curs xi - · pdf file-rinichi, uretere, vezica urinara, uretra-formarea, depozitarea si...
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Curs XI
Sistemul urinar
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Sistemul urinar
-Rinichi, uretere, vezica urinara, uretra
-Formarea, depozitarea si eliminarea urinii
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1. Reglarea volumului de lichid extracelular – plasma si lichidul interstitial
2. Reglarea concentratiei electrolitilor din lichidul extracelular – Na+, K+, Cl-,
Ca2+, HCO3-
3. Reglarea pH-ului sangvin
4. Eliminarea produsilor metabolici (uree, acid uric, creatinina, etc…)
5. Eliminarea unor molecule exogene (medicamente, pesticide, aditivi,
etc…)
6. Gluconeogeneza – sinteza de glucoza pornind de la aminoacizi si alti
precursori
7. Rol endocrin – eritropoietina, calcitriol (vitamina D), renina (enzima)
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Anatomia sistemului urinar
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Anatomia sistemului excretor - rinichii
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Anatomia rinichiului
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Vascularizatia rinichilor
Artera renala – artere interlobare – artere arcuate – artere interlobulare – arteriole
eferente - glomeruli
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Nefronul – unitatea functionala a rinichiului
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Tipuri de nefroni
-Corticali
-Juxtamedulari
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Formarea urinii
Rata de filtrare glomerulara – 125 ml/minut – 180 l/zi – volumul de
fluid filtrat de rinichi
Volumul de fluid excretat prin urina –1,5 l/zi – >99% din volumul de
fluid filtrat este reabsorbit
Volumul total al plasmei ~ 3,5 l – toata plasma sangvina este filtrata
in <30 min
La trecerea prin capilarele glomerulare ~20% din plasma este filtrata
Volumul de urina poate varia intre 0,4 l/zi (pierderea de apa obligatorie)
si 25 l/zi
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Filtrare
Reabsorbtie
Secretie
Excretie
Procesele implicate in formarea urinii
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Filtrare
Reabsorbtie
Secretie
Excretie
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Exemple de procesare a unor substante de catre rinichi
Agenti exogeni (medicamente) Apa Glucoza
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Filtrarea glomerulara
parietal
visceral
spatiu capsular
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Filtrarea glomerulara
Podocita
Procese pediculate
Fante de filtrare
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Filtrarea glomerulara
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Fortele Starling implicate in filtrare
PGC – presiunea hidrostatica din capilarele glomerulare
PBS – presiunea hidrostatica din spatiul capsulei Bowman
GC – presiunea osmotica datorata proteinelor din plasma
PF = PGC – PBS - GC = 60 – 15 – 29 = 16 mm Hg - filtrare
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Reabsorbtie
Secretie
Excretie
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Reabsorbtia solutilor in tubulul proximal
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Reabsorbtia ionilor de Na+ in tubulul proximal
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Reabsorbtia H2O in tubulul proximal
- Reabsorbtia de apa are loc prin osmoza, datorita gradientului de osmolaritate
generat in urma reabsorbtiei active de Na+
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Ansa lui Henle – nefroni juxtamedulari
Segment descendentSegment ascendent
Vasa recta
Tubulul colector
H2O
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Ansa lui Henle – formarea gradientului osmotic
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Ansa lui Henle – formarea gradientului osmotic
Reabsorbtie activa de NaClin segmentul ascendent
Formarea unui gradient osmotic intre lumen si
interstitiu
Reabsorbtia de H2O in segmentul descendent
Cresterea concentratiei de NaCl in lumen
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Formarea urinii concentrate – retentia de apa
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ADH (vasopresina) – controlul
reabsorbtiei de H2O
Dehidratare (hemoragie, diaree)
Osmolaritatea lichidului extracelular (plasma)
Activitatea osmoreceptorilor centrali
Eliberarea de ADH
Permeabilitatea tubuluilor colectori pentru H2O
Reabsorbtia de H2O
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Efectul ADH-ului asupra tubulilor colectori
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Reabsorbtia ionilor de Na+ in tubulul distal si colector
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Sistemul renina – angiotensina - aldosteron
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Aparatul juxtaglomerular – secretia de renina
a. Activarea terminatiilor simpatice renale
b. Detectia scaderii presiunii arteriale in arteriola aferenta de catre celulele granulare
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Presiuneasangvina
Renina
Angiotensinogen
Angiotensina I
Angiotensina II
ACE
Vasoconstrictie
Aldosteron
Retentie de Na+ si H2O
Presiuneasangvina
Sistemul renina – angiotensina - aldosteron
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Rolul aldosteronului in reabsorbtia de Na+
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Structura peretelui ureterului
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Vezica urinara
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Maladia renala polichistica (ADPKD – autosomal
dominant polycystic kidney disease)
- Mutatii ale unui canal ionic TRPP1 din membrana apicala a celulelor epiteliale
renale
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Hemodializa – rinichiul artificial