腎臟髓質組織間的高滲透度
腎臟髓質組織是腎臟中的一部分，它負責調節尿液的濃度以維持體液平衡。腎小管在這些組織中運作，並參與尿液的再吸收和排泄。
當尿液進入腎臟髓質組織時，這些組織中的滲透壓會影響尿液的濃度。尿液的濃度越高，腎小管就需要更多的水分來稀釋尿液，以確保適當的體液平衡。這種高滲透壓的環境有助於腎小管的運作，進一步調節尿液的濃度。
足細胞（podocytes）
腎臟的足細胞（podocytes）在腎小球的過濾過程中扮演著關鍵角色，它們位於腎小球的毛細血管（腎小球毛細血管）外層，幫助構建腎小球的過濾屏障。因為足細胞足突負責從血液中濾出多餘的液體和蛋白質，當足細胞功能受損或突起消失時，腎臟的血管變得更加透水，允許液體和蛋白質漏入組織中。導致不能有效排除鈉和水分，而引起病人的水腫，進而產生蛋白尿(蛋白質從血液滲透到尿液)，也因此由於血液的蛋白質濃度降低，也同時降低了血液滲透壓。
Podocytes, located in the outer layer of the glomerular capillaries, play a key role in the filtration process of the glomerulus. They are responsible for filtering out excess fluid and proteins from the blood. When podocytes are damaged or their foot processes disappear, the blood vessels in the kidneys become more permeable, allowing fluid and proteins to leak into the tissues. This leads to swelling, especially in the feet, ankles, and legs.
This swelling is caused by the inability of the kidneys to effectively remove sodium and water. The leakage of fluid and proteins into the tissues also leads to proteinuria, which is the presence of protein in the urine. Proteinuria is caused by the loss of protein from the blood, which also lowers the blood's osmotic pressure.
furosemide為強效的利尿劑，排尿效果最顯著，主要作用在腎臟的亨利氏套環，透過抑制鈉離子和氯離子的再吸收，除了可以改善水腫，亦可用於治療高血鈣症（hypercalcemia）和高血壓，也可以短期拿來治療下足細胞功能受損或突起消失引起的水腫。
Furosemide is a potent diuretic that primarily acts on the loop of Henle in the kidney by inhibiting the reabsorption of sodium and chloride ions. It is most effective in promoting diuresis and is used to treat edema caused by heart failure, cirrhosis, or kidney disease. Additionally, it can be used to treat hypercalcemia and hypertension. Furosemide can also be used short-term to treat edema caused by podocyte injury or effacement.
尿素和氯化鈉的作用
尿素： 尿素是由肝臟產生的一種代謝產物，透過腎臟排泄。當尿素在腎小管內再吸收時，它會增加腎臟髓質組織中的滲透壓，創造出一個高滲透度的環境。這個環境有助於腎小管調節尿液濃度，同時保持適當的體液平衡。
氯化鈉： 食鹽中的氯化鈉分解成鈉離子和氯離子，這些離子也在腎小管中進行運輸和調節。氯離子的排泄可以幫助調節尿液中的電解質濃度，同時增加腎臟髓質組織中的滲透壓。
因此，尿素和氯化鈉的累積會增加腎臟髓質組織的滲透壓，創造一個高滲透度的環境，有助於腎小管的正常功能，同時維持適當的體液平衡和尿液濃度。
近曲小管的鈉離子再吸收
近曲小管是腎小管的起始部分，是腎臟中負責鈉離子再吸收(65%)的主要部位。
The proximal convoluted tubule (PCT) is the initial segment of the nephron and is the main site of sodium reabsorption (65%) in the kidney.
遠曲小管位於近曲小管之後，對鈉離子的再吸收能力較弱。在遠曲小管中，約 10% 的濾過鈉離子被再吸收，但若下丘腦分泌的激素-抗利尿激素的介入，其作用於遠曲小管的收集管，促進收集管對水的再吸收，因此，在抗利尿激素介入的情況下，遠曲小管對鈉離子的再吸收會增加，因此，在抗利尿激素介入的情況下，遠曲小管可能會成為對鈉離子再吸收最多的部位。
The distal convoluted tubule follows the proximal convoluted tubule and has a lower capacity for sodium reabsorption. Approximately 10% of filtered sodium is reabsorbed in the distal convoluted tubule. However, when antidiuretic hormone (ADH) is secreted by the hypothalamus and acts on the collecting duct, it promotes water reabsorption. Consequently, sodium reabsorption in the distal convoluted tubule may increase under the influence of ADH, potentially making it the primary site for sodium reabsorption.
