NEPHRO & HYPERTENSi

7/29/2019 NEPHRO & HYPERTENSi

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THE ROLE OF RENAL IN

BLOOD PRESSUREREGULATION AND

HYPERTENSION

Umar Zein

Medical Faculty

Prima Indonesia University


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Renal Function:

Excretory

Regulatory

Endocrine

Excretory Function:

Metabolic

GlomerularGlomerular Filtration Rate (GFR)

Creatinin Clearance.

UxV/P ml/min


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Retinopathy

Heart diseases

Stroke or TIA

Nephropathy,Proteinuria, CrCl

Peripheral arterial Disease(atherosclerotic plaqueiliac,carotid, femoral artery,aorta)

Sequelae of Hypertension

Complications of HTN

Cardiac

CNS

Vascular

Retinal

Renal


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Patho-physiology of Hypertension

HTN develop gradually over a long period of time.

The development of HTN requires the adjustment of

several compensatory mechanisms over time.

Several hypothesis exists for the original

pathogenesis of HTN:

Excess Na intake

Renal Na retention

Renal Angiotensin System (RAS)

Stress & sympathetic over activity

Peripheral resistance

cell membrane and endothelial dysfunction

Obesity

insulin resistance


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Regulation of aldosterone secretion


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Componentsof renin-angiotensin-aldosteronesystem


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Action of aldosterone on the renal tubule.


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Excess Na

intake

Reduced

NephronNumbers

Stress

Genetic

Alterations Obesity

Endothelium

derivedfactors

Renal Na

retention

Decreased

filtration

surface

Sympatheic

Over activity

RAS

Excess

Cell-membrane

alterations

Hyper

insulinemia

FluidVolume

Venous

constriction

Preload Contractibility Functionalconstriction

Structuralhypertrophy

Blood pressure=HTN

Cardiac Output Peripheral ResistanceXand/or


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Pathophysiology of blood pressure

changes

BLOODPRESSURE

CARDIAC

OUTPUT

PERIPHERAL

RESISTANCE

BLOOD VOLUME

CONTRACTILITY

PULSE RATESTRUCTURAL HYPERTROPHY

FUNCTIONAL

VASOCONSTRICTION

Normal Remodeling


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Pressure-natriuresis Relation in Arterial

Hypertension

Blood pressure

NatriuresisNormotensives

Hypertensives

Guyton, 1972


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Activity of the Autonomic Nervous System in

Hypertension

Heart

Vessels

Smooth muscle cells

membrane activity

Kidney

Pulse ratecontractility

Increased resistance

Sodium retention

vasoconstriction


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Renin-Angiotensin SystemThe Damaging Effects of

Angiotensin II


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Renin-Angiotensin System

Angiotensinogen

Angiotensin I

Angiotensin II

Renin

ACEChymase

tPACatepsin

AT1-R AT2-R ?

Bradykinin

Inactive quinines

B1-R

B2-R


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A-II

Vasoconstriction

Cell Growth

Cell Proliferation

Anti-Natriuresis

Vasodilation?

Inhibition of Cell Growth

Cell Differentiation

Apoptosis

Natruiresis

DIFFERENTIAL EFFECTS OF ANGIOTENSIN RECEPTORS

Production:-aldosterone, endothelin,catecholamines, PAI-1adhesion molecules,growth factors

Production :-Nitric Oxide

AT1

ANG IIAT2

ANG II


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Effects of angiotensin II

Peripheral

vasoconstriction

Vascular

proliferation

Adrenergicactivity

Renin

secretion

Aldosterone

secretion

Thirst

mechanism

Water and sodium retention

Efferent arteriole

vasoconstriction

AII

AT1-R


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Bradykinin and Endothelins

Bradykinin

B1-R B2-RETA-RTB-R

Proendothelins

ET1 ET2 ET3

Endothelial Cell

Nitric Oxide

Smooth Muscle Cell

Vasoconstrictionvasodilatation


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Nitric Oxide (NO)L-arginine

NO

O 2- Nitrogenated

Heam-proteins

cGMP

eNOS

oxidases

NO

Peripheralvasoconstriction

Renalresistance

Glomerulo-tubular

Feedback

Renin Secretion

SodiumReabsorption

Pressure-

natriuresis

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