Effect of glomerular filtration rate impairment on diagnostic ...
Autoregulation of Glomerular Filtration Rate
-
Upload
garima-aggarwal -
Category
Health & Medicine
-
view
1.545 -
download
7
description
Transcript of Autoregulation of Glomerular Filtration Rate
![Page 1: Autoregulation of Glomerular Filtration Rate](https://reader035.fdocuments.net/reader035/viewer/2022062220/556af830d8b42a2a4f8b4957/html5/thumbnails/1.jpg)
Autoregulation of GFR
- Dr. Garima AggarwalResident, DM Nephrology
Amrita Institute of Medical SciencesKochi, India
![Page 2: Autoregulation of Glomerular Filtration Rate](https://reader035.fdocuments.net/reader035/viewer/2022062220/556af830d8b42a2a4f8b4957/html5/thumbnails/2.jpg)
Renal Blood Supply
![Page 3: Autoregulation of Glomerular Filtration Rate](https://reader035.fdocuments.net/reader035/viewer/2022062220/556af830d8b42a2a4f8b4957/html5/thumbnails/3.jpg)
Glomerular Filtration• Glomerular Filtration Rate - Volume of fluid filtered from
glomerular capillaries into Bowman’s per unit time.
RENAL PLASMA FLOWRENAL PLASMA FLOW
FILTRATION COEFFICIENTFILTRATION COEFFICIENT
STARLING’S FORCES
STARLING’S FORCES
![Page 4: Autoregulation of Glomerular Filtration Rate](https://reader035.fdocuments.net/reader035/viewer/2022062220/556af830d8b42a2a4f8b4957/html5/thumbnails/4.jpg)
• Glomerular Hydrostatic Pressure is determined by 3 variables, each of which is under physiological control
Arterial Pressure Afferent arteriolar resistance Efferent arteriolar resisitance
![Page 5: Autoregulation of Glomerular Filtration Rate](https://reader035.fdocuments.net/reader035/viewer/2022062220/556af830d8b42a2a4f8b4957/html5/thumbnails/5.jpg)
5
Changes in GFR by constriction or dilation of afferent Changes in GFR by constriction or dilation of afferent (AA) or efferent (EA) arterioles(AA) or efferent (EA) arterioles
![Page 6: Autoregulation of Glomerular Filtration Rate](https://reader035.fdocuments.net/reader035/viewer/2022062220/556af830d8b42a2a4f8b4957/html5/thumbnails/6.jpg)
Autoregulation of GFR• Feedback mechanisms which are intrinsic to the kidney
and keep the Renal Blood flow and GFR relatively constant despite marked changes in arterial blood pressure.
• Within a range of 70- 160 mmHg
• Without autoregulation even a slight change in BP would cause a significant change in GFR
• For eg at 100mmHg – 180l/day GFR, 1 l/day of urine
If 25% rise in BP to 125mmHg – 225l/day of GFR
46l/day of Urine !!!!
![Page 7: Autoregulation of Glomerular Filtration Rate](https://reader035.fdocuments.net/reader035/viewer/2022062220/556af830d8b42a2a4f8b4957/html5/thumbnails/7.jpg)
Other Factors involved in Autoregulation Neural Hormonal Vasoactive Substances
![Page 8: Autoregulation of Glomerular Filtration Rate](https://reader035.fdocuments.net/reader035/viewer/2022062220/556af830d8b42a2a4f8b4957/html5/thumbnails/8.jpg)
Myogenic Mechanism• Arterial smooth muscle contracts and relaxes in response
to increases and decreases in vascular wall tension.
• It contributes upto 50% of total autoregulatory response
• Occurs very rapidly, reaching a full response in 3-10 seconds
• It is a property of the preglomerular resistance vessels – arcuate, interlobular and the afferent
• It is not seen in efferent arterioles, probably because of lack of voltage gated Ca channels
![Page 9: Autoregulation of Glomerular Filtration Rate](https://reader035.fdocuments.net/reader035/viewer/2022062220/556af830d8b42a2a4f8b4957/html5/thumbnails/9.jpg)
Mechanism of Myogenic AutoregulationArterial Blood pressure
Afferent Arteriolar Blood pressure
Arterial wall stretch
Sensing by myogenic stretch receptors
Opening of voltage gated Calcium channels
Influx of Ca from ECF to Vascular SM cells
Contraction of Vascular Smooth Muscle cells
Vasoconstritction
Minimizes changes in Afferent arteriolar blood flow
Minimizes changes in GFR
![Page 10: Autoregulation of Glomerular Filtration Rate](https://reader035.fdocuments.net/reader035/viewer/2022062220/556af830d8b42a2a4f8b4957/html5/thumbnails/10.jpg)
Nephron is uniquely organised so that the same tubule that descends from the cortex eventually returns to the originating glomerulus
Tubuloglomerular Feedback
![Page 11: Autoregulation of Glomerular Filtration Rate](https://reader035.fdocuments.net/reader035/viewer/2022062220/556af830d8b42a2a4f8b4957/html5/thumbnails/11.jpg)
Juxtaglomerular Apparatus
MACULA DENSA CELLSMACULA DENSA CELLSEXTRAGLOMERULAR MESANGIUM
RENIN SECRETING CELLS of the afferent arteriole
![Page 12: Autoregulation of Glomerular Filtration Rate](https://reader035.fdocuments.net/reader035/viewer/2022062220/556af830d8b42a2a4f8b4957/html5/thumbnails/12.jpg)
Mechanism of Tubuloglomerular feedback
• This is a feedback mechanism that links sodium and chloride concentration at the macula densa with control of renal arteriolar resistance.
