肾脏病学总论ppt课件

NEPHROLOGY 肾脏病学总论 1 NEPHROLOGY Structureofthekidney 结构 FunctionofthekidneyClinicalmanifestationLaboratoryEvaluationofRenalDiseaseMajorRenalSyndromes 2 3 4 5 6 7 8 TheNephron 肾单位 Consistsoftheglomerulus 肾小球 anditsattachedtubules 肾小管 Thefunctionalunitofthekidney 是肾脏的功能单位 9 10 11 12 Glomerulus 肾小球 Endothelialcells 内皮细胞 Glomerularbasementmembrane 肾小球基底膜GBM Podocytes 足突细胞 VisceralEpithelialCellMesangialcellsandmatrix 系膜细胞和基质 ParietalepitheliumBowman sCapsule 13 14 15 16 NormalGlomerulus PAS 17 18 NormalGlomerulusEM GBM Mesangium 19 GlomerularBasementMembrane CapillarySpace Endothelium UrinarySpace GBM Podocyte 20 GlomerularBasementMembrane Podocytes 21 22 JuxtaglomerularApparatus 近球旁器 VascularcomponentAfferentarterioleEfferentarterioleExtraglomerularmensangialregionTubulecomponentthickascendinglimb 23 24 Mechanismofreninrelease ThemaculadensatheorychangesintheNa Cl concentrationThestretch receptortheoryalterationsinthevolumestretchoftheafferentarteriol 25 TUBULAREPITHELIALCELLS 26 NEPHROLOGY StructureofthekidneyFunctionofthekidney 功能 ClinicalmanifestationLaboratoryEvaluationofRenalDiseaseMajorRenalSyndromes 27 NephronFunction Glomerularfiltration 肾小球滤过功能 Tubulesecretionandreabsorption 肾小管重吸收和分泌功能 28 肾小球滤过功能 glomerularfiltrationfunction 含氮废物如尿素 肌酐等主要由肾小球滤过排出 马尿酸 苯甲酸 各类胺类及尿酸也有部分经滤过排出 肾小球滤过示意图 排泄功能 excretoryfunction 29 肾小管重吸收和分泌功能 tubularreabsorptionandexcretionfunction 近端小管重吸收髓袢维持髓质高张及尿液的浓缩和稀释远端小管AVP作用下 尿素再循环 马尿酸 苯甲酸 各类胺类及尿酸主要由肾小管分泌 30 NephronFunction Waterbalance 水平衡 Eletrolytemetabolism 电解质代谢 Acid basebalance 酸碱平衡 Ureasecretion 代谢产物排泄 Others 31 内分泌功能 endocrinefunction 球旁器分泌肾素血管紧张素原 血管紧张素 血管紧张素 血管紧张素 RAS系统 32 Renin angiotensinsystem 肾素血管紧张素系统RAS angiotensinogenangiotensin angiotensin AldosteroneAT1 AT2 Renin ACE 33 Angiotensin IncreasepreglomerularandefferentarterioarresistancesEnhancethereabsorptionofsodiumEffectsonvasavectaDecreaseKf adecreaseinhydraulicconductivityEnhanceproductionofPG TGF 34 Endocrinefunction Prostaglandin PGE2 I2 A2 F2 TXA2 前列腺素族 Bradykinin 缓激肽 Erythropietin 促红细胞生成素EPO 1 25 dihydroxycholecalciferol 活性 1 25 OH 2D3 1 羟化酶 Decomposeorgan insulinTargetorgan PTH TH CA ADHEGF PDGF IGF 1 TGF 35 NEPHROLOGY StructureofthekidneyFunctionofthekidneyClinicalmanifestation 临床症状 LaboratoryEvaluationofRenalDiseaseMajorRenalSyndromes 36 Clinicalmanifestation Edema 水肿 Hypertension高血压Proteinuria蛋白尿Hematuria血尿Lossofrenalfunction肾功能丧失Painintheflankarea renalcolicChangesinurinevolumeOthers 37 NEPHROLOGY StructureofthekidneyFunctionofthekidneyClinicalmanifestationLaboratoryEvaluationofRenalDiseaseMajorRenalSyndromes 38 尿液检查 uronoscopy 39 U AChemistry DipStick ProteinGlucoseHemoglobinKetones pHBilirubinUrobilinogenNitriteLeukocyteesterase MOREIMPORTANT LESSIMPORTANT 40 U AChemistry Holdhere Dipuptohere Thereactionsaretimedandthecolorschangeifanalysesarepresent