常用肾脏功能实验室检测课件

诊断学,肾功能检查AssessmentofRenalFunction,山东大学刘运芳,提要,UrineTests:Cheapandconvenient;ForscreeningandfollowingRenalFunctionsImmunologicalTestImagingExaminationRenalBiopsy,3,WhenorforWhat,KidneydiseasesorinjuriesOtherdiseasesinducedkidneyfunctioninjuriesDiabetesmellitusHypertensionShockorextensiveburnAuto-immunologicaldiseasesDrugtoxicity,4,StructureofKidney,5,肾单位,集合管,肾小体,肾小管,肾小球,肾小囊,近曲小管,远曲小管,髓袢,肾小球功能检查,Glomerularfunctionassessment,6,StructureandFunction,GFR:thevolumeoffluidfilteredfromtheglomerularcapillariesintotheBowmanscapsuleperunittime120-160ml/min,Contents,SerumCreatinine(sCr)&Serumurea(SU)CreatinineClearanceRate,CcrCystatinCMicroalbumin(MA)、Transferrinuria(TRU)、uricacid、urineIg,SerumCreatinine(sCr),Endogenousawasteproductproducedbymusclemetabolism,9,SerumCreatinine(sCr),Asmallmolecule,filtratedbyglomerularcompletely,andnotreabsorbedbytubulesCr:riseifthefilteringofthekidneyisdeficient,NormalValue:SerumCr:male:44-132mol/Lfemale:70-106mol/L,10,Stageofrenalfailure(male),11,Scr,ClinicalSignificanceofsCrincrease,12,riseonlywithmarkeddamagetonephronsfiltration,Serumurea(SU),alsonamedasBUN,InfluencefactorsProteinintakeProteindegradationLiverfunctionGlomerularfiltrationNormalvalue:Adults:1.8-7.1mmol/LChildrenorinfants:1.8-6.5mmol/L,13,Ureaorornithinecycleinliver,ClinicalSignificanceofSU,Renaldamage:ChronicrenalfailureCompensatorystage:SU9mmol/LFailurestage:SU20mmol/LUremia:SU28.6mmol/LAcuterenaldisease,14,ClinicalSignificance,Physical:：highproteindiet：pregnancyPre-renal:Highfever,Shock,Uppergastrointestinalhemorrhage,extensiveburn，severetraumaPost-renal:Obstructioninurinarytract,15,SU/Crratio:,CreatinineClearanceRate,Ccr,Definition：Ccristhevolumeofbloodplasmawithcreatininethatisclearedbykidneysperunittime.即：单位时间内,肾脏可全部清除多少毫升血浆中的肌酐,Normalvalue：80-120ml/min1.73m2,ClinicalSignificanceofCcr,Physiological：relatedwithsports,diets,agePathologicaldecreaseSensitiveforkidneyinjuryGFR50%时Ccr50ml/min,Stageofrenalfailure,19,CCr,Fortreatment,20,combinetreatment,planningforend-stagefailure,Stageofkidneyimpairement,Expressedinallnucleatedcells,encodedbyhousekeepinggeneLowmolecularweight,FiltratedfreelythroughglomerulusConcentrationinserumorplasmaisdeterminedbyGFR,CystatinC,CystatinCbetterthancreatinineinpredicting,CystatinCbetterthancreatinineinpredicting,优点,Highsensitivity：betterthanCcrHighspecificity：notinfluencedbyacutephasereaction,activities,genderandage,etal.Usedwidely:forrenaltransplantationstatusformonitoringGFRinnephrotoxicdrugtherapyforacuteandchronickidneydiseasesincludingadiabeticnephropathyOperatedeasily,肾小管功能检查,Testsoftubularfunction,26,Functionofrenaltubular,重吸收：水、电介质、小分子蛋白葡萄糖、氨基酸,肾单位,集合管,肾小体,肾小管,肾小球,肾小囊,近端小管,远端小管,髓袢,尿液稀释、浓缩,远端肾单位,近端肾小管功能检查,Testsofproximaltubularfunction,28,TestsofProximaltubularFunction,2-microglobulin1-microglobulinRetinol-bindingprotein,RBPN-acetyl-D-glucosaminidase,N-NAGFractionofurinenatriumexcretion,FeNa,2-microglobulin,2-MG,Presentonallnucleatedcells,especiallyonlymphocytes,andstableinbloodSmallprotein,freelyfiltratedbyglomeruliAlmostreabsorbedbytubulescompletelyThresholdofreabsorption:5mg/L,Normalvalue:Urine：0.3mg/L,ClinicalSignificanceof2-MG,Serum2-MG：GFR:whenCcr80ml/min，moresensitivethanScr恶性肿瘤、炎性疾病（肝炎、类风湿关节炎等）Reabsorptionfunctionofproximaltubules：urine2-MGincrease(blood2-MG5mg/L)AcuteandchronicpyelonephritisDrugortoxininducedtubularnecrosis,ClinicalSignificance,EvaluationfortransplantkidneyfunctionUrine2-MG，impliedgraftrejectionserum2-MG:helpforsub-clinicalrejectionofgrafts肾移植虽有少尿，但血2-MG下降者提示预后良好。,1-microglobulin,1-MG,Smallglycoproteins,synthesizedinliverFreelyfiltratedthroughglomeruliAlmostreabsorbedbyproximaltubulescompletely,Normalvalue:Urine：15mg/24h,ClinicalSignificanceof1-MG,Decrease:severehepatitisandhepaticnecrosisSerum1-MG：GFR:whenCcrlower，location,Fractionofurinenatriumexcretion,Natrium:freelyfiltratedthroughglomeruliand99%wasreabsorbedbyproximaltubulesNormalvalues:FeNa:0.009,ClinicalSignificance,Impairmentindistaltubules：Earlystage：overnighturine750ml,Day/