蛋白尿的诊断与注意事项.ppt

蛋白尿的诊断治疗与注意事项,basicstructurebehindtwosidesofperitoneum11cm6cm3cmWt.100-140g,肾小球旁器,（1）球旁细胞afferentarteriole中膜内的肌上皮样细胞。分泌renin。（2）系膜细胞afferent和efferentarteriole之间的间质细胞群。吞噬功能。,（3）致密斑:调节juxtaglomerularcell释放renin。,*（一）肾小球滤过率GFR：单位时间内（每分钟）两肾生成的原尿量。GFR与体表面积成正比。每日滤过量是全身totalplasmavolume的60倍，即kidney每日净化处理全身plasma60次。,判断肾功能的指标-肾小球滤过率,GFR取决于：effectivefiltrationpressure和filtrationmembrane通透性,影响滤过率的因素,filtrationmembraneeffectivefiltrationpressure,滤过膜的结构1.内层毛细血管壁的内皮细胞：有50100nm的窗孔，血细胞不能通过。2.中层基膜：有48nm的纤维网孔，蛋白质和脂质不能通过。（主要）3.外层肾小囊的上皮细胞：裂隙膜上有414nm的孔，大分子蛋白质不能通过。,水分子,阳离子,葡萄糖,小分子阴离子,蛋白质,滤过膜通透作用的选择性滤过膜的机械屏障作用：glomerularfiltrationmembrane上大小不等的孔道，阻止大分子物质通过。（起主要作用）半径3.6nm不能通过，如plasmaglobulin，fibrinogen。,有效滤过压,有效滤过压:是glomerularfiltration的动力。肾小球有效滤过压肾小球毛细血管血压（血浆胶体渗透压囊内压）,Afferentarteriole端EFP45（2510）10mmHgEfferentarteriole端EFP45（3510）0mmHg由此可见，glomerularcapillary不是全段都有滤过作用。,肾小球毛细血管压平均动脉压（舒张压+1/3脉压差）：BP80180mmHg肾小球毛细血管压维持稳定GFR基本不变。BP4080mmHg肾小球毛细血管压滤过压GFR。BP40mmHgGFR0无尿。入球动脉和出球动脉的口径：入球动脉收缩肾小球毛细血管压有效滤过压GFR。出球动脉收缩肾小球毛细血管压有效滤过压GFR。,肾小管和集合管的转运功能,包括：reabsorption、secretion、excretion,Proteinuria,Whatisproteinuria?,Proteinuriameanstheappearanceofproteinintheurine.24-hoururineMicroalbuminuria30-150mgMild150-500mgModerate500-1000mgHeavy1000-3000mgNephroticrangemorethan3500mg,SIGNSANDSYMPTOMS,foamyurineedemaHypoalbuminemiaandhypotensionpre-renalacuterenalfailurehyperlipidemiaInfection,MechanismsofProteinuria,BenignProteinuriaGlomerularProteinuriaPrimaryorsecondaryglomerulopathyTubularProteinuriaTubularorinterstitialdiseaseOverflowProteinuriaasinmultiplemyelomasecretory(postglomerular),Primaryglomerulonephropathy,-MinimalchangediseaseMsPGNIdiopathicmembranousglomerulonephritisFocalsegmentalglomerulonephritisMembranoproliferativeglomerulonephritisIgAnephropathy,MCD,MsPGN,IgAN,IgAN,IgAN,MPGN,Secondaryglomerulonephropathy,DiabetesmellitusCollagenvasculardisorders(e.g.,lupusnephritis)AmyloidosisPreeclampsia先兆子痫Infection(e.g.,HIV,hepatitisBandC,poststreptococcalillness,syphilis,malariaandendocarditis)GastrointestinalandlungcancersLymphoma,chronicrenaltransplantrejection,SLELN,淀粉样变,DN,DN,DN,Tubular,HypertensivenephrosclerosisTubulointerstitialdiseasedueto:UricacidnephropathyAcutehypersensitivityinterstitialnephritisFanconisyndromeHeavymetalsSicklecelldiseaseNSAIDs,antibiotics,Acutepyelonephritis,AINS,AIN,CRF,Overflow,-HemoglobinuriaMyoglobinuriaMultiplemyelomaAmyloidosis,DiagnosticEvaluationofProteinuria,AgehealthandfamilyhistoryphysicalexaminationUrinalysisBloodanalysiskidneybiopsy,Howisproteinuriatreated?,Die