CompareSticktocolorsonDipStickBottleandgrade0 1 2 3 4 thedarkerthecolor thegreaterthegrade pH Protein Glucose Hgb ETC 41 Proteinuria蛋白尿 定义 持续超过150mg 日尿蛋白 肌酐 200mg g微量白蛋白尿 30 300mg d尿白蛋白 肌酐17 250mg g male 25 355mg g female大量蛋白尿 超过3 5g 1 73m2 日或50mg kg 日 42 按发病机制分类 肾小球性 肾小管性 溢出性 功能 体位性 43 按发病机制分类 1Glomerulardisease肾小球性蛋白尿 肾小球滤过膜损伤或通透性增高机械屏障受损 滤过膜孔径异常增大或断裂电荷屏障受损 滤过膜负电荷减少按分子量分类 1 选择性蛋白尿 2 非选择性蛋白尿 44 按发病机制分类 2Tubuledisease肾小管性蛋白尿 肾小管重吸收 由小分子蛋白构成 2 MG 溶菌酶 2g 日3Spillover溢出性蛋白尿 血中异常蛋白增多 免疫球蛋白轻链 血红蛋白 45 Proteinuria 功能性蛋白尿 发热 寒冷 运动 淤血 直立 1g 天体位性蛋白尿 直立位或脊柱前凸 46 3个 HP10万 h50万 12h 血尿 红细胞尿 hematuria 泌尿系 全身性 邻近器官 运动性 47 肾小球性 非肾小球性 48 49 3 管型尿5000个 12h 50 WhatisanRBCcast 51 白细胞尿 脓尿 细菌尿5个 HP40万 h100万 12h每HP见细菌或培养105 ml 52 肾小球滤过功能CcrScrBUN肾小管功能近端肾小管功能B2 MG等尿浓缩 稀释试验尿渗透压测定肾血浆流量测定酸化功能 肾功能检查 renalfunctionexamination 53 GlomerularFiltrationRate AsmeasuredbyCreatinineClearance UrineFlow ml d xUcr m umol L CrCl Pcr umol L x1440 min d WhereCrCl CreatinineClearanceUcr UrineCreatininePcr PlasmaCreatinine 54 KUB IVP或逆行肾盂造影 膀胱镜检查 放射性核素 超声检查 CT 核磁共振等 影像检查 55 Renalbiopsy IndicationsPreparationComplications 56 Renalbiopsy Tohelpestablishthediagnosis suggestprognosis directtherapy 57 正常肾小球 58 a脏层上皮细胞bGBMc内皮细胞d系膜e副系膜 59 NEPHROLOGY StructureofthekidneyFunctionofthekidneyClinicalmanifestationLaboratoryEvaluationofRenalDiseaseMajorRenalSyndromes 60 MajorRenalSyndromes TheNephroticSyndrome肾病综合征AcuteNephriticSyndrome急性肾炎综合征RapidlyProgressiveGlomerulonephritis急进性肾炎综合征ChronicNephriticSyndrome慢性肾炎综合征AsymptomaticHematuriaand orProteinuria无症状性尿异常 61 MajorRenalSyndromes cont AcuteRenalFailure急性肾衰竭综合征Chronicrenalfailure慢性肾衰竭综合征UrinaryTractInfection尿路感染综合征Nephrolithiasis肾石症 62 肾病综合征TheNephroticSyndrome Proteinuria 3 5gm day Hypoalbuminemia 30g L EdemaHyperlipidemaLipiduria 63 急性肾炎综合征AcuteNephriticSyndrome SuddenonsetofhematuriawithRBCcastsandrenalfailure days weeks RBCcastsnotlistedinthebook Butthisiscritical Proteinuria mildtomoderatebutNOTNephroticRange HypertensionHallmarkDisease PostStreptococcalGlomerulonephritis 64 急进性肾炎综合征RapidlyProgressiveGlomerulonephritis NephronalhematuriaRenalfailuredevelopingoverweekstomonthsDiffuseglomerularcrescentformation 65 无症状性尿异常AsymptomaticHematuriaorProteinuria HematuriawithorwithoutRBCcastsand orProteinuriausually 2 0gm dayNORENALFAILURENONEPHROTICSYNDROME 66 急性肾衰竭综合征AcuteRenalFailure Oliguria 400ml day RarelyanuriaRecentOnsetofAzotemia hours days 67 慢性肾衰竭综合征ChronicRenalFailure UremiaFinalCommonPathofAllChronicRenalDiseases 68 尿路感染综合征UrinaryTractInfection BacteriuriaandPyuriaDysuria Frequency UrgencyPyelonephritisorCystitisWBCcasts PyelonephritisTheBookMissesthisone FeverTheBookMissesthisone 69 肾石症Nephrolithiasis RenalstonesRenalcolic OOOUUUCCCHHH Severe CrampyPainintheflankareaHematuria NotRBCcasts 70 肾脏疾病的诊断 根据患者的病史 症状及体征 并辅以实验室检查和特殊检查 作出正确诊断病因诊断部