T

24/03/2010 8:44 CH
Nguyn Hu Tr 1
He I|eI n|eu
Ur|nory sysIem
24/03/2010 8:44 CH
Nguyn Hu Tr 2
Chng 8.1 H BI TIT
1. Cc sn phm thi c Nit
a. Ammonia
b. Ur
c. Acid uric
2. S tin ha ca h tit niu
3. Cu trc thn ca ng vt hu nh
4. Chc nng ca thn
5. Tun hon thn
6. iu ha hot ng thn
24/03/2010 8:44 CH
Nguyn Hu Tr 3
He bo| I|eI
8o| I|eI |o quo Ir|nh Iho| coc choI bo,
coc choI du Ihuo quo quo Ir|nh b|en
duong ro kho| co Ihe, g|up co Ihe
khong b| nh|em doc vo g|u duo c con
bong no| mo|.
Ihom g|o voo chuc nong noy co nh|eu
co quon pho| hop vo| nhou nhu. he ho
hop- he Iuon hoon- he I|eu hoo- he I|eI
n|eu- do
24/03/2010 8:44 CH
Nguyn Hu Tr 4
Coc son phom Iho| co N|Io
24/03/2010 8:44 CH
Nguyn Hu Tr 5
Coc son phom
Iho| co N|Io
300 500 mL/gN
1 bc x l
50 mL/gN
4 bc x l
10 mL/gN
15 bc x l
kh| coc om|no oc|d vo
nuc|e|c oc|d duoc
chuyen hoo, moI son
phom Ioo ro |o ommon|o
(NH3), |o moI choI kho
doc nhung co Ihe duoc
|oo| ro Ihong quo mong
cuo co xuong (Ie|eosI
f|sh). Ihu chuyen
ommon|o Ihonh ureo, moI
choI |I doc hon. Ch|m vo
bo soI Iren con chuyen
no Ihonh ur|c oc|d, moI
choI khong Ion Irong
nuoc.
24/03/2010 8:44 CH
Nguyn Hu Tr 6
He I|eI n|eu
Ioo ro nuoc I|eu gom ho| buoc. $u
|oc (khong chon |oc) Io| hop Ihu
(coc choI Ion)
I|en don Ihon - g|un dep (f|oI worm)
on Ihon - g|un doI (onne||d) (he
Ihong pheu co |ong)
Ong Mo|p|gh| - Con Irung (|nsecI) (ong
Irong ong I|eu ho o)
Ihon- ong voI co xuong song
(verIebroIes)
2
24/03/2010 8:44 CH
Nguyn Hu Tr 7
$u I|en hoo cuo he I|eI n|eu
24/03/2010 8:44 CH
Nguyn Hu Tr 8
I|en Ihon
I|en Ihon Irung Ihon
Hou Ihon
$u I|en hoo cuo he I|eI n|eu
24/03/2010 8:44 CH
Nguyn Hu Tr 9
I|en nguyen Ihon o g|un dep
ong voI khong xuong song
do boo nho nhu g|un dep co
nhung cou Iruc phuc Iop hon
de bo| xuoI |o he Ihong coc
ong nho vo| Ie boo ngon |uo
(f|ome ce||), vo coc |o bo| I|eI
cou Ihonh nen nguyen Ihon
cuo g|un dep. Coc |ong rung
(c|||o) ben Irong Ie boo ngon
|uo don choI d|ch Iu co Ihe
nho hooI dong uon m|nh. Coc
choI bo| I|eI sou do duoc
Iong ro ngoo| quo coc |o
Ihong vo| mo| Iruong ben
ngoo|.
24/03/2010 8:44 CH
Nguyn Hu Tr 10
on Ihon o g|un doI
Hou heI dong voI khong co xuong
song, v| du g|un doI (onne||d), co
don Ihon (meIonephr|d|o). on
Ihon gom moI co| ong vo| cho mo
voo khoong co Ihe h|nh co| pheu
go| |o pheu don Ihon
(nephrosIomes), moI ong nho uon
khuc ngoon ngoeo, moI phon ong
nho phong |en de I|ch Iru go| |o Iu|
vo moI |o ro quo Ihonh co Ihe go|
|o |o don Ihon. Muo| co Ihe duoc
Io| hop Ihu Iu nhung ong noy, vo
choI d|ch (f|u|d) co Ihe duoc g|u
|o|. Nuoc I|eu (ur|ne) duoc g|o|
phong ro mo| Iruong Ihong quo
coc |o don Ihon (nephr|d|opores).
24/03/2010 8:44 CH
Nguyn Hu Tr 11
Coc ong Mo|p|gh| o con Irung
Coc ong Mo|p|gh| cuo con Irung
|o phon mo rong cuo ong I|eu
hoo, Iom Irong d|ch huyeI Iuong .
