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23.1:

์ฝฉํŒฅ ๊ตฌ์กฐ

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– [๊ฐ•์‚ฌ] ์‹ ์žฅ์€ ๋‘ ๊ฐœ์˜ ์ฝฉ ๋ชจ์–‘์˜ ์žฅ๊ธฐ์ด๋ฉฐํšก๊ฒฝ๋ง‰ ์•„๋ž˜์— ์œ„์น˜ํ•ฉ๋‹ˆ๋‹ค์‚ผํˆฌ์•• ์กฐ์ ˆ์— ๋Œ€ํ•œ ์ฑ…์ž„์„ ์ง€๋ฉฐํ˜ˆ์•ก ์†์˜ ๋ฌผ๊ณผ ์šฉ์งˆ์˜ ๊ท ํ˜•์„ ๊ด€์žฅํ•ฉ๋‹ˆ๋‹คํ˜ˆ์•ก์ด ์ฝฉํŒฅ ๋™๋งฅ์„ ํ†ตํ•ด ์‹ ์žฅ์— ๋“ค์–ด๊ฐ€๋Š”๋ฐ์ด๋Š” ๋ฌธ์ด ์œ„์น˜ํ•œ ์˜ค๋ชฉ๋ฉด์— ์žˆ์œผ๋ฉฐ์ž‘์€ ๋™๋งฅ ๊ฐ€์ง€์™€ ๋ชจ์„ธ ํ˜ˆ๊ด€์œผ๋กœ๋„คํ”„๋ก ์— ๋“ค์–ด๊ฐˆ ๋•Œ๊นŒ์ง€ ํ๋ฆ…๋‹ˆ๋‹คํ”ผ์งˆ ๋‚ด๋ถ€์˜ ์‹ ์†Œ์ฒด๋Š”๋ชจ์„ธ ํ˜ˆ๊ด€ ์‚ฌ๊ตฌ์ฒด๊ฐ€ ํ•จ์œ ๋˜์–ด ์žˆ์œผ๋ฉฐ์ด๋Š” ๋ณด๋จผ์˜ ์บก์Š์— ๋‘˜๋Ÿฌ์‹ธ์—ฌ๋‹จ๋ฐฑ์งˆ์„ ์ œ์™ธํ•œ ๊ฑฐ์˜ ๋ชจ๋“  ์šฉ์งˆ์„ ๊ฑธ๋Ÿฌ ๋ƒ…๋‹ˆ๋‹ค์ด ์—ฌ๊ณผ์•ก์€ ์„ธ๋‡จ๊ด€์— ๋ชจ์ด๋Š”๋ฐ์„œ๋กœ ๋‹ค๋ฅธ ๋ถ€๋ถ„์„ ํฌํ•จํ•ฉ๋‹ˆ๋‹ค๊ฐ€์žฅ ๊ฐ€๊นŒ์šด ์†Œ์ฒด๋Š” ๊ทผ์œ„๊ณก ์š”์„ธ๊ด€์ด๋‚˜PCT์ด๋ฉฐ, ํ—จ๋ ˆ ๊ณ ๋ฆฌ๊ฐ€ํ•˜ํ–‰๊ฐ๊ณผ ์ƒํ–‰๊ฐ์œผ๋กœ ๋’ค๋”ฐ๋ฅด๋ฉฐ๋งˆ์ง€๋ง‰์œผ๋กœ ์›์œ„ ๊ณก๋‡จ ์„ธ๊ด€ ๋˜๋Š” DCT๊ฐ€ ์žˆ์Šต๋‹ˆ๋‹ค์„ธ๊ด€ ๋‚ด์˜ ๋ฌผ๊ณผ ๊ฐ™์€ ์ผ๋ถ€ ๋ถ„์ž๋Š”๋ชจ์„ธ ํ˜ˆ๊ด€์œผ๋กœ ์žฌํก์ˆ˜๋˜๋ฉฐ์ด๋กœ ์ธํ•ด ๋” ํฐ ์„ธ์ •๋งฅ์œผ๋กœ ์žฌํ•ฉ๋ฅ˜ํ•ฉ๋‹ˆ๋‹ค๊ถ๊ทน์ ์œผ๋กœ๋Š” ์‹ ์žฅ ์ •๋งฅ์„ ํ˜•์„ฑํ•˜๋ฉฐ์ƒˆ๋กญ๊ฒŒ ๊ฑธ๋Ÿฌ์ง„ ํ˜ˆ์•ก์„ ํ˜ˆ์•ก ์ˆœํ™˜์œผ๋กœ ์ด๋™์‹œํ‚ต๋‹ˆ๋‹ค๋‚˜๋จธ์ง€ ํก์ˆ˜๋˜์ง€ ์•Š์€ ์—ฌ๊ณผ์•ก์€์„ธ๊ด€์—์„œ ์ง‘ํ•ฉ๊ด€์œผ๋กœ ํ†ต๊ณผ๋ฉ๋‹ˆ๋‹ค๋งŽ์€ ์ˆ˜์˜ ๊ด€์ด ๊ฒฐํ•ฉ๋˜์–ด์ˆ˜์งˆ ํ”ผ๋ผ๋ฏธ๋“œ๋ฅผ ํ˜•์„ฑํ•˜๋ฉฐํ•ด๋‹น ๊ผญ์ง€์ ์€ ๋ฌธ์„ ๊ฐ€๋ฆฌํ‚ต๋‹ˆ๋‹ค.๊ผญ์ง€์ ์€ ์—ฌ๊ณผ์•ก์„ ์‹ ๋ฐฐ ์•ˆ์œผ๋กœ ๋น„์›Œ ๋‚ด๊ณ ์ด๋Š” ์‹ ์šฐ ์•ˆ์œผ๋กœ ๋น„์›Œ์ง‘๋‹ˆ๋‹ค์‹ ์šฐ๋Š” ์š”๊ด€์œผ๋กœ ์—ด๋ ค์ ธ์†Œ๋ณ€์ธ ์ตœ์ข… ์—ฌ๊ณผ์•ก์ด์‹ ์žฅ์—์„œ ๋ฐฉ๊ด‘์œผ๋กœ ์˜ฎ๊ฒจ์ง€๊ฒŒ ํ•ฉ๋‹ˆ๋‹ค