抗利尿激素（antidiuretic hormone）最主要的作用就是增加集尿管對水的通透性，促進水的再吸收（reabsorption）。這會導致尿液濃縮，減少尿量，同時維持體內的水平衡。當集尿管大量重吸收水分時，管腔內的尿液濃度會增加。由於濃度梯度的變化，遠曲小管內的鈉離子會更容易沿著濃度梯度被動運輸到管腔內。
The primary function of ADH is to increase the permeability of the collecting duct to water, thereby promoting water reabsorption. This results in concentrated urine, reduced urine volume, and maintenance of water balance. As the collecting duct reabsorbs large amounts of water, the concentration of the tubular fluid increases. This concentration gradient facilitates the passive diffusion of sodium ions from the distal convoluted tubule into the tubular lumen.
尿崩症Diabetes insipidus
尿崩症是一種由於抗利尿激素（ADH）分泌不足或腎臟對ADH反應不佳所導致的疾病，其主要特徵是多尿、煩渴和尿比重降低。
Diabetes insipidus is a disease caused by insufficient secretion of antidiuretic hormone (ADH) or a reduced renal response to ADH. Its primary characteristics include polyuria, polydipsia, and low urine specific gravity.
腎臟血漿清除濾：
葡萄糖為0，因為尿中不含葡萄糖--最低清除濾
尿素為70ml/min
肌酐酸成人內生肌酐清除率平均為128L/24h--最高清除濾
胺基馬尿酸可反映腎臟血漿流速，被用作一種無毒的診斷工具來量測有效的腎血漿流量。當血漿濃度較低時，這種藥物被腎小球過濾，並在通過腎臟的一次轉運中通過活躍的腎小管分泌物幾乎完全從腎血流中清除。其清除率與腎血漿血流量相對應
腎絲球過濾率（GFR）
是指腎臟每分鐘通過腎小球濾出的血漿體積。它是腎臟功能的重要指標，GFR 越高，表示腎臟功能越好。
Glomerular filtration rate (GFR) is the volume of plasma filtered by the kidneys per minute. It is an important indicator of kidney function, with higher GFR indicating better kidney function.
腎小管是腎臟中的主要排泄器官。它負責從血液中過濾出的尿液中重吸收水分、電解質和其他有用的物質，並排出代謝廢物和有毒物質。
The renal tubules are the main excretory organs in the kidneys. They are responsible for reabsorbing water, electrolytes, and other useful substances from the filtered urine, and excreting metabolic waste and toxins.
腎小管分泌是指腎小管細胞從血液中主動將物質排入尿液的過程。腎小管分泌的物質包括尿素、肌酐、氨、重金屬等。
Tubular secretion is the process of actively transporting substances from the blood into the urine by renal tubular cells. Substances that are secreted by the renal tubules include urea, creatinine, ammonia, and heavy metals.
當物質經腎臟排出至尿液的量大於其腎絲球過濾率時，則表示該物質在腎臟中被腎小管分泌。這是因為腎絲球過濾率是物質從血液中被濾出尿液的最大限度。如果物質的濃度在血液中高於腎絲球過濾率，則剩餘的物質就會被腎小管分泌排出。
When the amount of a substance excreted by the kidneys into the urine is greater than its glomerular filtration rate, it indicates that the substance is being secreted by the renal tubules. This is because the glomerular filtration rate is the maximum amount of a substance that can be filtered from the blood into the urine. If the concentration of a substance in the blood is greater than the glomerular filtration rate, the remaining substance will be secreted by the renal tubules.
以肌酸酐計算腎絲球過濾率/크레아티닌으로 사구체 여과율 계산
若要以健康檢查EXCEL總表計算腎絲球過濾率，只要代入以下公式，即可算出所有公司員工的腎絲球過濾率：
건강검진 엑셀 총표를 이용하여 사내 직원의 사구체 여과율을 계산하려면 다음 공식을 대입하면 됩니다.
eGFR腎絲球過濾率/사구체 여과율 eGFR
eGFR ≧ 90
=IF(性別="男",186*POWER(肌酸酐,-1.154)*POWER(年齡,-0.203),186*POWER(肌酸酐,-1.154)*POWER(年齡,-0.203)*0.742)
=IF(성별 = "남성", 186 * POWER(크레아티닌, -1.154) * POWER(나이, -0.203), 186 * POWER(크레아티닌, -1.154) * POWER(나이, -0.203) * 0.742)
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