Aldosterone: Renal Action and Physiological Effects.

IF 4.2 2区 医学 Q1 PHYSIOLOGY Comprehensive Physiology Pub Date : 2023-03-30 DOI:10.1002/cphy.c190043
Jermaine G Johnston, Amanda K Welch, Brian D Cain, Peter P Sayeski, Michelle L Gumz, Charles S Wingo
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Abstract

Aldosterone exerts profound effects on renal and cardiovascular physiology. In the kidney, aldosterone acts to preserve electrolyte and acid-base balance in response to changes in dietary sodium (Na+ ) or potassium (K+ ) intake. These physiological actions, principally through activation of mineralocorticoid receptors (MRs), have important effects particularly in patients with renal and cardiovascular disease as demonstrated by multiple clinical trials. Multiple factors, be they genetic, humoral, dietary, or otherwise, can play a role in influencing the rate of aldosterone synthesis and secretion from the adrenal cortex. Normally, aldosterone secretion and action respond to dietary Na+ intake. In the kidney, the distal nephron and collecting duct are the main targets of aldosterone and MR action, which stimulates Na+ absorption in part via the epithelial Na+ channel (ENaC), the principal channel responsible for the fine-tuning of Na+ balance. Our understanding of the regulatory factors that allow aldosterone, via multiple signaling pathways, to function properly clearly implicates this hormone as central to many pathophysiological effects that become dysfunctional in disease states. Numerous pathologies that affect blood pressure (BP), electrolyte balance, and overall cardiovascular health are due to abnormal secretion of aldosterone, mutations in MR, ENaC, or effectors and modulators of their action. Study of the mechanisms of these pathologies has allowed researchers and clinicians to create novel dietary and pharmacological targets to improve human health. This article covers the regulation of aldosterone synthesis and secretion, receptors, effector molecules, and signaling pathways that modulate its action in the kidney. We also consider the role of aldosterone in disease and the benefit of mineralocorticoid antagonists. © 2023 American Physiological Society. Compr Physiol 13:4409-4491, 2023.

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醛固酮:肾脏作用和生理效应。
醛固酮对肾脏和心血管生理有着深远的影响。在肾脏中,醛固酮的作用是保持电解质和酸碱平衡,以应对饮食中钠(Na+)或钾(K+)摄入量的变化。这些生理作用,主要是通过激活盐皮质激素受体(MRs),具有重要作用,特别是在肾脏和心血管疾病患者中,正如多项临床试验所证明的那样。多种因素,无论是遗传、体液、饮食还是其他因素,都可以在影响肾上腺皮质醛固酮合成和分泌的速率方面发挥作用。正常情况下,醛固酮的分泌和作用对饮食中Na+的摄入有反应。在肾脏中,远端肾单位和集合管是醛固酮和MR作用的主要靶点,其部分通过上皮Na+通道(ENaC)刺激Na+吸收,ENaC是负责微调Na+平衡的主要通道。我们对允许醛固酮通过多种信号通路正常发挥作用的调节因素的理解清楚地表明,这种激素是许多在疾病状态下功能失调的病理生理作用的核心。许多影响血压(BP)、电解质平衡和整体心血管健康的病理是由于醛固酮分泌异常、MR、ENaC突变或其作用的效应物和调节剂。对这些病理机制的研究使研究人员和临床医生能够创造新的饮食和药理学靶点来改善人类健康。这篇文章涵盖了醛固酮合成和分泌的调节、受体、效应分子以及调节其在肾脏中作用的信号通路。我们还考虑了醛固酮在疾病中的作用以及盐皮质激素拮抗剂的益处。©2023美国生理学会。Compr Physiol 13:4409-449120023。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
10.50
自引率
0.00%
发文量
38
审稿时长
6-12 weeks
期刊介绍: Comprehensive Physiology is the most authoritative and comprehensive collection of physiology information ever assembled, and uses the most powerful features of review journals and electronic reference works to cover the latest key developments in the field, through the most authoritative articles on the subjects covered. This makes Comprehensive Physiology a valued reference work on the evolving science of physiology for both researchers and clinicians. It also provides a useful teaching tool for instructors and an informative resource for medical students and other students in the life and health sciences.
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