Coc Ie boo cuo Ihonh ong co Ihe
hop Ihu oc|d ur|c, k+ vo coc choI
khoc Iu huyeI Iuong ro| voo ong
nho nho voo quo Ir|nh Ihom Ihou
(osmoI|co||y). Fhon |on nuoc duoc
Io| hop Ihu (reobsorbed) quo
Ihonh o ruoI sou. Coc ong
Mo|p|gh| cuo con Irung g|ong nhu
don Ihon cuo g|un doI |o no| |oo|
bo choI Iho| N|Irogen vo |o cho on
d|nh con bong nuoc vo muo| Irong
co Ihe
24/03/2010 8:44 CH
Nguyn Hu Tr 12
$u song Irong nuoc ngoI
3
24/03/2010 8:44 CH
Nguyn Hu Tr 13
$u Ih|ch ngh| cuo dong voI
nuoc ngoI
Coc dong voI nuoc ngoI do| pho vo| von de cong
phong vo moI muo| nhu Ihe noo?
1. Hou heI chung khong boo g|o uong nuoc
2. Co Ihe chung duoc choI nhoy boo phu, g|up
ngon con dong nuoc Ihuong xuyen d| voo
3. Chung bo| xuoI moI |uong |on nuoc Irong nuoc
I|eu |oong
4. Coc Ie boo hop Ihu muo| doc b|eI Iren be moI
Ihu nhon muo| moI coch I|ch cuc su dung AIF
24/03/2010 8:44 CH
Nguyn Hu Tr 14
$u song Irong nuoc mon
24/03/2010 8:44 CH
Nguyn Hu Tr 15
$u Ih|ch ngh| cuo dong voI
nuoc mon
Coc dong voI nuoc mon dou Ironh vo| su |oo|
nuoc vo goI bo muo| du Ihuo nhu Ihe noo?
1. Chung Ihuong xuyen uong nuoc b|en de
Ihoy Ihe nuoc do b| moI quo mong hoy Ihom
quo be moI co Ihe.
2. Chung bo| xuoI moI so |on muo| (Mg
++
, $O4
--
)
vo| moI |uong nho nuoc I|eu dom doc.
3. Chung bo| xuoI No+ vo C|- do coc Ie boo
I|eI muo| o mong bong von chuyen I|ch cuc
nguoc grod|enI nong do su dung AIF.
24/03/2010 8:44 CH
Nguyn Hu Tr 16
Cou Iruc Ihon cuo dong voI
huu nhu
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Nguyn Hu Tr 17
kho| n|em
He I|eI n|eu boo gom do| Ihon, n|eu
quon, bong quong vo n|eu doo.
He I|eI n|eu go p phon duy Ir| co n
bong no| mo bo| moI quo Ir|nh
phuc Iop gom. |oc, hop Ihu chu
dong, hop Ihu Ihu dong, bo| I|eI.
keI quo |o Ioo ro nuoc I|eu mong
Iheo nh|eu choI Iho| chuyen hoo
24/03/2010 8:44 CH
Nguyn Hu Tr 18 T8
Co quon he I|eI n|eu
Mo| quo Ihon co k|ch Ihuoc 3 x 6 x12
cm, duoc boc Irong moI boo ||en keI,
nom Irong moI o doy mo go| |o o Ihon
vo d|nh |ong |eo vo| Ihonh |ung bong
mo ||en keI.
Cou Ioo cuo Ihon.
M|en vo. mou do Ihom
M|en Iuy. mou nhoI hon, gom -12 Ihop
Mo|p|gh|, dnh quoy voo Irong, doy
quoy ro ngoo|.
8e Ihon. mou Irong, no| chuo nuoc I|eu
do coc ong gop o Ihop Mo|p|gh| do ve.
4
24/03/2010 8:44 CH
Nguyn Hu Tr 19
Ihon vo v| Ir| cuo bong quong
Mo| Ihon duoc cou Ioo bo| hon moI Ir|eu don v|
Ihon go| |o nephron
24/03/2010 8:44 CH
Nguyn Hu Tr 20 2
V| Ir| cuo Ihon
V| Ir| nom sou mong
bung sou mong
phuc moc
(per|Ioneum )
Vung Iren IhoI |ung
- Iu doI nguc Ihu 12
cho den doI song
|ung Ihu 3
- Ihon pho| Ihop hon
Ihon Iro|
Iuyen Iren Ihon
24/03/2010 8:44 CH
Nguyn Hu Tr 21
Ihon co moI moI |om go| |o
ron Ihon (h||us) no| co Ihon
k|nh d| voo, moch mou vo
moch boch huyeI d| voo
vo d| ro, vo n|eu quon d| ro.
Vo moI moI |o|.
8e Ihon |o doon Iren cuo
n|eu quon, ph|nh Io Ihonh 2,
hooc 3 do| Ihon |on, mo|
do| Ihon |on cho coc
nhonh nho hon d| ro go| |o
do| Ihon be
Chuc nong cuo Ihon
24/03/2010 8:44 CH
Nguyn Hu Tr 22
Nhu mo Ihon gom vung vo vo vung
Iuy. O Ihon nguo| vung Iuy co Iu 10-18
cou Iruc h|nh chop go| |o Ihop Iuy.