23.1:

์ฝฉํŒฅ ๊ตฌ์กฐ

์ฝฉํŒฅ(kidney; ์‹ ์žฅ)์€ ์œ—๋ฐฐ(upper abdomen; ์ƒ๋ณต๋ถ€)์— ์žˆ๋Š” ๋‘ ๊ฐœ์˜ ํฐ ์ฝฉ ๋ชจ์–‘์˜ ๊ธฐ๊ด€์ž…๋‹ˆ๋‹ค. ํ•˜๋ฃจ์— ์—ฌ๋Ÿฌ ๋ฒˆ ํ˜ˆ์•ก์„ ๊ฑธ๋Ÿฌ ๋…์†Œ๋ฅผ ์ œ๊ฑฐํ•˜๊ณ  ์ฝฉํŒฅ์ •๋งฅ(renal vein; ์‹ ์žฅ์ •๋งฅ)์„ ํ†ตํ•ด ์ˆœํ™˜๊ณ„(circulatory system)์˜ ๋ฌผ๊ณผ ์ „ํ•ด์งˆ์„ ์žฌ์กฐ์ •ํ•ฉ๋‹ˆ๋‹ค. ์ฝฉํŒฅ์€ ์ฝฉํŒฅ๋™๋งฅ(renal artery; ์‹ ์žฅ๋™๋งฅ)์„ ํ†ตํ•ด ์‹ฌ์žฅ์—์„œ ์ง์ ‘ ํ˜ˆ์•ก์„ ๋ฐ›์Šต๋‹ˆ๋‹ค. ์ด ๋™๋งฅ์€ ์ฝฉ์˜ ์˜ค๋ชฉํ•œ ํ‘œ๋ฉด์ธ ์ฝฉํŒฅ๋ฌธ(hilum; ์‹ ์žฅ๋ฌธ)์œผ๋กœ ๋“ค์–ด๊ฐ€ ์ž‘์€ ํ˜ˆ๊ด€๊ณผ ๋ชจ์„ธํ˜ˆ๊ด€(capillary)์œผ๋กœ ๊ฐˆ๋ผ์ง‘๋‹ˆ๋‹ค.

