Kidney blood pressure regulation

The chromaffin cells of the adrenal medulla may be considered to be modified sympathetic neurons that are able to synthesize E from NE by /V-methylation. In this case the amine is Hberated into the circulation, where it exerts effects similar to those of NE in addition, E exhibits effects different from those of NE, such as relaxation of lung muscle (hence its use in asthma). Small amounts of E are also found in the central nervous system, particularly in the brain stem where it may be involved in blood pressure regulation. DA, the precursor of NE, has biological activity in peripheral tissues such as the kidney, and serves as a neurotransmitter in several important pathways in the brain (1,2). 

There is another system involved in blood pressure regulation the renin-angiotensin-aldosterone system (Fig. 2). The arterial blood pressure in the kidney influences intrarenal baroreceptors which together with the sodium load at the macula densa lead to renin liberation, angiotensin formation and aldosterone secretion, which by influencing the sodium balance changes the blood volume and influences the arterial blood pressure. 

The kidneys are critical organs. They filter wastes produced by metabolism from the blood and excrete them with water as urine. They are also major organs in whole body homeostasis, with acid-base balance, electrolyte concentration regulation, blood volume control, and blood pressure regulation functions. 

Renin Kidney Conversion of angiotensinogen to angiotensin I regulation of blood pressure... 

Although blood pressure control follows Ohm s law and seems to be simple, it underlies a complex circuit of interrelated systems. Hence, numerous physiologic systems that have pleiotropic effects and interact in complex fashion have been found to modulate blood pressure. Because of their number and complexity it is beyond the scope of the current account to cover all mechanisms and feedback circuits involved in blood pressure control. Rather, an overview of the clinically most relevant ones is presented. These systems include the heart, the blood vessels, the extracellular volume, the kidneys, the nervous system, a variety of humoral factors, and molecular events at the cellular level. They are intertwined to maintain adequate tissue perfusion and nutrition. Normal blood pressure control can be related to cardiac output and the total peripheral resistance. The stroke volume and the heart rate determine cardiac output. Each cycle of cardiac contraction propels a bolus of about 70 ml blood into the systemic arterial system. As one example of the interaction of these multiple systems, the stroke volume is dependent in part on intravascular volume regulated by the kidneys as well as on myocardial contractility. The latter is, in turn, a complex function involving sympathetic and parasympathetic control of heart rate intrinsic activity of the cardiac conduction system complex membrane transport and cellular events requiring influx of calcium, which lead to myocardial fibre shortening and relaxation and affects the humoral substances (e.g., catecholamines) in stimulation heart rate and myocardial fibre tension. 

Aldosterone A hormone produced in and secreted by the zona glomerulosa of the adrenal cortex. Aldosterone acts on the kidneys to reabsorb sodium and excrete potassium. It is also a part of the renin-angiotensin-aldosterone system, which regulates blood pressure and blood volume. 

Renin-angiotensin-aldosterone system (RAAS) The hormonal system controlled mainly by the kidneys and adrenal glands that regulates blood pressure, blood volume, and electrolyte balance. 

Antidiuretic hormone promotes the reabsorption of water from the tubules of the kidney, or antidiuresis. Specifically, it acts on the collecting ducts and increases the number of water channels, which increases the diffusion coefficient for water. This results in the body s conservation of water and the production of a low volume of concentrated urine. The reabsorbed water affects plasma osmolarity and blood volume. This effect of ADH on the kidney occurs at relatively low concentrations. At higher concentrations, ADH causes constriction of arterioles, which serves to increase blood pressure. Antidiuretic hormone secretion is regulated by several factors ... 

Vasopressin (antidiuretic hormone) is a peptide synthesized in the hypothalamus and secreted from the neurohypophysis of the pituitary gland. This substance plays an important role in the long-term regulation of blood pressure through its action on the kidney to increase reabsorption of water. The major stimulus for release of vasopressin is an increase in plasma osmolarity. The resulting reabsorption of water dilutes the plasma toward its normal value of 290 mOsM. This activity is discussed in more detail in Chapter 10 (the endocrine system) and Chapter 19 (the renal system). 