Mo| Ihon co Iu 1-4 Ir|e u nephron. Mo|
nephron boo gom I|e u cou Ihon, ong
|uon gon, conh mong vo conh doy,
quo| Hen|e, ong |uon xo, ong gop vo
ong Ihong.
Nephron |o don v| chuc nong cuo
Ihon
Nuoc I|eu duoc Ioo ro o Ihon d| quo
n|eu quon den bong quong, |uu Iru
Iom Iho| ro| duoc Iho| ro ngoo| quo
n|eu doo.
24/03/2010 8:44 CH
Nguyn Hu Tr 23
Chuc nong cuo don v| Ihon
ong mochJI|nh moch Ihon. dong mou choy Irong
Ihon
N|eu quon (UreIer). ong don nuoc I|eu
8ong quong (b|odder). du Iru nuoc I|eu
N|eu doo (UreIhro). ong Iho| nuoc I|eu ro ngoo|
Vung vo Ihon (vung ben ngoo|)
Vung Iuy Ihon (vung ben Irong)
Nguyen Ihon (Nephron). don v| chuc nong cuo Ihon
CorI|co| nephron (nom o vung vo, 80%)
JuxIomedu||ory nephron (nom o vung Iuy, 20%)
24/03/2010 8:44 CH
Nguyn Hu Tr 24
Cou Iruc nguyen Ihon
ong moch huong Iom. cung cop mou cho nephron
Iu dong moch Ihon
I|eu cou Ihon (G|omeru|us). cou cuo moo moch
ong moch || Iom. mou d| ro Iu I|eu cou Ihon
Nong 8owmon. boo quonh I|eu cou Ihon
5
24/03/2010 8:44 CH
Nguyn Hu Tr 25
Nguyen Ihon (Nephron)
Ong |uon gon (Frox|mo|
Iubu|e). bo| I|eI & Io| hop Ihu
Moo moch ben (Fer|Iubu|or
cop|||or|es). Iu coc dong
moch |y Iom, boo
quonh ong |uon gon vo ong
|uon xo
Ouo| Hen|e. Io| hop Ihu
muo| vo nuoc
Ong |uon xo (D|sIo| Iubu|e).
bo| I|eI & Io| hop Ihu
Ong gop (Co||ecI|ng ducI).
mong d|ch |oc Io| be Ihon
24/03/2010 8:44 CH
Nguyn Hu Tr 26 2
Nguyen Ihon (Nephron)
Nguyen Ihon |o don v| cou Iruc vo chuc nong cho
v|ec h|nh Ihonh nuoc I|eu, co chuo.
1. I|eu Ihe Ihon. |o IhuoI ngu dung ch Iop hop coc
cou Ihon vo co vo boo quonh
Cou Ihon (G|omeru|us). chum moo moch
nong hoo
Nong 8owmon's .
2. Ong Ihon. ong mo Irong do d|ch choy quo
Ong |uon gon (Frox|mo| convo|uIed Iubu|e)
Ouo| Hen|e (Ioop of Hen|e)
Ong |uon xo (D|sIo| convo|uIed Iubu|e)
24/03/2010 8:44 CH
Nguyn Hu Tr 27
l|g. 3.T2
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Nguyn Hu Tr 28 28
Nguyen Ihon (Nephron)
885 lcl cc ngUyen lhcn ncm c vUng vc
- f|eU lhe lhcn ncm c vUng ngcc| cUc
m|en vc
T52 ngUyen lhcn ncm gcn vUng lUy
- f|eU lhe lhcn ncm cU lrcng m|en vc gcn
m|en lUy
24/03/2010 8:44 CH
Nguyn Hu Tr 29 2
Ong
lhcng
Nguyen Ihon
vung Iuy
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Nguyn Hu Tr 30
Cuon moch I|eu cou

24/03/2010 8:44 CH
Nguyn Hu Tr 31 3T
Cuon moch + nong 8owmon
= I|eu cou Ihon
Io phon dou cuo nguyen Ihon
ong moch huong Iom don mou voo cuon
moch I|eu cou Ihon, no| co moI mong moo
moch doc b|eI.
$u |oc. Iuc Ihuy I|nh cuo op |uc mou doy
d|ch Iu mou voo Irong nong 8owmon.
Nuoc |oc. d|ch duoc doy ro boo gom
nh|eu Ihu |oo| Iru Ie boo mou vo coc
proIe|n |on.
24/03/2010 8:44 CH
Nguyn Hu Tr 32
Mo| I|eu cou Ihon co duong k|nh
khoong 200mm, gom moI cuon moo
moch go| |o cuon moch I|eu cou
Ihon (g|omeru|us) duoc boo quonh
bo| nong 8owmon. Iop Irong cu o
boo |o |o Iong (v|scero| |oyer) Iruc
I|ep boo quonh chum moo mo ch
I|eu cou Ihon. Iop ngoo| cuo boo |o
g|o| hon ngoo| cuo I|eu cou go| |o |o
Ihonh (por|eIo| |oyer)
G|uo ho| |op cuo nong 8owmon |o
khoong n|eu hoy khoong 8owmon
I|ep nhon d|ch do |oc quo Ihonh
moo moch vo |o Iong.
