MED LEZ 24 WATER BALANCE
Transcript of MED LEZ 24 WATER BALANCE
![Page 1: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/1.jpg)
REGOLAZIONE
DELL’OMEOSTASI
DELL’ ACQUAGlomerulo renale
![Page 2: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/2.jpg)
Cervello 80.5 %
Tes. osseo 13 %
Rene 82.7 %
Tes. Muscolare 75%
Sangue 90 %
![Page 3: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/3.jpg)
![Page 4: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/4.jpg)
![Page 5: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/5.jpg)
![Page 6: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/6.jpg)
RENE
Metabolismo aerobio
acidi grassi, lattato,
glutammato, citrato,
corpi chetonici
![Page 7: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/7.jpg)
![Page 8: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/8.jpg)
ORMONI IMPLICATI
• VASOPRESSINA
• SISTEMA RAS
• ALDOSTERONE
• PEPTIDI NATRIURETICI
• ADRENOMEDULINA
![Page 9: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/9.jpg)
VASOPRESSINA ADH
![Page 10: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/10.jpg)
![Page 11: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/11.jpg)
![Page 12: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/12.jpg)
![Page 13: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/13.jpg)
SISTEMA RAS
mineralcorticoidi
fegato
![Page 14: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/14.jpg)
![Page 15: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/15.jpg)
![Page 16: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/16.jpg)
ACE e ACE2(2000)
![Page 17: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/17.jpg)
AT2R
![Page 18: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/18.jpg)
Alti livelli di Ang II
![Page 19: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/19.jpg)
• No ipertensione arteriosa nei topi knockout di ACE2;
• Aumenta in una dieta ricca di sale
IPERTENSIONE
fattori genetici piu’ ambientali
![Page 20: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/20.jpg)
RAS e Remodelling Cardiaco
• ACE e AT1R e AT2R rilevati in tutte 4 le valvole
• Valvole ricche di collagene e fibroblasti
• RAS (AT2R) regola il turnover
del collagene prodotto
da miofibroblasti
![Page 21: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/21.jpg)
ACE inibizione
riduce la mortalita’ e la morbilita’cardiopatia ischemica
riduce l’azione della AngIIsull’omeostasi del Na sul tono vascolare e sulla deposizione di collagene
![Page 22: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/22.jpg)
Prevenzione del rimodellamento cardiaco
• Enalapril (ACE inibitore)
attenua la deposizione di collagene
• Losartan (AT1R inibitore)
riduce l’area infartuale bloccando
l’apoptosi dei cardiomiciti
![Page 23: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/23.jpg)
RAS e Infiammazione
![Page 24: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/24.jpg)
![Page 25: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/25.jpg)
ALDOSTERONE
Dotto collettore
Sintesi ex-novo
canali del Na e
Na/K ATP-asi
![Page 26: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/26.jpg)
![Page 27: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/27.jpg)
Danno renale indotto da Aldosterone
![Page 28: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/28.jpg)
PEPTIDI NATRIURETICIANP, BNP CNP
Scoperti nel 1983 ANP1998 BNP2000 CNP
![Page 29: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/29.jpg)
Geni
• Per ogni peptide 1 gene
• 3 esoni, 2 introni, una regione regolatoria 5’ terminale
• ANP e BNP cromosoma 1
• CNP cromosoma 2
![Page 30: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/30.jpg)
ANP
• Pro ANP (stoccato nei granuli dei miociti)
mRNA atrio e vent. sinistro
Corina (proteasi)
in circolo in funzione
N-proANP + ANP della pressione
![Page 31: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/31.jpg)
BNP
• ProBNP (mRNA atrio e ventricolo)
N-proBNP + BNP
stoccato nell’ atrio e nel
ventricolo
endoproteasi
![Page 32: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/32.jpg)
CNP
• ProCNP (mRNA cellule nervose ed endoteliali)
N-proCNP + CNP-53 CNP-22
Azione autocrina/paracrina
![Page 33: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/33.jpg)
Recettori GCs NPRs
• NPR-A (GC-A) ANP e BNP
• NPR-B (CG-B) CNP
• NPR-C (CG-C) Clearence di NPs