์ฝฉํŒฅ ๊ฒ‰์งˆ(renal cortex; ์‹ ์žฅ ํ”ผ์งˆ)์€ ์ฝฉํŒฅ์˜ ๋‘๊บผ์šด ์™ธํ”ผ์ธต์ž…๋‹ˆ๋‹ค. ๊ฒ‰์งˆ์€ ๋ชจ์„ธํ˜ˆ๊ด€์ด ์„ธ๋‡จ๊ด€(renal tubule) ๋๊ณผ ๋ฐ€์ ‘ํ•˜๊ฒŒ ์ ‘์ด‰ํ•˜๋Š” ์ฝฉํŒฅ์†Œ์ฒด(renal corpuscle; ์‹ ์žฅ ์†Œ์ฒด; ์‹ ์†Œ์ฒด)๋ฅผ ์ˆ˜์šฉํ•˜๊ณ  ์žˆ์Šต๋‹ˆ๋‹ค. ๊ด€์˜ ๋, ์ฆ‰ ๋ณด๋จผ์ฃผ๋จธ๋‹ˆ(Bowman’s capsule)๋Š” ๊ณต์ฒ˜๋Ÿผ ์ƒ๊ธด ๋ชจ์„ธํ˜ˆ๊ด€์˜ ๊ทธ๋ฌผ, ์ฆ‰ ์‚ฌ๊ตฌ์ฒด(glomerulus; ํ† ๋ฆฌ)๋ฅผ ๋‘˜๋Ÿฌ์‹ธ๊ณ  ์žˆ์Šต๋‹ˆ๋‹ค. ๋ชจ์„ธํ˜ˆ๊ด€์˜ ํŠน์ดํ•œ ๋ฐฐ์—ด์€ ์„ธ๋‡จ๊ด€ ๋๊ณผ ๋ชจ์„ธํ˜ˆ๊ด€์ด ์ƒํ˜ธ์ž‘์šฉํ•˜๋Š” ํ‘œ๋ฉด์ ์„ ์ฆ๊ฐ€์‹œํ‚ต๋‹ˆ๋‹ค. ์ด๋Ÿฐ ๋ณต์žกํ•œ ๊ด€์€ ๋ณด๋จผ์ฃผ๋จธ๋‹ˆ์—์„œ ์ฝฉํŒฅ ๊ฒ‰์งˆ ์•„๋ž˜์˜ ์กฐ์ง์ธ ์ฝฉํŒฅ ์†์งˆ(renal medulla; ์‹ ์žฅ ์ˆ˜์งˆ) ์•ˆ์— ํ—จ๋ ˆ๊ณ ๋ฆฌ(loop of Henle)๊นŒ์ง€ ์—ฐ์žฅ๋ฉ๋‹ˆ๋‹ค.