24/03/2010 8:44 CH
Nguyn Hu Tr 33
Nang
Bowman
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Nguyn Hu Tr 34
Coc |op mong |oc cuo cou Ihon
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Nguyn Hu Tr 35
Ie boo g|on moo moch Irong I|eu cou
o| Ihuc boo
PecepIor MHC II
Co Ihe co |o| (ong|oIens|n II & ADH)
I|eI FrosIog|ond|n
24/03/2010 8:44 CH
Nguyn Hu Tr 36 3
Cou Ioo cuo ong Ihon & ong go p
Ong |uon gon
- 8|eu mo vuong don ($|mp|e cubo|do|) vo| bo bon cho|
(brush border) cuo coc |ong nho (m|crov||||) |om g|o
Iong d|en I|ch I|ep xu c
Conh mong d| xuong cuo quo| Hen|e
- 8|eu mo deI don ($|mp|e squomous)
Conh doy d| xuong cuo quo| Hen|e
- 8|eu mo vuong don ($|mp|e cubo|do|)
Conh doy d| |en cuo quo| Hen|e
- 8|eu mo vuong don $|mp|e cubo|do| vo moI |I Iru don
Conh mong d| |en cuo quo| Hen|e
- 8|eu mo deI don ($|mp|e squomous)
Ong |uon xo & ong gop
- 8|eu mo vuong don ($|mp|e cubo|do|) keI hop vo| Ie
boo ch|nh & Ie bo o chen co v| nhung (m|crov||||)
7
24/03/2010 8:44 CH
Nguyn Hu Tr 37 37
24/03/2010 8:44 CH
Nguyn Hu Tr 38
Ong |uon gon
Do| hon ong |uon xo, o gon coc I|eu
cou Ihon vo no m o vung vo. Coc Ie
boo b|eu mo cuo ong |uon gon co
boo Iuong mou hong, moI dnh Ie
boo co nh|eu v| nhung do| 1mm Ioo
bo bon cho|. Do co k|ch Ihuoc |on,
mo| |oI coI ngong ong |uon gon co
Iu 3-5 nhon h|nh cou
24/03/2010 8:44 CH
Nguyn Hu Tr 39
Ong |uon gon
24/03/2010 8:44 CH
Nguyn Hu Tr 40
65-70% nuoc, No
+
, k
+
100% g|ucose, HCO
3
-
,
om|no oc|d, c|IroIe, pepI|de nho
40-50% Co
+2
80-5% FO
4
-
Ong |uon gon
ong Ihom |oc Io| hop Ihu
24/03/2010 8:44 CH
Nguyn Hu Tr 41 4T
24/03/2010 8:44 CH
Nguyn Hu Tr 42
Ouo| hen|e
H|nh chu U vo| conh xuong doy, conh xuong mong,
conh |en mong vo conh |en doy.
Coc conh xuong doy co duong k|nh ngoo| khoong
60 mm, doI ngoI Ihu hep |o| con 12mm vo ||en Iuc
vo| conh xuong mong. O conh mong, |ong quo|
hen|e |o rong, |o b|eu mo |oI don co nhon nho voo
|ong ong.
khoong 1J7 Iong coc nephron nom gon ronh g|o|
m|en vo vo m|en Iuy, coc nephron noy duoc go| |o
con Iuy. Coc nephron con |o| duoc go| |o nephron
vo. IoI co coc nephron deu Ihom g|o voo quo Ir|nh
|oc, hop Ihu vo bo| xuoI.
Iuy voy coc nephron con Iuy co vo| Iro Ioo grod|enI
uu Iruong Irong mo ke vung Iuy, |o co so cho Ihon
Ioo ro nuoc I|eu uu Iruong.
8
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Nguyn Hu Tr 43
Nephron con Iuy co quo| Hen|e do|, d| sou
voo Irong vung Iuy. Coc quo| Hen|e noy co
conh xuong doy ngon, conh xuong mong
do|, conh |en mong ngon, conh |en doy
do|.
Coc nephron vung vo co conh xuong
mong ngon vo khong co conh |en mong.
Ouo| Hen|e Ihom g|o g|u nuoc, ch co
nhung dong voI co quo| Hen|e mo| co kho
nong Ioo nuoc I|eu uu Iruong vo duy Ir|
nuoc Irong co Ihe.
Ouo| Hen|e Ioo grod|enI uu Iruong Irong mo
ke vung Iuy co vo| Iro co dong nuoc I|eu
kh| choy quo Ihonh ong gop.
24/03/2010 8:44 CH
Nguyn Hu Tr 44
Quai Henle
24/03/2010 8:44 CH
Nguyn Hu Tr 45
Conh xuong mong cuo quo| Hen|e cho
nuoc Ihom quo Iu do, con Ioon bo conh |en
khong cho nuoc Ihom quo.
