肾脏病学总论

NEPHROLOGY

(肾脏病学总论）1整理pptNEPHROLOGYStructureofthekidney(结构)FunctionofthekidneyClinicalmanifestationLaboratoryEvaluationofRenalDiseaseMajorRenalSyndromes2整理ppt3整理ppt4整理ppt5整理ppt6整理ppt7整理ppt8整理pptTheNephron(肾单位)

Consistsoftheglomerulus(肾小球)

anditsattachedtubules(肾小管).Thefunctionalunitofthekidney(是肾脏的功能单位)9整理ppt10整理ppt11整理ppt12整理pptGlomerulus(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’sCapsule13整理ppt14整理ppt15整理ppt16整理pptNormalGlomerulus(PAS)17整理ppt18整理pptNormalGlomerulusEMGBMMesangium19整理pptGlomerularBasementMembraneCapillarySpaceEndotheliumUrinarySpaceGBMPodocyte20整理pptGlomerularBasementMembranePodocytes21整理ppt22整理pptJuxtaglomerularApparatus

(近球旁器)VascularcomponentAfferentarterioleEfferentarterioleExtraglomerularmensangialregionTubulecomponentthickascendinglimb23整理ppt24整理pptMechanismofreninreleaseThemaculadensatheorychangesintheNa+,Cl-concentrationThestretch-receptortheoryalterationsinthevolumestretchoftheafferentarteriol25整理pptTUBULAREPITHELIALCELLS26整理ppt

NEPHROLOGYStructureofthekidneyFunctionofthekidney(功能)ClinicalmanifestationLaboratoryEvaluationofRenalDiseaseMajorRenalSyndromes27整理pptNephronFunctionGlomerularfiltration(肾小球滤过功能）Tubulesecretionandreabsorption（肾小管重吸收和分泌功能）28整理ppt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整理ppt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整理pptNephronFunctionWaterbalance(水平衡)Eletrolytemetabolism(电解质代谢)Acid-basebalance(酸碱平衡)Ureasecretion(代谢产物排泄)Others:31整理ppt内分泌功能

（endocrinefunction）

球旁器分泌肾素血管紧张素原→血管紧张素Ⅰ→血管紧张素Ⅱ、血管紧张素ⅢRAS系统32整理pptRenin-angiotensinsystem

(肾素血管紧张素系统RAS)angiotensinogenangiotensinⅠangiotensinⅡAldosteroneAT1,AT2ReninACE33整理pptAngiotensinⅡIncreasepreglomerularandefferentarterioarresistancesEnhancethereabsorptionofsodiumEffectsonvasavectaDecreaseKf—adecreaseinhydraulicconductivityEnhanceproductionofPG,TGFβ

34整理ppt

EndocrinefunctionProstaglandin: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ＶＤ３）

1,25-(OH)2D3(

1α羟化酶)Decomposeorgan:insulinTargetorgan:PTH,TH,CA,ADHEGF,PDGF,IGF-1,TGFα,β35整理ppt

NEPHROLOGYStructureofthekidneyFunctionofthekidneyClinicalmanifestation(临床症状)LaboratoryEvaluationofRenalDiseaseMajorRenalSyndromes36整理pptClinicalmanifestationEdema(水肿)Hypertension高血压Proteinuria蛋白尿Hematuria血尿Lossofrenalfunction肾功能丧失Painintheflankarea:renalcolicChangesinurinevolumeOthers37整理ppt

NEPHROLOGYStructureofthekidneyFunctionofthekidneyClinicalmanifestationLaboratoryEvaluationofRenalDiseaseMajorRenalSyndromes38整理ppt尿液检查

（uronoscopy）

39整理pptU/A

Chemistry(DipStick)ProteinGlucoseHemoglobinKetonespHBilirubinUrobilinogenNitriteLeukocyteesteraseMOREIMPORTANTLESS

IMPORTANT40整理pptU/A

ChemistryHoldhereDipuptohereThereactionsaretimedandthecolorschangeifanalysesarepresent.CompareSticktocolorsonDipStickBottleandgrade0,1+,2+,3+,4+;thedarkerthecolor,thegreaterthegrade!pHProteinGlucoseHgbETC.41整理pptProteinuria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整理ppt按发病机制分类肾小球性肾小管性溢出性功能、体位性43整理ppt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整理ppt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：β2-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整理pptProteinuria４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整理ppt

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整理ppt肾小球性非肾小球性48整理ppt49整理ppt

3.管型尿5000个/12h50整理pptWhatisanRBCcast?

51整理ppt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/ml52整理ppt

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整理pptGlomerularFiltrationRate

(AsmeasuredbyCreatinineClearance)

UrineFlow(ml/d)xUcr(m=umol/L)CrCl=--------------------------------------------Pcr(umol/L)x1440(min/d)WhereCrCl=CreatinineClearanceUcr=UrineCreatininePcr=PlasmaCreatinine54整理ppt

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整理pptRenalbiopsyIndicationsPreparationComplications56整理pptRenalbiopsyTohelpestablishthediagnosis,suggestprognosis,directtherapy.57整理ppt正常肾小球58整理ppta脏层上皮细胞bGBMc内皮细胞d系膜e副系膜59整理pptNEPHROLOGYStructureofthekidneyFunctionofthekidneyClinicalmanifestationLaboratoryEvaluationofRenalDisease

MajorRenalSyndromes60整理pptMajorRenalSyndromesTheNephroticSyndrome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AsymptomaticHematuria

and/or

Proteinuria无症状性尿异常

61整理pptMajorRenalSyndromes(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整理ppt肾病综合征

TheNephroticSyndromeProteinuria(>3.5gm/day)Hypoalbuminemia（〈30g/L)EdemaHyperlipidemaLipiduria63整理ppt急性肾炎综合征

AcuteNephriticSyndromeSuddenonsetofhematuriawithRBCcastsandrenalfailure(days-weeks)RBCcastsnotlistedinthebook!!Butthisiscritical!!Proteinuria(mildtomoderatebutNOTNephroticRange)HypertensionHallmarkDisease:PostStreptococcalGlomerulonephritis64整理ppt急进性肾炎综合征

RapidlyProgressiveGlomerulonephritisNephronalhematuriaRenalfailuredevelopingoverweekstomonthsDiffuseglomerularcrescentformation.65整理ppt无症状性尿异常

AsymptomaticHematuria

orProteinuriaHematuriawithorwithoutRBCcastsand/orProteinuriausually<2.0gm/dayNORENALFAILURENONEPHROTICSYNDROME66整理ppt急性肾衰竭综合征

AcuteRenalFailureOliguria(<400ml/day)RarelyanuriaRecentOnsetofAzotemia(hours/days)67整理ppt慢性肾衰竭综合征

ChronicRenalFailureUremiaFinalCommonPathofAllChronicRenalDiseases68整理ppt尿路感染综合征

UrinaryTractInfectionBacteriuriaandPyuriaDysuria,Frequency,UrgencyPyelonephritisorCystitisWBCcasts=PyelonephritisTheBookMissesthisone!!FeverTheBookMissesthisone!!69整理ppt肾石症

NephrolithiasisRenalstonesRenalcolic-OOOUUUCCCHHH!!Severe,Crampy