Although the kidneys are not considered endocrine glands per se, they are involved in hormone production. Erythropoietin is a peptide hormone that stimulates red blood cell production in bone marrow. Its primary source is the kidneys. Erythropoietin is secreted in response to renal hypoxia. Chronic renal disease may impair the secretion of erythropoietin, leading to development of anemia. The kidneys also produce enzymes. The enzyme renin is part of the renin-angiotensin-aldosterone system. As will be discussed, these substances play an important role in the regulation of plasma volume and therefore blood pressure. Other renal enzymes are needed for the conversion of vitamin D into its active form, 1,25-d i hyd ro xyv itamin D3, which is involved with calcium balance. 

There are seven membrane forms of GC, designated GC-A to GC-G [33], Two forms, GC-A and GC-B (Mr = 120kDa), serve as receptors for atrial natriuretic peptide (ANP) and related peptides. ANP is a 28-amino-acid peptide isolated originally from cardiac atria as an important factor in the regulation of sodium excretion and blood pressure. GC-A binds ANP, as well as brain natriuretic peptide (BNP), and is located in vascular tissue and kidney. 

The gross appearance (macrostructure) of a kidney is recognizable to most people, even those who have no detailed knowledge of mammalian physiology. Furthermore, many people would be able to state that the role of the kidneys is to excrete waste materials in the urine. What is less likely to be so widely appreciated is the importance and complexity of action of the kidney in regulating the chemical composition and volume of the body fluids, a key aspect of homeostasis. Receiving approximately 25% of cardiac output per minute, the kidneys are adapted to monitoring blood pressure. 

Assuming the capsular pressures opposing the movement of water out of the blood and into the top of the nephron are constant, the net filtration pressure is due largely to the blood pressure. Any fall in blood pressure can have a dramatic effect on the efficiency of filtration and therefore clearance of waste materials. So important is the pressure within the renal vasculature that the kidney is critical in regulating systemic blood pressure via the renin-angiotensin-aldosterone (RAA) axis, a physiological process which relies on transport mechanisms within the renal tubules. 

Reabsorption of water is a fundamental function of the kidney because loss of fluid volume and reduction in blood pressure (hypotension) would have devastating consequences on all other tissues, possibly leading to severe metabolic disruption or even death. Blood pressure is monitored by the kidney and regulated by secretion of a proteolytic enzyme called renin, which initiates a cascade involving angiotensin and aldosterone to restore blood volume. 

The other hormone of note synthesized by kidney is erythropoietin (EPO), a glycosylated peptide hormone (molecular weight approximately 50 000), which promotes red blood cell formation and is secreted in response to poor oxygen perfusion (hypoxia) of the kidney. This, along with the control of blood pressure via the RAA system illustrates the importance of the kidney in regulating aspects of the blood vascular system. Further details of EPO can be found in Chapter 5. 

Certain antibiotics such as the tetracyclines, streptomycin, neomycin and kanamycin can cripple the tubules if taken in excessive amounts. Toxic damage to the kidneys can affect not only their filtration functions, but can alter the organs control over blood levels of certain critical molecules. A complex biochemical-hormonal system controlling blood pressure and volume, for example, is regulated by the kidneys, so that chronic kidney damage can inflict damage on the... 

Hypertension is a common and progressive disorder which, if not effectively treated, results in an increased risk of atherosclerosis (see above), haemorrhagic stroke and damage to the kidney. For most cases of hypertension, there is no obvious cause, hence it is known as essential hypertension, so called because it was originally thonght to be essential to maintain tissue perfusion. In order to better nnderstand the regulation of blood pressure, a brief description of the regulation of contraction of smooth mnscle is provided. 

The major function of kidneys is to filter the redundant nutrients and metabolites out of the blood, including those that come from the natural breakdown of tissues as well as those that we ingest with food intake. In this way, the kidneys maintain the homeostatic balance with respect to water and electrolytes as well as nutrients and metabolites. In addition, the actions of the kidneys also regulate blood pressure and erythropoiesis. 

Concentrations of Na", C, and Cl in body fluids, and the physiological variables dependent on these (e. g. blood pressure), are subject to strict regulation. The principal site of action of the hormones involved is the kidneys, where hormones increase or reduce the resorption of ions and recovery of water (see pp. 326-331). The concentrations of Ca and phosphate, which form the mineral substance of bone and teeth, are also precisely regulated. 

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