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Kidney and adrenocortical hormones.

C R Kleeman, J Levi, O Better

    Nephron
    |January 1, 1975
    PubMed
    Summary

    Adrenocortical steroids, aldosterone and cortisol, are vital for kidney function and electrolyte balance. Kidney disease impacts steroid levels, while kidneys manage steroid clearance, highlighting their crucial interrelationship.

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    Area of Science:

    • Nephrology
    • Endocrinology

    Background:

    • The kidney and adrenocortical steroids (aldosterone and cortisol) are intricately linked in regulating water and electrolyte metabolism.
    • This review examines their interrelationship across renal structure, function, disease effects, and plasma clearance.

    Purpose of the Study:

    • To review the influence of cortisol and aldosterone on kidney structure and function.
    • To examine the impact of kidney disease on adrenocortical steroid secretion and metabolism.
    • To elucidate the role of the kidneys in the plasma clearance of these steroids and their metabolites.

    Main Methods:

    • Literature review synthesizing existing research on adrenocortical steroids and renal physiology.
    • Analysis of the effects of steroid excess/deficiency on renal parameters.
    • Discussion of the 'escape' phenomenon and glucocorticoid antagonism.

    Main Results:

    • Cortisol and aldosterone are essential for normal Glomerular Filtration Rate (GFR) and Renal Plasma Flow (RPF), though not directly impacting renal structure.
    • Pharmacologic glucocorticoid doses augment renal hemodynamics; impaired water diuresis in glucocorticoid deficiency stems from lack of permissive action and potential ADH increase.
    • Chronic renal failure may induce hyperaldosteronism to maintain potassium excretion, possibly influenced by potassium ions rather than the renin-angiotensin system.

    Conclusions:

    • Adrenocortical steroids play a critical, albeit indirect, role in maintaining renal hemodynamics and water/electrolyte balance.
    • Kidney disease can alter adrenocortical steroid metabolism and secretion, necessitating adaptive mechanisms like hyperaldosteronism in chronic renal failure.
    • The kidney's role in clearing these steroids is crucial for overall metabolic homeostasis.

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