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Updated: Nov 2 2018

Kidney Endocrine Functions

  • Introduction
    • The kidneys are also involved in promoting erythropoiesis and producing activated vitamin D
      • erythropoiesis (red blood cell production)
        • the kidneys produce a glycoprotein growth factor called erythropoietin (EPO)
          • in hypoxia, there is less O2 being delivered to the kidneys
            • this in turn causes the production of hypoxia-inducible factor-1α (HIF-1α) which acts on the fibroblasts in the renal cortex to transcribe EPO (increased EPO mRNA)
              • EPO promotes the differentiation of proerythroblasts to eventually form into erythrocytes (red blood cells)
                • note that one can commonly see anemia in patients with chronic renal failure since the functioning renal mass is decreased
                  • this is why recombinant human EPO is a treatment for anemia of chronic renal failure
      • vitamin D production
        • the kidneys contain an enzyme called 1α-hydroxylase
          • 1α-hydroxylase catalyzes the hydroxylation (at the C1 position) of 25-hydroxycholecalciferol into 1,25-dihydroxycholecalciferol
            • 1,25-dihydroxycholecalciferol is a physiologically active form of vitamin D
              • in the kidney, 25-hydroxycholecalciferol can also be hydroxylated (at the C24 position) into 24,25-hydroxycholecalciferol, an inactive form of vitamin D
            • 1α-hydroxylase is regulated by a number of factors such as
              • plasma Ca2+ concentration
                • a decrease in plasma Ca2+ increases 1α-hydroxylase activity
              • parathyroid hormone
                • increases 1α-hydroxylase activity
              • plasma phosphate concentration
                • a decrease in plasma phosphate increases 1α-hydroxylase activity
    • Prostaglandins
      • the kidneys locally produce prostaglandins (e.g., PGE2) that result in vasodilation of the afferent arteriole
        • this in turn increases renal blood flow
        • nonsteroidal antiinflammatory drugs (NSAIDs) impair prostaglandin synthesis
          • the renoprotective effects of prostaglandins are loss in low blood volume states (e.g., hemorrhage)
    • Dopamine
      • low levels of dopamine dilates the renal arterioles and thus increases renal blood flow
        • secreted by proximal tubular cells to promote natriuresis
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