O conh |en doy NoC| duoc von chuyen chu
dong ro kho| ong de Ioo grod|enI uu Iruong
Irong mo ke vung Iuy con cho su co dong
nuoc I|eu.
Ap suoI Ihuy I|nh o mo ke dnh Ihop Iuy coo
gop 4 |on op suoI Ihuy I|nh cuo mou
Quai Henle
24/03/2010 8:44 CH
Nguyn Hu Tr 46
Conh mong cuo quo| Hen|e
24/03/2010 8:44 CH
Nguyn Hu Tr 47
Ouo| Hen|e. Conh doy d| |en
24/03/2010 8:44 CH
Nguyn Hu Tr 48
Ong |uon xo
Conh |en quo| Hen|e d| Iro ve vung vo, Iro nen
ngoon ngoeo vo Iro Ihonh ong |uon xo. Ong
|uon xo co cou Ioo g|ong conh |en doy, co
b|eu mo vuong hoy Iru don.
Ong |uon xo khoc ong |uon gon (co ho| ong
deu nom Irong vung vo) o cho khong co bo
bon cho|, khong co coc v| ong o moI dnh, vo
Ie bo| c| k|ch Ihuoc nho hon.
O ong |uon xo co su Iroo do| |on neu
o|dosIerone o nong do coo. hop Ihu No+, vo
bo| xuoI k+. CO che noy Ioc dong den Iong
|uong muo| Irong co Ihe. Ong |uon xo con che
I|eI H+, omon|um voo nuoc I|eu, hooI dong
noy nhom duy Ir| con bong oc|d-k|em Irong
mou.

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Nguyn Hu Tr 49
Ong |uon xo
24/03/2010 8:44 CH
Nguyn Hu Tr 50
Ong Ihong
24/03/2010 8:44 CH
Nguyn Hu Tr 51
Ong gop vo ong Ihong
NUcc l|eU c| lU cng |Ucn xc cen cng gcp rc|
hcp vc| ccc cng gcp khcc h|nh lhcnh cng
lhcng |cn hcn, ccng cen gcn c|nh cUc lhcp
lUy lh| cng lhcng ccng |cn hcn.
Ccc cng gcp cc c|eU mc vUcng ccn,
cUcng k|nh khccng 4m. Kh| c| cU vcc
vUng lUy, ccc le ccc cng gcp ccc ccn lrc
lhcnh le ccc lrU, cUcng k|nh cng gcp cc
lhe |en lc| 2m kh| cen c|nh lhcp lUy.
frcng vUng lUy, ccc cng lhcng |c ccU lrUc
ch|nh ccm nhcn v|ec cc ccc nUcc l|eU
24/03/2010 8:44 CH
Nguyn Hu Tr 52
Ong gop
24/03/2010 8:44 CH
Nguyn Hu Tr 53 53
VeI doc (Mocu|o Denso)
oy |o moI phon cuo ong |uon xo
nom I|ep g|op vo| dong moch
huong Iom.
Ie boo veI doc (Mocu|o denso ce||)
co Ihu Ihe com nhon op suoI Iho m
Ihou vo co Ihe dop ung |o| nong do
No
+
Irong d|ch |oc
- Neu No
+
Irong d|ch |oc Ihop, veI doc
se gu| moI I|n h|eu hoo hoc Io| Ie boo
con I|eu cou de g|o| phong ren|n.
24/03/2010 8:44 CH
Nguyn Hu Tr 54 54
Chu y su gop
cuon cuo ong
|uon xo gon vo|
dong moch
huong Iom
Nguyen Ihon
T
24/03/2010 8:44 CH
Nguyn Hu Tr 55 55
Ie boo con I|eu cou
Nom Irong dong moch huong Io m
no| I|ep xuc vo| ong |uon xo, o doy
co coc Ie boo co Iron duoc go| |o
Ie boo con I|eu cou
(juxIog|omeru|or ce|| = Ie boo JC).
Nhung Ie boo JG co chuo moI
|uong |on coc hoI che I|eI cho
chuo ren|n
kh| huyeI op Ihop, Ie boo JC g|o|
phong ren|n
24/03/2010 8:44 CH
Nguyn Hu Tr 56
Fhuc hop con I|eu cou Ihon
Conh I|eu cou Ihon, Ie boo co Iron o oo g|uo
cuo dong moch den b|en do| Ihonh coc Ie
boo con I|eu cou, boo Iuong co nh|eu hoI che
I|eI. ChoI I|eI cuo Ie boo con I|eu cou co vo|
Iro duy Ir| huyeI op. VeI doc o ong |uon xo
Ihuong nom gon dong moch den co coc Ie
boo con I|eu cou. Ie boo con I|eu cou cuo
dong moch den cung vo| veI doc Ioo nen
phuc hop con I|eu cou.
