Mechanisms underlying the differential control of blood flow in the renal medulla and cortex

被引:99
作者
Evans, RG [1 ]
Eppel, GA [1 ]
Anderson, WP [1 ]
Denton, KM [1 ]
机构
[1] Monash Univ, Dept Physiol, Melbourne, Vic 3800, Australia
关键词
blood vessels; eicosanoids; juxtamedullary arterioles; kidney medulla; laser Doppler flowmetry; nitric oxide; outer medullary descending vasa recta; renal circulation; vascular geometry;
D O I
10.1097/01.hjh.0000133744.85490.9d
中图分类号
R6 [外科学];
学科分类号
1002 ; 100210 ;
摘要
There is much evidence that the medullary circulation plays a key role in regulating renal salt and water handling and, accordingly, the long-term level of arterial pressure. It has also recently become clear that various regulatory factors can affect medullary blood flow (MBF) differently from cortical blood flow (CBF). It appears likely that the influence of hormonal and neural factors on the control of arterial pressure is mediated partly through their impact on MBF In this review, we focus on the mechanisms underlying the differential control of MBF and CBF, particularly the relative insensitivity of MBF to vasoconstrictors such as angiotensin II, endothelin-1 and the sympathetic nerves. The vascular architecture of the kidney appears to be arranged in a way that protects the renal medulla from ischaemic insults, with juxtamedullary arterioles, the source of MBF, having larger calibre than their counterparts in other kidney regions. Indeed, recent studies using vascular casting methodology suggest that juxtamedullary glomerular arterioles are not the chief regulators of MBF, which is consistent with the idea that outer medullary descending vasa recta play a key role in MBF control. Release of vasoactive paracrine factors such as nitric oxide and various eicosanoids from the vascular endothelium, and probably also from the tubular epithelium, appear to differentially modulate responses of MBF and CBF to hormonal and neural factors. The prevailing intrarenal hormonal milieu and existing haemodynamic conditions also appear to strongly modulate these responses, indicating that multiple control systems interact to regulate regional kidney blood flow at an integrative level.
引用
收藏
页码:1439 / 1451
页数:13
相关论文
共 98 条
[31]   EFFECT OF VOLUME EXPANSION ON PAPILLARY BLOOD-FLOW AND SODIUM-EXCRETION [J].
FENOY, FJ ;
ROMAN, RJ .
AMERICAN JOURNAL OF PHYSIOLOGY, 1991, 260 (06) :F813-F822
[32]   Renal cortical and medullary blood flow responses during water restriction: Role of vasopressin [J].
Franchini, KG ;
Cowley, AW .
AMERICAN JOURNAL OF PHYSIOLOGY-REGULATORY INTEGRATIVE AND COMPARATIVE PHYSIOLOGY, 1996, 270 (06) :R1257-R1264
[33]   Sensitivity of the renal medullary circulation to plasma vasopressin [J].
Franchini, KG ;
Cowley, AW .
AMERICAN JOURNAL OF PHYSIOLOGY-REGULATORY INTEGRATIVE AND COMPARATIVE PHYSIOLOGY, 1996, 271 (03) :R647-R653
[34]   Effects of daily sodium intake and ANG II on cortical and medullary renal blood flow in conscious rats [J].
Gross, V ;
Kurth, TM ;
Skelton, MM ;
Mattson, DL ;
Cowley, AW .
AMERICAN JOURNAL OF PHYSIOLOGY-REGULATORY INTEGRATIVE AND COMPARATIVE PHYSIOLOGY, 1998, 274 (05) :R1317-R1323
[35]   Effect of renal perfusion pressure on responses of intrarenal blood flow to renal nerve stimulation in rabbits [J].
Guild, SJ ;
Malpas, SC ;
Eppel, GA ;
Nguang, SK ;
Evans, RG .
CLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, 2004, 31 (1-2) :35-45
[36]   Interactions between neural and hormonal mediators of renal vascular tone in anaesthetized rabbits [J].
Guild, SJ ;
Barrett, CJ ;
Evans, RG ;
Malpas, SC .
EXPERIMENTAL PHYSIOLOGY, 2003, 88 (02) :229-241
[37]   Regional responsiveness of renal perfusion to activation of the renal nerves [J].
Guild, SJ ;
Eppel, GA ;
Malpas, SC ;
Rajapakse, NW ;
Stewart, A ;
Evans, RG .
AMERICAN JOURNAL OF PHYSIOLOGY-REGULATORY INTEGRATIVE AND COMPARATIVE PHYSIOLOGY, 2002, 283 (05) :R1177-R1186
[38]   Differential regulation of renal regional blood flow by endothelin-1 [J].
Gurbanov, K ;
Rubinstein, I ;
Hoffman, A ;
Abassi, Z ;
Better, OS ;
Winaver, J .
AMERICAN JOURNAL OF PHYSIOLOGY-RENAL PHYSIOLOGY, 1996, 271 (06) :F1166-F1172
[39]   Autoradiographic analysis and regulation of angiotensin receptor subtypes AT4, AT1, and AT(1-7) in the kidney [J].
Handa, RK ;
Handa, SE ;
Elgemark, MKS .
AMERICAN JOURNAL OF PHYSIOLOGY-RENAL PHYSIOLOGY, 2001, 281 (05) :F936-F947
[40]   ATRIOPEPTINS AND RENAL CORTICAL AND PAPILLARY BLOOD-FLOW [J].
HANSELL, P ;
ULFENDAHL, HR .
ACTA PHYSIOLOGICA SCANDINAVICA, 1986, 127 (03) :349-357