• It acts in response to acute perturbations in delivery of fluid and solutes to the JGA.
• It has 2 components Afferent arteriolar feedback Efferent arteriolar feedback (hormonal)
It helps in
• Autoregulation of GFR
• Controls distal solute delivery, hence Tubular Reabsorption
![Page 13: Autoregulation of Glomerular Filtration Rate](https://reader035.fdocuments.net/reader035/viewer/2022062220/556af830d8b42a2a4f8b4957/html5/thumbnails/13.jpg)
Tubuloglomerular feedback continued.
Arterial Pressure
Glomerular Filtration Pressure
GFR
Na and water retention by PCT
Na delivery at Macula Densa
Signal to Afferent arteriole Renin
Adenosine/ATP Angiotensin II
Aff A Resistance Eff A Resistance
Vasodilation of AA Vasoconstriction of EA
![Page 14: Autoregulation of Glomerular Filtration Rate](https://reader035.fdocuments.net/reader035/viewer/2022062220/556af830d8b42a2a4f8b4957/html5/thumbnails/14.jpg)
Tubuloglomerular feedback cellular level
TUBULE LUMEN
MACULA DENSA
INTERSTITIUM
MESANGIAL CELLS
GRANULAR CELLS
AFFERENT ARTERIOLE
![Page 15: Autoregulation of Glomerular Filtration Rate](https://reader035.fdocuments.net/reader035/viewer/2022062220/556af830d8b42a2a4f8b4957/html5/thumbnails/15.jpg)
ARTERIAL PRESSUREGFR
SOLUTE DELIVERY TO MACULA DENSA
![Page 16: Autoregulation of Glomerular Filtration Rate](https://reader035.fdocuments.net/reader035/viewer/2022062220/556af830d8b42a2a4f8b4957/html5/thumbnails/16.jpg)
Regulation of Tubuloglomerular feedback
• Mediators Adenosine ATP
• Modulators Neuronal NOS Angiotensin II Endothelin
![Page 17: Autoregulation of Glomerular Filtration Rate](https://reader035.fdocuments.net/reader035/viewer/2022062220/556af830d8b42a2a4f8b4957/html5/thumbnails/17.jpg)
Neural regulation of GFR
Sympathetic nerve fibers innervate afferent and efferent arteriole
• Normally sympathetic stimulation is low nd has no effect on GFR
• During excessive Sympathetic stimulation (Defense, Brain Ischemia, Severe Hemorrhage) lastin from few minutes to few hours can stimulate the Renal vessels
• Vasoconstriction occurs as a result which conserves blood volume(hemorrhage)and causes a fall in GFR.
Parasympathetic Nervous System – Acetylcholine causes release of NO from the Endothelial cells, hence Vasodilation.
![Page 18: Autoregulation of Glomerular Filtration Rate](https://reader035.fdocuments.net/reader035/viewer/2022062220/556af830d8b42a2a4f8b4957/html5/thumbnails/18.jpg)
Hormonal regulation of GFRVASOCONSTRICTORS•Norepinephrine
•Epinephrine
Released in stressful situations, alongside the Sympathetic stimulation
•Endothelin
ARF, Toxaemia of pregnacy, Vascular Injury, Chronic uraemia
•Angiotensin II.
Produced by Renin, released by JGA cells
•Leukotrienes – LTC4, LTD4
VASODILATORS•NO
•Prostaglandin E2
•Prostaglandin I2
•Bradykinin
•Leukotriene LTB4
![Page 19: Autoregulation of Glomerular Filtration Rate](https://reader035.fdocuments.net/reader035/viewer/2022062220/556af830d8b42a2a4f8b4957/html5/thumbnails/19.jpg)
Renin
Aldosterone
Adrenalcortex
Corticosterone
Angiotensinogen
(Lungs)
renal blood flow &/or Na+
++ Juxtaglomerular apparatus of kidneys
(considered volume receptors)
Angiotensin I Convertingenzymes
Angiotensin II(powerful
vasoconstrictor)
Angiotensin III(powerful
vasoconstrictor)
Renin-Angiotensin System:
N.B. Aldosterone is the main regulator of Na+ retention.
![Page 20: Autoregulation of Glomerular Filtration Rate](https://reader035.fdocuments.net/reader035/viewer/2022062220/556af830d8b42a2a4f8b4957/html5/thumbnails/20.jpg)
REFERENCES1.Brenner and Rector’s- The Kidney, 9th Edition2.Guyton and Hall- Textbook of Medical Physiology, 11th Edition3.Uptodate.com4.Tubuloglomerular Feedback and the Control of Glomerular Filtration Rate Volker Vallon, Physiology 18:169-174, 20035.Glomerulotubular Balance, Tubuloglomerular Feedback, and Salt Homeostasis, Journal of American society of Nephrology 19: 2272–2275, 2008
![Page 21: Autoregulation of Glomerular Filtration Rate](https://reader035.fdocuments.net/reader035/viewer/2022062220/556af830d8b42a2a4f8b4957/html5/thumbnails/21.jpg)
Thank you for your patience
![Page 22: Autoregulation of Glomerular Filtration Rate](https://reader035.fdocuments.net/reader035/viewer/2022062220/556af830d8b42a2a4f8b4957/html5/thumbnails/22.jpg)