Ngoo| ro phuc hop con I|eu cou con co coc
Ie boo go| |o coc Ie boo g|on moo moch
ngoo| I|eu cou
24/03/2010 8:44 CH
Nguyn Hu Tr 57
Fhuc hop con I|eu cou
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Nguyn Hu Tr 58
Ioo| bo coc choI co
Iho| cuo quo Ir|nh b|en
duong.
|eu hoo nong do choI
Ion Irong mou.
Von chuyen quo Ie
boo b|eu mo o ong
Ihon
Chuc nang cua than
24/03/2010 8:44 CH
Nguyn Hu Tr 59
Chuc nang cua than
1. $u |o c, op |u c |o c |en d|ch co Ihe Ioo ro d|ch |o c (nuo c,
muo|, duong, om|no oc|ds, choI Iho| co n|Io)
2. Io| hop Ihu, hop Ihu Iro |o| nhung choI Ion co g|o Ir|
(g|ucose, muo|, om|no oc|d) Iu d|ch |oc
3. $u I|eI, su Ihe m vo o co c phon Iu |o n nhu do c Io (Iox|n)
vo co c choI Ion kho c kh| quo Ihuo voo d|ch |o c
4. $u Iho| ro, d|ch |o c d| ro kho| he Iho ng Ihon
24/03/2010 8:44 CH
Nguyn Hu Tr 60
$u |oc
f||IroI|on
Ho| Ihon son xuoI 125m| d|ch
|ocJphuI Irong do 124m|
duoc hop Ihu |o| vo ch 1m|
duoc Iho| ro n|eu quon
Ihonh nuoc I|eu.
Irong 24 g|o co khoong 800
||I mou quo Ihon Ioo khoong
200 ||I d|ch |oc vo ch co 1,5
||I nuoc I|eu duoc Ioo ro.
TT
24/03/2010 8:44 CH
Nguyn Hu Tr 61 T
$u |oc
Mou Io| Ihon Iu moI
dong moch |on |o
dong moch huong
Iom vo voo Irong cou
Ihon cuo mo| nguyen
Ihon duo| op suoI coo
(70mmHg) op suoI noy
Ihuc Ie doy dung d|ch
gom nuoc, muo|, ureo,
vo coc phon Iu khoc
voo Irong nong
8owmon
24/03/2010 8:44 CH
Nguyn Hu Tr 62 2
$u Io| hop Ihu
(PeobsorpI|on)
Io| hop Ihu |o quo
Ir|nh d| chuyen
coc choI Iu d|ch
|oc Iro |o| voo
mou
24/03/2010 8:44 CH
Nguyn Hu Tr 63
$u Io| hop Ihu
24/03/2010 8:44 CH
Nguyn Hu Tr 64 4
$u I|eI ($ecreI|on)
SU che l|el |c c|
chUyen ccc chcl
cc lrcng mcU vc
cUc chUng vcc
lrcng c|ch |cc
24/03/2010 8:44 CH
Nguyn Hu Tr 65 5
8ong quong
(8|odder)
8ong quong vo coc ong don I|eu ( do|
Ihon, be Ihon, n|eu quon) |uu Iru nuoc
I|eu duoc Ioo ro o Ihon vo don ro ngoo|
Ihonh cuo n|eu quon Iro nen doy hon
kh| I|en den bong quong.
N|em moc bong quong vo coc ong don
I|eu co b|eu mo chuyen dong, |op dem
co mo ||en keI Ihuo vo doc. Ouonh |op
dem co coc so| co Iron ben voo nhou
24/03/2010 8:44 CH
Nguyn Hu Tr 66
8ong quong
N|eu quon. | voo Ihonh bong quong Iheo moI huong
cheo, co Ioo moI von ngon khong cho nuoc I|eu Iroo
nguoc
T2
24/03/2010 8:44 CH
Nguyn Hu Tr 67 67
8ong
quong o
nu vo
n|eu doo
Io n|eu quon
N|eu
quon
Vung
Iom g|oc
Co IhoI ph|o
ngoo| n|eu
doo
Mong ngon
n|eu -s|nh duc
Co IhoI ph|o Irong
n|eu doo
24/03/2010 8:44 CH
Nguyn Hu Tr 68 8
N|eu doo o nu
N|eu quon o nu boo choI quonh ph|o Iruoc
vonh om doo.
Co b|eu mo |oI Iong vo moI so vung co
b|eu mo Iru g|o Iong.
oon g|uo n|eu doo nu co co von xep
vong, co IhoI Iheo y muon
No mo ro ve ph|o Iruoc Io| om doo vo ph|o
sou Io| om voI
Do| 3-4 cm
- N|eu doo o nu ngon don den de b| nh|em Irung
24/03/2010 8:44 CH
Nguyn Hu Tr 69 6
Io n|eu quon
Vung Iom
g|oc
Co IhoI Irong
n|eu doo
Co IhoI ngoo|
n|eu doo
N|eu
quon
8ong quong o nom
24/03/2010 8:44 CH
Nguyn Hu Tr 70
N|eu doo
I|en ||eI
N|eu doo I|en ||eI . d| quo
Iuyen I|en ||eI nom soI bong
quong
N|eu doo mong . do| ch
1cm, co b|eu mo Iru Iong
hoy g|o Iong, boo quonh
n|eu doo mong co coc so|
co IhoI |o co von
N|eu doo xop. Do| khoong.
