Mechanisms underlying the antihypertensive functions of the renal medulla
Mechanisms underlying the antihypertensive functions of the renal medulla
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DOI：
10.1111/j.1365-201x.2004.01321.x
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发表时间：
2004-08-01
期刊：
影响因子：
--
通讯作者：
Evans, RG
中科院分区：
文献类型：
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作者：
Bergström, G;Evans, RG
有充分的证据表明，肾髓质在血压的长期调节中起着关键作用。“肾髓质”血压调节系统被假定涉及外分泌（压力尿钠排泄/利尿）和内分泌[肾髓质降压激素（RMDH）]功能。然而，最近的研究表明，压力利尿/尿钠排泄占主导地位的抗高血压肾反应增加肾灌注压，这表明一个假定的RMDH在代偿反应急性血压升高的生理作用。延髓循环似乎在介导压力利尿中起关键作用，尽管所涉及的确切机制仍存在争议。至少部分通过脉管系统和肾小管上皮之间的串扰介导的反调节血管舒张剂机制（例如一氧化氮）保护髓质循环免受激素因子（例如血管紧张素II）的血管收缩作用。这些机制似乎也有助于补偿反应增加盐摄入量耐盐的个人。这些机制的失败使生物体倾向于发展高血压，似乎是某些形式的实验性高血压发展的基础，甚至可能有助于原发性高血压的发病机制。
There is good evidence that the renal medulla plays a pivotal role in long-term regulation of blood pressure. 'Renal medullary' blood pressure regulating systems have been postulated to involve both exocrine (pressure natriuresis/diuresis) and endocrine [renal medullary depressor hormone (RMDH)] functions. However, recent studies indicate that pressure diuresis/natriuresis dominates the antihypertensive renal response to increased renal perfusion pressure, suggesting little physiological role for a putative RMDH in compensatory responses to acutely increased blood pressure. The medullary circulation appears to play a key role in mediating pressure diuresis, although the precise mechanisms involved remain controversial. Counter-regulatory vasodilator mechanisms (e.g. nitric oxide), at least partly mediated through cross-talk between the vasculature and the tubular epithelium, protect the medullary circulation from the vasoconstrictor effects of hormonal factors such as angiotensin II. These mechanisms also appear to contribute to compensatory responses to increased salt intake in salt-resistant individuals. Failure of these mechanisms predisposes the organism towards the development of hypertension, appears to underlie the development of some forms of experimental hypertension, and may even contribute to the pathogenesis of essential hypertension.