no GMPc ma accoppiato a Gi
![Page 34: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/34.jpg)
Funzione sconosciuta
![Page 35: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/35.jpg)
![Page 36: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/36.jpg)
![Page 37: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/37.jpg)
Secrezione
• Disfunzione ventricolare -BNP-
• Distensione delle camere cardiache
• Ischemia
• Ipossia
• Esercizio fisico
• Catecolamine, NO, ET-1,
• prostacicline, citochine
![Page 38: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/38.jpg)
ANP/GC-A system
• Modulazione volume e pressione sanguigna
• Azione ipotensiva e ipovolumetrica
• Azione vasodilatativa• Azione diuretica e natriuretica• Inibizione di RAS ed Aldosterone• Aumento della permeabilità endoteliale• Azione anti-mitogena (endotelio, miociti e
fibroblasti)
![Page 39: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/39.jpg)
![Page 40: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/40.jpg)
![Page 41: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/41.jpg)
BNP/GC-A system
• Azione locale paracrina a livello dei fibroblasti cardiaci (ricchi di CG-A) durante il processo di “remodelling”
FATTORE ANTI-FIBROTICO
• Utilizzo per monitore disfunzionalità ventricolare sinistra e dispnea
Cut-off 80pg/ml
![Page 42: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/42.jpg)
• L’associazione BNP – aumento rischio di morte,
è indipendente dalla funzionalità renale, dai
livelli di troponina e ad alterazioni dell’ECG
• I livelli plasmatici aumentati di BNP, sono
associati all’ estensione dell’infarto ed
aumentano, in rapporto al grado di
rimodellamento cardiaco
![Page 43: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/43.jpg)
![Page 44: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/44.jpg)
CNP/CG-B system
• Tes. Vascolare e Osseo, fibroblasti , muscolatura liscia, cervello
• Azione vasodilatativa locale• Ruolo nell’ angiogenesi• Inibisce la proliferazione dei miofibroblasti• Regola la crescita dei condrociti• Riproduzione • Funzioni cerebrali
![Page 45: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/45.jpg)
![Page 46: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/46.jpg)
![Page 47: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/47.jpg)
ADRENOMEDULINA
• 52 aa
• Tirosina amidata C-terminale
• Anello di 6 aa altamente conservati
ESSENZIALI PER IL LEGAME CON IL RECETTORE e PER LA PRODUZIONE DI cAMP
![Page 48: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/48.jpg)
![Page 49: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/49.jpg)
(10-15moli)
![Page 50: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/50.jpg)
Siti di produzione
• Surrene, polmoni, reni, cuore, endotelio, miociti, fibroblasti, neuroni, cellule della glia, cellule ep. pigmentate della retina, tumori primari.
• Midollare e corticale regola la secrezione di Aldosterone e i processi di apoptosi
![Page 51: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/51.jpg)
Recettori
• CLR (calcitonin like- receptor)
• RAMPs (receptor activity modifying proteins)
RAMP 2 RAMP 3
![Page 52: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/52.jpg)
Effetti fisiologici di mAM• Apparato vascolare
(vasodilatante e ipotensivo)• Proprieta’ diuretiche e natriuretiche;
mantenimento dell’omeostasi di liquidi ed elettroliti
• Crescita’ cellulare ed apoptosi• Broncodilatante • Metabolismo osso• Embriogenesi• Regolazione sistema simpatico
![Page 53: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/53.jpg)
![Page 54: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/54.jpg)
![Page 55: MED LEZ 24 WATER BALANCE](https://reader030.fdocuments.net/reader030/viewer/2022013005/586f88461a28ab54768b5bf9/html5/thumbnails/55.jpg)
L’acqua è il maggior costituente corporeo, rappresentando mediamente circa il 60-70% del peso ed è il componente maggiore di molti organi e tessuti; insomma, l’acqua è dappertutto: "…l’omo è composto di terra acqua aria e foco e questo corpo della terra è simigliante. Se l’omo ha in se…. il lago del sangue …la terra ha il suo oceano mare…, se dal detto lago del sangue diriva vene, che si vanno ramificando per lo corpo umano, similmente il mare oceano empie il corpo della terra di infinite vene di acqua…" (Leonardo da Vinci)