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Samenvatting - nier 1
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Samenvatting van het vak nier 1. Gemaakt aan de hand van de slides en eigen notities.
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Nier 1Inhoudsopgave
Fysiologie van de nier – functies van de nier .................................................................................................... 4
Regulatie extracellulair volume & bloeddruk...................................................................................................... 4
Regulatie van de osmolariteit ............................................................................................................................. 4
Behoud van ionenbalans ..................................................................................................................................... 5
Homeostase van de pH ....................................................................................................................................... 5
Uitscheiding van afvalstoffen ............................................................................................................................. 6
Productie van hormonen .................................................................................................................................... 6
Fysiologie van de nier ......................................................................................................................................... 7
Fysiologie van de nier – glomerulaire filtratie ................................................................................................ 10
Glomerulus ........................................................................................................................................................ 10
Podocyt met ‘foot processes’ ............................................................................................................................ 10
Glomerulaire filtratie barrière .......................................................................................................................... 10
Glomerulaire Filtratie Rate (GFR)...................................................................................................................... 10
Toepassingen en oefeningen fysiologie van de nier ....................................................................................... 15
Normale histologie van het nefron ................................................................................................................. 16
Algemene kenmerken ....................................................................................................................................... 16
Bloedvoorziening .............................................................................................................................................. 17
Nefron – glomerulus ......................................................................................................................................... 18
Nefron – tubuli .................................................................................................................................................. 21
Juxtaglomerulair apparaat ............................................................................................................................... 23
Tubulaire reabsorptie, secretie en excretie .................................................................................................... 24
Reabsorptie ....................................................................................................................................................... 24
Reabsorptie ....................................................................................................................................................... 25
Secretie ............................................................................................................................................................. 27
Excretie ............................................................................................................................................................. 27
Tubulaire functie: reabsorptie, secretie en excretie; voorbeelden uit de klinische praktijk ............................ 28
SGLT2 inhibitoren .............................................................................................................................................. 28
Penicilline en probenecid .................................................................................................................................. 29
1
,Nierfunctiemeting (zie ook aangepaste slides op BB) ..................................................................................... 30
Het begrip klaring ............................................................................................................................................. 30
Inulineklaring .................................................................................................................................................... 30
Glomerular filtration rate (GFR)........................................................................................................................ 30
Oefeningen nierfunctiemeting ....................................................................................................................... 32
Zuur-base evenwicht ...................................................................................................................................... 33
Inleiding ............................................................................................................................................................ 33
Zelfstudie zuurbase-evenwicht ......................................................................................................................... 36
Casussen ........................................................................................................................................................... 37
Zoutbalans en extracellulair volume (ECV) ..................................................................................................... 39
Total Body Water (TBW) ................................................................................................................................... 39
Zoutbalans/behoud ECV ................................................................................................................................... 39
Tubuloglomerulaire feedback (JGA) .................................................................................................................. 39
Waterbalans................................................................................................................................................... 42
TBW .................................................................................................................................................................. 42
Waterbalans ..................................................................................................................................................... 42
ADH ................................................................................................................................................................... 43
ADH effect nier .................................................................................................................................................. 44
Concentreren en dilueren van urine .................................................................................................................. 44
ADH ................................................................................................................................................................... 46
Zoutbalans en waterbalans – toepassingen en oefeningen ............................................................................ 48
Zoutbalans versus waterbalans ........................................................................................................................ 48
Kaliumbalans.................................................................................................................................................. 50
Kalium ............................................................................................................................................................... 50
Kaliumbalans .................................................................................................................................................... 50
Kalium en de membraanpotentiaal .................................................................................................................. 50
Hypokaliëmie – symptomen.............................................................................................................................. 51
Hyperkaliëmie – symptomen ............................................................................................................................ 51
Kaliumbalans .................................................................................................................................................... 52
Kaliumbalans en zuur-base ............................................................................................................................... 53
Oorzaken ........................................................................................................................................................... 53
Behandeling hyperkaliëmie............................................................................................................................... 54
2
, Behandeling hypokaliëmie ................................................................................................................................ 55
Transport in de nier ........................................................................................................................................ 56
Natrium (Na+) ................................................................................................................................................... 56
Chloor................................................................................................................................................................ 57
Waterreabsorptie ............................................................................................................................................. 58
Kalium (K+) ........................................................................................................................................................ 59
Andere molecules.............................................................................................................................................. 60
Overzicht ........................................................................................................................................................... 64
3
, Fysiologie van de nier – functies van de nier
1. Regulatie extracellulair volume en bloeddruk
2. Regulatie osmolariteit
3. Behoud van ionen balans
4. Homeostatische regulatie pH
5. Uitscheiding van afvalstoffen
6. Aanmaak van hormonen
Regulatie extracellulair volume & bloeddruk
Factoren met invloed op de mean arterial pressure
Regulatie van de osmolariteit
• Osmolariteit = de “tonus” van in het ECV opgeloste deeltjes
o Osmolariteit: mOsm/L plasma
o Osmolaliteit: mOsm/kg water
→ Concentratie aan osmotisch werkzame deeltjes per eenheid oplosmiddel
o Toniciteit = osmotisch actieve deeltjes in de oplossing per eenheid oplosmiddel
(deeltjes die niet door membraan kunnen)
• Osmolariteit wordt constant gehouden door de nieren (± 280 mOsM) en voornamelijk
bepaald door de Na+-concentratie en die van glucose en ureum in plasma
o Effectieve Osm (= toniciteit) = [Na+] x 2 + glucose
o H2O doet de cel zwellen of krimpen volgens de variatie in IC of EC toniciteit
4
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