Neural Control of Renal Function
Neural Control of Renal Function
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DOI：
10.1002/cphy.c100043
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发表时间：
2011-04-01
影响因子：
5.8
通讯作者：
DiBona, Gerald F.
中科院分区：
文献类型：
--
作者：
Johns, Edward J.;Kopp, Ulla C.;DiBona, Gerald F.
肾脏受传出交感神经纤维支配，交感神经纤维直接接触血管系统、肾小管和肾小球颗粒细胞。通过特异性肾上腺素受体，增加的传出肾交感神经活性降低肾血流量和肾小球滤过率，增加肾小管钠和水重吸收，并增加肾素释放。传出肾交感神经活动减少产生相反的功能反应。该整合系统在生理条件下对钠和水平衡的稳态调节以及疾病中钠和水平衡的病理改变做出重要贡献。肾脏包含传入感觉神经纤维，其主要位于肾盂壁中，在那里它们感觉拉伸。这些传入感觉神经纤维的牵张激活引起抑制性肾肾反射反应，其中对侧肾脏由于传出肾交感神经活动减少而表现出代偿性尿钠排泄和利尿。肾肾反射协调两个肾脏的排泄功能，以促进钠和水平衡的稳态调节。存在负反馈回路，其中传出肾交感神经活动促进传入肾神经活动的增加，其继而抑制传出肾交感神经活动，从而避免过量的肾钠潴留。在肾脏疾病或损伤的状态下，存在兴奋性传入感觉神经纤维的激活，导致外周交感神经活动增加、血管收缩和动脉压增加。在原发性高血压患者中进行的原理性研究证明，去肾神经支配可持续降低动脉压。(C)2011年美国生理学会。Compr Physiol 1：731-767，2011年。
The kidney is innervated with efferent sympathetic nerve fibers that directly contact the vasculature, the renal tubules, and the juxtaglomerular granular cells. Via specific adrenoceptors, increased efferent renal sympathetic nerve activity decreases renal blood flow and glomerular filtration rate, increases renal tubular sodium and water reabsorption, and increases renin release. Decreased efferent renal sympathetic nerve activity produces opposite functional responses. This integrated system contributes importantly to homeostatic regulation of sodium and water balance under physiological conditions and to pathological alterations in sodium and water balance in disease. The kidney contains afferent sensory nerve fibers that are located primarily in the renal pelvic wall where they sense stretch. Stretch activation of these afferent sensory nerve fibers elicits an inhibitory renorenal reflex response wherein the contralateral kidney exhibits a compensatory natriuresis and diuresis due to diminished efferent renal sympathetic nerve activity. The renorenal reflex coordinates the excretory function of the two kidneys so as to facilitate homeostatic regulation of sodium and water balance. There is a negative feedback loop in which efferent renal sympathetic nerve activity facilitates increases in afferent renal nerve activity that in turn inhibit efferent renal sympathetic nerve activity so as to avoid excess renal sodium retention. In states of renal disease or injury, there is activation of afferent sensory nerve fibers that are excitatory, leading to increased peripheral sympathetic nerve activity, vasoconstriction, and increased arterial pressure. Proof of principle studies in essential hypertensive patients demonstrate that renal denervation produces sustained decreases in arterial pressure. (C) 2011 American Physiological Society. Compr Physiol 1: 731-767, 2011.