Tubules physiology

Most diuretics act upon a single anatomic segment of the nephron (Figure 15-1). Because these segments have distinctive transport functions, the first section of this chapter is devoted to a review of those features of renal tubule physiology that are relevant to diuretic action. The second section is devoted to the basic pharmacology of diuretics, and the third section discusses the clinical applications of these drugs. 

Calcium is freely filtered along with other components of the plasma through the nephrons of the kidney. Most of this calcium is reabsorbed into the blood from the proximal tubule of the nephron. However, because the kidneys produce about 1801 of filtrate per day, the amount of calcium filtered is substantial. Therefore, the physiological regulation of even a small percentage of calcium reabsorption may have a significant effect on the amount of calcium in the blood. Parathyroid hormone acts on the Loop of Henle to increase the reabsorption of calcium from this segment of the tubule and... 

This reabsorption occurs regardless of the sodium content of the body. In order to make adjustments in the sodium load, the reabsorption of the remaining 10% of filtered Na+ ions from the distal tubule and collecting duct is physiologically controlled by two hormones ... 

Sodium is freely filtered at the glomerulus. Therefore, any factor that affects GFR will also affect sodium filtration. As discussed previously, GFR is directly related to RBF. In turn, RBF is determined by blood pressure and the resistance of the afferent arteriole (RBF = AP/R). For example, an increase in blood pressure or a decrease in resistance of the afferent arteriole will increase RBF, GFR, and, consequently, filtration of sodium. The amount of sodium reabsorbed from the tubules is physiologically regulated, primarily by aldosterone and, to a lesser extent, by ANP. Aldosterone promotes reabsorption and ANP inhibits it. The alterations in sodium filtration and sodium reabsorption in response to decreased plasma volume are illustrated in Figure 19.6. 

The major FSH target in the male is the Sertoli cells, found in the walls of the seminiferous tubules of the testis. They function to anchor and nourish the spermatids, which subsequently are transformed into spermatozoa during the process of spermatogenesis. Sertoli cells also produce inhibin (discussed later), which functions as a negative feedback regulator of FSH. The major physiological effect of FSH in the male is thus sperm cell production. 

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. 

Vasopressin occurs in two variations arginine-vasopressin (AVP) and lysine-vasopressin (LVP), in which Arg is replaced by Lys. The conformation of these hormones is almost identical to that of oxytocin, except that the terminal tail is con-formationally free and not held by the ring. The physiological role of the vasopressins is the regulation of water reabsorption in the renal tubules (i.e., an antidiuretic action). In high doses, they promote the contraction of arterioles and capillaries and an increase in blood pressure hence the name of these hormones. Because of their very similar structures, OT and VP overlap in a number of effects. 

This chapter is divided into three sections. The first section covers renal tubule transport mechanisms. The nephron is divided structurally and functionally into several segments (Figure 15-1, Table 15-1). Many diuretics exert their effects on specific membrane transport proteins in renal tubular epithelial cells. Other diuretics exert osmotic effects that prevent water reabsorption (mannitol), inhibit enzymes (acetazolamide), or interfere with hormone receptors in renal epithelial cells (aldosterone receptor blockers). The physiology of each segment is closely linked to the basic pharmacology of the drugs acting there, which is discussed in the second section. Finally, the clinical applications of diuretics are discussed in the third section. 

The main functions of the human kidney are the formation and excretion of urine, and control of the composition of body fluids. Details of the structure and functions ofthe human kidney may be found in textbooks of physiology [1] or biomedical engineering [13]. Each ofthe two human kidneys contains approximately one million units of tubules (nephrons), each 20-30 pm in diameter, and with a total... 

In adult males, testosterone is the principal androgen produced by the testes.39,40,144 Testosterone is synthesized by Leydig cells located in the interstitial space between the seminiferous tubules (Fig. 30-1). The seminiferous tubules are the convoluted ducts within the testes in which sperm production (spermatogenesis) takes place. Testosterone produced by the Leydig cells exerts a direct effect on the seminiferous tubules, as well as systemic effects on other physiologic systems (see Physiologic Effects of Androgens ). 

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