20 cm
N|eU ccc
xcp
N|eU ccc
mcng
N|eu doo o nom co bo doon
N|eu doo o nom
24/03/2010 8:44 CH
Nguyn Hu Tr 71
Iuon hoon Ihon
Mo| Ihon nhon mou Iu moI dong moch
Ihon, Ihuong ch|o ho| nhonh Iruoc kh| d|
voo Ihon, nhonh d| Io| phon Iruoc Ihon, moI
nhonh d| ro phon sou Ihon. kh| o ron Ihon
coc nhonh noy phon ch|o I|ep cho coc
dong moch g|on Ihuy nom xen g|uo coc
vung Ihop Ihon.
O vung ronh g|o| vo -Iuy, coc dong moch
g|on Ihuy cho ro coc dong moch cung.
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Nguyn Hu Tr 72
Coc dong moch g|on I|eu Ihuy xuoI phoI
Iu coc dong moch cung vo choy voo
vung vo Iheo huong Ihong goc vo| vo
Ihon.
Coc dong moch g|on I|eu Ihuy cho ro
coc dong moch huong Iom cung cop
mou cho coc cuon moo moch Ihon.
Mou Iu cuon moo moch I|eu cou Ihon
do voo dong moch |y Iom, ro| phon
nhonh moI |on nuo Ioo Ihonh mong |uo|
moo moch quonh ong cung cop mou
nuo| ong |uon gon vo ong |uon xo, vo
mong d| coc |on do hop Ihu cung coc
choI co Irong |uong phon Iu Ihop.
T3
24/03/2010 8:44 CH
Nguyn Hu Tr 73
Coc I|eu dong moch d| co o coc nephron
con Iuy se Ioo nen coc moo moch do| vo
monh. Coc moch mou noy choy Ihong
voo vung Iuy ro| |o| vong den ronh g|o|
g|uo vung vo Iuy, duoc go| |o coc moch
Ihong (Voso recIo)
Coc moo moch o phon ngoo| cung vo
Ihon vo vo xo Ihon sop nhop |o| Ioo nen
coc I|nh moch soo ro| do voo I|nh moch
g|on I|eu Ihuy. Coc I|nh moch I|ep Iuc d|
Iheo huong nguoc |o| cuo coc dong
moch. Mou Iu I|nh moch g|on I|eu Ihuy do
voo I|nh moch cung, vo Iu do den I|nh
moch g|on Ihuy, I|nh moch Ihon vo Iu do
d| ro kho| Ihon
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Nguyn Hu Tr 74 74
Iuon hoon Ihon
ong moch Ihon
ong moch g|on Ihuy
ong moch cung
ong moch g|on I|eu Ihuy
ong moch huong Iom
Cuon moo moch I|eu cou Ihon
ong moch |y Iom
I|nh moch soo
I|nh moch g|on I|eu Ihuy
I|nh moch cung
I|nh moch g|on Ihuy
I|nh moch Ihon
24/03/2010 8:44 CH
Nguyn Hu Tr 75
75
cng mcch
|y lcm
cng mcch
hUcng lcm
Nhcnh c| xUcng
cUc Uc| Hen|e
CUc| Hen|e vc
mcng mcc mcch
Ong |Ucn gcn
Ong |Ucn xc
Ncng Bcwmcn
Ong gcp
24/03/2010 8:44 CH
Nguyn Hu Tr 76
|eu hoo Ihon. hormone
AnI|d|ureI|c hormone (ADH) - duoc I|eI ro
|om Iong I|nh Ihom cuo ong |uon xo vo ong
gop do| vo| nuoc (H
2
O quoy Iro |o| co Ihe),
b| uc che bo| o|coho| vo coffee
JuxIog|omeru|or opporoIus (JGA) - g|om su
hop Ihu muo|-->enzyme ren|n kho| dou cho
v|ec chuyen ong|oIens|on (proIe|n huyeI
Iuong) Ihonh ong|oIens|on II (pepI|de), g|o
Iong huyeI op vo Ihe I|ch mou nho co
moch
24/03/2010 8:44 CH
Nguyn Hu Tr 77
|eu hoo Ihon. hormone
Ang|oIens|on II ch k|ch
Ih|ch Iuyen Iren Ihon I|eI
o|dosIerone, hooI dong
Irong ong |uon xo de Io|
hop Ihu nh|eu hon sod|um,
do do g|o Iong huyeI op
(PAA$)
AIr|o| noIr|ureI|c hormon
(ANH) - do coc voch Iom
nh| I|eI ro, uc che v|ec g|o|
phong ren|n, uc che Io| hop
Ihu muo| vo uc che g|o|
phong o|dosIerone
24/03/2010 8:44 CH
Nguyn Hu Tr 78 78
He Ihong Pen|n-Ang|oIens|n
Pen|n |o moI enzyme phon coI proIe|n huyeI Iuong
ong|oIens|nogen Ihonh ong|oIens|n I.
