rate Regulation of renal blood flow and glomerular filtration rate 92 Further reading 94 Problem 95 8 Regulation of body fluid osmolality 8.1 Introduction 8.2 Osmoreceptors 8.3 Regulation of water excretion and water reabsorption Further reading

6 Contents vii 9 Regulation of body fluid volume Introduction Aldosterone Renin and angiotensin, and their relationship to aldosterone Starling forces and proximal tubular sodium reabsorption Renal nerves Prostaglandins and other arachidonate metabolites Atrial natriuretic peptide and urodilatin Other factors which may be involved in regulating sodium excretion ADH and the relationship between osmotic regulation and volume regulation Overall scheme of body fluid volume regulation 121 Further reading Renal regulation of body fluid ph Introduction Physiological buffers Renal regulation of plasma bicarbonate concentration Regulation of H+ secretion according to acid-base balance requirements 134 Further reading 142 Problem Renal control of body fluid potassium content Importance of K+ in the body Regulation of body K Hypokalaemia Hyperkalaemia 148 Further reading Renal regulation of body calcium, magnesium and phosphate Introduction Calcium Phosphate Calcium and phosphate homeostasis Magnesium 157 Further reading Summary of the principal reabsorptive and secretory processes in the nephron segments Introduction Sodium 161

7 viii Contents 13.3 Water Potassium Hydrogen ions and HC03" Phosphate Calcium Glucose Urea and other nitrogenous waste products Disease conditions which alter renal sodium and water reabsorption Introduction Oedema Congestive heart failure Hypovolaemia and shock Hypertension Liver disease Nephrotic syndrome 181 Further reading Use of diuretics Introduction Osmotic diuretics Loop diuretics Thiazides Aldosterone antagonists N a channel blockers Carbonic anhydrase inhibitors Clinical use of diuretics 186 Further reading 188 Answers to problems 189 Index 193

8 Preface to the fourth edition The first edition of this book appeared in In the preface to that first edition, I wrote 'This book is based on the lecture course in renal physiology which I give to medical students at the University of Birmingham. The purpose of the book is primarily to set out the principles of renal physiology for preclinical medical students, and it is therefore concerned mainly with normal renal function. However, diseases or abnormalities in other body systems may lead to adaptations or modifications of renal function, so that a good knowledge of renal physiology is essential to the understanding of many disease states, for example the oedema of heart failure or liver disease, or the consequences of haemorrhage and shock.' The new edition is still based on the lectures which I continue to give at Birmingham University, but over the years the course has gradually changed, to being a system based course covering all aspects of the kidney - the anatomy, physiology, pharmacology and pathology. The new edition of the book, which has been extensively revised and rewritten, reflects this. However, it continues to offer a concise, easily readable format, primarily intended for undergraduate medical and medical science students. This new edition will carry the book through to twenty years of continuous publication, so it must be doing something right! I hope the new generation of readers will find it interesting and that it meets their needs, and I would like to encourage all of them to let me have their comments and suggestions. Chris Lote ix

9 Terminology and abbreviations General ADH ANP EeG ERPF GFR RBF RPF Antidiuretic hormone (vasopressin) Atrial natriuretic peptide Electrocardiogram Effective renal plasma flow Glomerular filtration rate Renal Blood flow Renal plasma flow Units of measurement mosmol milliosmoles mmhg millimetres of mercury (pressure measurement) mm millimoles I litre mmol millimoles nm nanometres (10-9 metres) flm micrometres (10-6 metres) Symbols Square brackets, [], denote concentration, e.g. plasma [N a +] = 140 mm means plasma sodium concentration = 140 mm. x

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