์œ„์™€ ๊ฐ™์ด ๊ฒ‰์งˆ์„ ๊ด€ํ†ตํ•ด ๋“ค์–ด๊ฐ„ ๊ตฌ์กฐ๋“ค์€ ์†์งˆ์„ ์—ฌ๋Ÿฌ ๊ฐœ์˜ ์ฝฉํŒฅ ํ”ผ๋ผ๋ฏธ๋“œ(renal pyramid)๋กœ ๊ตฌ์„ฑํ•ฉ๋‹ˆ๋‹ค. ๊ฐ ํ”ผ๋ผ๋ฏธ๋“œ์˜ ๊ผญ์ง“์ ์€ ์ฝฉํŒฅ๋ฌธ ์˜์—ญ์„ ๊ฐ€๋ฆฌํ‚ค๋ฉฐ, ๋”ฐ๋ผ์„œ ์ง‘ํ•ฉ๊ด€(collecting duct)์€ ์ฝฉํŒฅ๊น”๋Œ€๊ธฐ(renal pelvis; ์‹ ์šฐ)์— ์žˆ๋Š” ์ฝฉํŒฅ์ž”(calyx; ์‹ ๋ฐฐ)์œผ๋กœ ๋น„์›Œ์ง‘๋‹ˆ๋‹ค. ์ฝฉํŒฅ๊น”๋Œ€๊ธฐ๊ฐ€ ์ฑ„์›Œ์ง€๋ฉด ์†Œ๋ณ€์ด ์š”๊ด€(ureter)์œผ๋กœ ๋น„์›Œ์ง‘๋‹ˆ๋‹ค. ์š”๊ด€์€ ์ฝฉํŒฅ์„ ๋ฐฉ๊ด‘(bladder)๊ณผ ์—ฐ๊ฒฐํ•ด ์†Œ๋ณ€์ด ๋ฐฐ์ถœ๋˜๊ธฐ ์ „๊นŒ์ง€ ๋ฐฉ๊ด‘์— ๋ณด๊ด€ํ•ฉ๋‹ˆ๋‹ค.

์ฝฉํŒฅ์†Œ์ฒด, ๊ทผ์œ„๊ณก์„ธ๋‡จ๊ด€(proximal convoluted tubule; ํ† ๋ฆฌ์ชฝ๊ณฑ์Šฌ์„ธ๊ด€), ์›์œ„๊ณก์„ธ๊ด€(distal convoluted tubule; ๋จผ์ชฝ๊ณฑ์Šฌ์„ธ๊ด€), ํ—จ๋ ˆ๊ณ ๋ฆฌ, ๊ทธ๋ฆฌ๊ณ  ์ง‘ํ•ฉ๊ด€์€ ์ฝฉํŒฅ์˜ ๊ธฐ๋Šฅ ๋‹จ์œ„์ธ ๋„คํ”„๋ก (nephron)์„ ํ˜•์„ฑํ•ฉ๋‹ˆ๋‹ค. ๋„คํ”„๋ก ์€ ํ˜ˆ์•ก์„ ๊ฑธ๋Ÿฌ ๋ฌผ๊ณผ ์ „ํ•ด์งˆ์„ ์žฌํก์ˆ˜ํ•˜๊ณ  ๋…์†Œ๋ฅผ ๋ฐฐ์ถœํ•ฉ๋‹ˆ๋‹ค. ์ธ๊ฐ„์˜ ์‹ ์žฅ์—๋Š” ์•ฝ ๋ฐฑ๋งŒ ๊ฐœ์˜ ๋„คํ”„๋ก ์ด ์žˆ์Šต๋‹ˆ๋‹ค.

