OutlinesofKidneyDisease英文版医学资料专家讲座

OutlinesofKidneyDiseasePanLing第1页Whatistheurinarysystemcomposedof?kidneyureterbladder/cysturethralassociatedvesselsandnervesAReviewofUrinarySystem第2页第3页Thefunctionalunitofthekidneyisthenephron.Thenephroninclude：

therenalcorpuscle

（glomerulusBowmancapsule)thetubule第4页第5页Anabilitytomaintainfluid,electrolyteandacid-basebalanceAnabilitytoexcretemetabolicsubstance(mainlynitrogenouswastes)EndocrinefunctionKidneyfunction第6页1strucure:

endothelialbasementmembraneepithelial2character:size-selectivebarriercharge-selectivebarrier3function：anultrafiltrateofplasma.Glomerolar第7页第8页第9页第10页ProximalTubules:reabsorption100%Glucose,aminoacid90%bicarbonate70%water,natriumsecretehydrogenDistalTubule:

secretehydrogen,potassium,ammoniaTheLimbsofHenle’sLoop:urineinspissationanddilutionTubularfunction第11页Vasoactivesubstance:Vasoconstriction:renin,angiotensinⅡVasodilatation:kinin,prostaglandinNon-vasoactivesubstance:

erythropoietincalcitriolEndocrinefunction

第12页

APPROACHTOTHEPATIENTWITHRENALDISEASE第13页Apatientwillpresentwithrenaldiseaseinoneoftwoways:discoveredincidentallywithevidenceofrenaldysfunctionGeneralconsiderations第14页

thediseaseevaluationincludes:anestimationofdiseasedurationacarefulurinalysisglomerularfiltrationrateGeneralconsiderations第15页DISEASEDURATIONrenaldiseasemaybeacuteorchronic,forinstance,Acuterenalfailure:worseningofrenalfunctionoverhourstodays

chronicrenalfailure:alossofrenalfunctionovermonthstoyears第16页尿液检查

（uronoscopy）

第17页Itinclude:dipstickexamination:gravity,pH,protein,hemoglobin,nitrites,ketones,etc.microscopicexamination:searchesforallformedelements----cells,casts,andinfectingorganisms.

URINALYSIS

第18页PROTEINURIA

whatisproteinuria?proteinintheurine＞150mg/24hoursurineprotein/urinecreatinine＞200mg/gwhatismicroalbuminuria?

urinealbumin/urinecreatinine30-300ug/mg第19页

Classificationofproteinuria:

①.functionalproteinuria.

cause:acuteillness,exercise,andorthostaticposition.

characteristic:transient

generally＜1g/d第20页

②ProteinuriaresultsfromoverproductionofcirculatingsuchasBencejonesproteinsassociatedwithmultiplemyeloma.第21页③glomerularproteinuria:

cause:abnormalitiesintheglomerularfiltrationbarrier

characteristic:bigormiddlemolecularproteinalargeamountofprotein﹥2g/d第22页④Tubularproteinuria:

cause:damagedreabsorptionofnormallyfilteredproteinsintheproximaltubule.

characteristic:smallmolecularproteingenerally＜2g/d第23页Hematuria

Whatishematuria?

＞3redcells/HP.(microscopicexaminationisessentialfordiagnosis.)

第24页Causeofhematuria

RenalcauseGlomerulardisease:adistinctivedimorphicredcells.nonglomerular:stones,infection,tuberculosis,etc.Extrarenalcause:第25页GlomerularHematuriaPainlessandtotalhematuriaProteinuriaandcastsdimorphicredcells

第26页第27页Leukocyturia(pyuria)

Conception:

＞5whitecells/HPurinarytractinfectioninterstitialnephritisLupusnephritis

第28页Estimationofglomerularfiltrationrate(GFR)

Definition:

theamountofplasmaultrafilteredacrosstheglomerularcapillariesinacertaintime.Creatinineclearance(Ccr)isaindicatorofGFRNormalrangeofCcr:90-110mL/min/1.73m2

第29页

InfluencesfactorsofGFRGlomerularhydraulicpressureColloidosmoticpressureFitrationsurfacearea

第30页IMAGINGSTUDIESUltrasonographyIntravenousUrography(IVP)ComputedTomography(CT)Magneticresonanceimaging(MRI)

Arteriography,venographyRadionuclideStudies第31页IMAGINGSTUDIESUltrasonography:usedwidelyinrenaldisease.itcanidentifytherenalcortex,medulla,pyramids,andadistendedcollectionsystemorureter.第32页Ultrasonography:identifyKidneysizeidentifyhydronephrosis,renalmasslesions,polycystickidneydisease.Localizethekidneyforapercutaneousinvasiveprocedure.Assesspostvoidingbladderresidual.第33页RENALBIOPSYArenalbiopsycanbeobtainedtohelpestablishthediagnosis,suggestprognosis,ordirecttherapy.Meansforhistologicstudy:LightmicroscopicstudiesImmunofluorescencetechniquesElectronmicroscopy第34页第35页RENALBIOPSYIndications:UnexplainedacuterenalfailureofchronicrenalinsufficiencyAcutenephriticsyndromesUnexplainedproteinuria第36页RENALBIOPSYIndications:PreviouslyidentifiedandtreatedlesionstoplanfuturetherapySystemicdiseasesassociatedwithkidneydysfunctionSuspectedtransplantrejection

第37页RENALBIOPSYContraindications:

asolitaryorectopickidneyuncorrectedbleedingdisorderSevereuncontrolledhypertensionRenalinfection第38页RENALBIOPSYContraindications:HydronephrosisEnd-stagerenaldiseaseRenalneoplasm,congenitalanomalies,multiplecysts,oranuncooperativepatient.第39页Syndromeofrenaldisease

NephroticSyndrome

heavyproteinuria:＞3.5g/dhypoalbuminemia：＜30g/Ledemahyperlipidemia第40页Syndromeofrenaldisease

NephriticSyndrome

proteinuriahematuriahypertension＜1yearacutenephriticsyndrom＞1yearchronicnephriticsyndromRenalfailurewithinweekstomonthsacuterapidlyprogressivenephriticsyndrom第41页第42页crescent第43页Syndromeofrenaldisease

AsymptomaticUrinalysisAbnormalnosymptomispresent,yetUrinalysisAbnormalexists.HemauriaLeukocyturia