- Ang|oIens|nogen duoc Iong hop o gon (||ver)
Ang|oIens|n I se duo c chuyen Ihonh
ong|oIens|n II bo| Ang|oIens|n ConverI|ng Enzyme (ACE) o pho|
(|ung)
Ang|oIens|n II |o moI nhon Io goy co moch monh vo v| voy
|om g|o Iong huyeI op (8F).
$u g|o Iong 8F se |om Iong op |u c |o c o cou Ihon
T4
24/03/2010 8:44 CH
Nguyn Hu Tr 79 7
Ang|oIens|n II
Ang|oIens|n II |o nguyen nhon.
- Goy co mo ch co Ihe (g|o Iong huye I op)
- Iom m|en vo Iuyen Iren Ihon g|o| phong o|dosIerone
- Ihuy sou Iuyen yen g|o| phong onI|d|ureI|c hormone (ADH).
A|dosIerone se |o nguyen nhon |om cho Ie boo ong
|uong xo vo Ie boo ong gop Io| hop Ihu nh|eu hon
No
+
vo v| voy Iong hop Ihu nuoc.
ADH se |om ong gop vo ong |uon xo g|o Iong Io|
hop Ihu nuoc.
- Nuo c noy se duo c Io| hop Ihu vo o Irong moo mo ch ben
(per|Iubu|or cop|||or|es) |om Iong co Ihe I|ch mou |on huyeI
op.
24/03/2010 8:44 CH
Nguyn Hu Tr 80
Kim sot s phng thch aldosteron
v h Renin Angiotensin
Angiotensinogen
gan
Angiotensin I
Decapeptid v
hot
Angiotensin II
Octapeptid
Angiotensin III
Heptapeptid
Angiotensin IV
Hexapeptid
Sn xut, phng
Angiotensin
Co mch Gy kht
EnzymRenin
t bo
gn cu thn
juztaglomerular
ACE-Angiotensin
converting
Enzym phi,
huyt tng
Angiotensinase
Sn phm phn gii c hot tnh yu hn
24/03/2010 8:44 CH
Nguyn Hu Tr 81
nh hng algiotensin II ln s
tng hp aldosteron
Sinh tng hp aldosteron c kch thch
bi Angiotensin II, ACTH v nng cao
ca ion K
+
Angiotensin gy co mch tng huyt
p
Captoril l cht c ch ACE (Angiotensin
converting enzyme) gim angiotensin II,
iu tr huyt p cao v suy tim
24/03/2010 8:44 CH
Nguyn Hu Tr 82
Pen|n-ong|oIens|n-
o|dosIerone sysIem (PAA$)
24/03/2010 8:44 CH
Nguyn Hu Tr 83
Ihe I|ch mou Ihop se hooI hoo he Ihong ren|n-ong|oIens|n-
o|dosIerone.
(1) Ihe I|ch mou Ihop keI hop vo| v|ec g|o m nong do |on
No+ Irong mou.
(2) G|om |uong mou cho y quo phuc hop con I|eu cou
(3) Fhu c hop g|o| phong ren|n voo mou, no se xuc Io c Ioo
ong|oIens|n I Iu ong|oIens|nogen.
(4) Ang|oIens|n I duo c chuyen Iho nh dong hooI hoo, |o
ong|oIens|n II.
(5) Ang|oIens|n II k|ch Ih|ch co mo ch mou vo
(6) phong Ih|ch o|dosIerone Iu vung vo Iuyen Iren Ihon
(7) A|dosIerone k|ch Ih|ch su Io| hop Ihu No+ Irong ong |uon
xo.
(8) Io m Iong N nong do No+ Io| ho p Ihu Iheo sou do |o su
Iong Io| hop Ihu cuo C| - vo nuoc.
() |eu noy |o m Iong Ihe I|ch mou. $u Iong Ihe I|ch mou
|om g|o| phong oIr|o| noIr|ureI|c hormone co Io c dung uc
che su phong Ih|ch o|dosIerone. Ho| he Ihong noy hooI
dong vo| nhou de duy Ir| con bong no| mo|.
24/03/2010 8:44 CH
Nguyn Hu Tr 84
Cn bng nc v mui
T5
24/03/2010 8:44 CH
Nguyn Hu Tr 85
Cn bng nc v mui
24/03/2010 8:44 CH
Nguyn Hu Tr 86
Cn bng pH
Ihon con bong nuoc vo choI d|en g|o| co Ihe, |o
no| son xuoI ren|n Ihom g|o d|eu hoo huyeI op.
Ihon cung |o no| Iong hop eryIhropo|eI|n k|ch
Ih|ch Ioo hong cou. EryIhropo|eI|n con Ihuy phon
v|Iom|nD3 Ihonh dong hooI dong.
24/03/2010 8:44 CH
Nguyn Hu Tr 87
Chy thn nhn to