์‚ฌ๋žŒ์ด ์ฝฉํŒฅ์„ ๊ธฐ์ฆํ•˜์—ฌ ๋„คํ”„๋ก ์˜ ์ˆ˜๊ฐ€ ๋ฐ˜์œผ๋กœ ์ค„์–ด๋“ค๋ฉด, ๋‚จ์€ ์ฝฉํŒฅ์€ ํฌ๊ธฐ์™€ ๋ถ€ํ”ผ๊ฐ€ ์ฆ๊ฐ€ํ•˜๋ฉด์„œ ์—†๋Š” ์ฝฉํŒฅ์„ ๋ณด์ƒํ•ฉ๋‹ˆ๋‹ค. ๊ธฐ์ฆ์ž๋“ค์€ ์‚ฌ๋ง ์œ„ํ—˜์ด ์ฆ๊ฐ€ํ•˜์ง€ ์•Š๊ณ  ๊ธฐ์ฆ ํ›„์— ๊ฑด๊ฐ•ํ•œ ์‚ถ์„ ์‚ด ์ˆ˜ ์žˆ์Šต๋‹ˆ๋‹ค. ํ•˜์ง€๋งŒ, ์ผ๋ถ€ ๊ธฐ์ฆ์ž๋“ค์€ ํ•˜๋‚˜์˜ ์ฝฉํŒฅ์ด ๋‘˜ ๋ชซ์„ ํ•ด์•ผ ํ•˜๋ฏ€๋กœ ๊ณ ํ˜ˆ์••์ด ์ƒ๊ธธ ์ˆ˜๋„ ์žˆ์Šต๋‹ˆ๋‹ค.

์ฝฉํŒฅ ๊ฒฐ์„์€ ์šฉ์งˆ(solute)์ด ๊ณผํฌํ™”(supersaturation)๋˜์–ด ์ƒ๊ธฐ๋Š” ํ˜„์ƒ์ด๋ฉฐ, ๊ฐ€์žฅ ์ผ๋ฐ˜์ ์œผ๋กœ ์นผ์Š˜์ด ๊ฒฐ์ •ํ™”ํ•˜๊ณ  ์‘์ง‘ํ•ฉ๋‹ˆ๋‹ค. ์นผ์Š˜์˜ ๊ณผํฌํ™”๋Š” ์นผ์Š˜์ด ํก์ˆ˜๋˜๋Š” ํ—จ๋ ˆ๊ณ ๋ฆฌ์—์„œ ๋ฐœ์ƒํ•  ์ˆ˜ ์žˆ์Šต๋‹ˆ๋‹ค. ์—ฌ๊ณผ๋œ ์•ก์ฒด์˜ ๋ถ€ํ”ผ๊ฐ€ ์ถฉ๋ถ„ํ•˜์ง€ ์•Š์œผ๋ฉด ์นผ์Š˜์ด ์ง‘ํ•ฉ๊ด€์„ ํ†ต๊ณผํ•ด ์ฝฉํŒฅ๊น”๋Œ€๊ธฐ๋กœ ์ด๋™ํ•˜๋ฉด์„œ ๊ฒฐ์ •ํ™”ํ•˜๊ณ  ์‘์ง‘ํ•  ์ˆ˜ ์žˆ์Šต๋‹ˆ๋‹ค. ๋Œ€๋ถ€๋ถ„์˜ ๋Œ์€ ์ฆ์ƒ ์—†์ด ์ง€๋‚˜๊ฐ‘๋‹ˆ๋‹ค. ๊ทธ๋Ÿฌ๋‚˜ ๋งŒ์•ฝ ๋Œ์ด ์š”๊ด€์„ ๋ง‰์„ ์ˆ˜ ์žˆ์„ ๋งŒํผ ์ถฉ๋ถ„ํžˆ ํฌ๋ฉด ์ƒ๋‹นํ•œ ๊ณ ํ†ต์„ ์ค„ ์ˆ˜ ์žˆ์Šต๋‹ˆ๋‹ค.

Suggested Reading

Ratkalkar, Vishal N, and Jack G Kleinman. “Mechanisms of Stone Formation.” Clinical Reviews in Bone and Mineral Metabolism 9, no. 3–4 (December 2011): 187–97. [Source]

Fehrman-Ekholm, Ingela, Niclas Kvarnström, John M. Söfteland, Annette Lennerling, Magnus Rizell, Anders Odén, and Tomas Simonsson. “Post-Nephrectomy Development of Renal Function in Living Kidney Donors: A Cross-Sectional Retrospective Study.” Nephrology Dialysis Transplantation 26, no. 7 (July 1, 2011): 2377–81. [Source]