Académique Documents
Professionnel Documents
Culture Documents
Pressure diuresis: An increase in arterial pressure only a few mm Hg can double the renal output of water
Pressure natriuresis: An increase in arterial pressure only a few mm Hg can double the renal output of salt
6
Elevated Pressure 4
Normal
Elevated Pressure
Importance of Salt in the Renal-Body Fluid Schema for Arterial Pressure Regulation
Excess salt in the body The osmolality of the body fluid increases Stimulate the thirst center Drink extra amounts of water Increases the extra-cellular fluid volume The increase in osmolality in the extracellular fluid Stimulate hypothalamus to secrete ADH The kidney reabsorb water from the renal tubular fluid Increasing the extracellular fluid volume. Increasing extracellular volume Elevation of the arterial pressure.
Hypertension
Its often caused by excess extra-cellular fluid volume MAP is greater than the upper range of the accepted normal measure (> 110 mm Hg).
Diastolic pressure > 90 mm Hg Systolic pressure > 135 mm Hg
brain (stroke)
Paralysis Dementia Blindness
Volume-Loading Hypertension Caused by Reduced Renal Mass Along with Simultaneous Increase in Salt Intake
70 % of renal tissue removed Mean arterial pressure (per cent of control)
150 140 130 120
0.9% NaCl Tap water 0.9% NaCl
110 100 90 0 10 20 30 40 50 60 70 80
Days
Renin-Angiotensin System
Renin:
Small protein Enzyme Synthesized in the JG cells Stored in an inactive form: Prorenin This secretion is stimulated by fall blood pressure Catalyze reaction: Angiotensinogen Angiotensin I. It persists in the blood for 30 60 minutes.
Liver
Angiotensin II
Blood vessels
Aldosteron secre.
ADH secretion
Vasoconstriction
Sodium reabsorption
Goldblatt Hypertension
Hypertension caused by renal artery constriction The early rise in arterial pressure is caused by the Renin-Angiotensin vasoconstrictor mechanism. The second rise in arterial pressure is caused by retention of salt and water by constricted kidney
200
Constriction released
150
100
Times normal
Renin secretion
1 0 0 4 8 12
Days
Essential Hypertension
About 90-95 % of hypertension cases Unknown origin & strong hereditary tendency Characteristics of severe essential hypertension:
1. MAP is increased 40 60 %. 2. In the late & more severe stages: RBF decreased 50 % 3. The resistance to blood flow through the kidneys is increased twofold to fourfold. 4. But, GFR is often near normal. 5. The cardiac output is about normal. 6. The TPR is increased about 40 60 % ~ elevation of arterial pressure. 7. The kidney will not excrete adequate amount of salt and water unless the arterial pressure is high.
Nonsalt-sensitive
Salt intake and output (times normal) Salt-sensitive
6
High intake
B1
Normal
Essential hypertension
Normal intake
1
D C
50
150
kidneys or blocking the action of the sympathetic transmitter substance on the renal vasculature 2. Directly paralyzing the smooth muscle of the renal vasculature 3. Blocking the action of the renin-angiotensin system on the renal vasculature or renal tubules.
Natriuretic Diuretic
Aldosterone
4 Hari
16