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Chapter1
GeneralIntroduction
Chapter1
GeneralIntroductioBasicstructureofkidneyLocationBasicstructureofkidneyLocatBasicstructureofkidneyLocation:towsidesofspinalcolumnbehindperitoneumLiftkidney:upperpoleT11lowpoleL2Rightkidney:neartheliverupperpoleT12lowpoleL3Length10.5-11.5cmWidth5-7.2cmThickness2-3cmBasicstructureofkidneyLocatBasicstructureofkidneyConstitute
kidneyunitjuxtaglomerularcomplexrenalinterstitiumbloodvesselnervusBasicstructureofkidneyConstBasicstructureofkidneyKidneyunitBasicstructureofkidneyKidneBasicstructureofkidneyKidneyunitrenalcorpuscle:glomerulusrenalcapsulerenaltubule:proximaltubule thinsegmentdistaltubuleconnectingtubuleBasicstructureofkidneyKidneBasicstructureofkidneyStructureofglomerulusBasicstructureofkidneyStrucBasicstructureofkidneyStructureofglomerulus:
endotheliumcellglomerularbasementmembranepodocyte/footcellBasicstructureofkidneyStruc內(nèi)科學(xué)教學(xué)課件:英文班泌尿系統(tǒng)疾病總論內(nèi)科學(xué)教學(xué)課件:英文班泌尿系統(tǒng)疾病總論Basicstructureofkidneyfootcell
sticktoGBMbypodocyticprocessstenopaicholeisclosedbystenopaicmembraneBasicstructureofkidneyfoot內(nèi)科學(xué)教學(xué)課件:英文班泌尿系統(tǒng)疾病總論Basicstructureofkidneyglomerularbasementmembrane(GBM):
1.middlelevel:compactlayersialoprotein2.strataexternumandendothecium:tectoriumheparansulfateanion3.Ⅳcollagenprotein:basicstructurefillinglaminin,fibronectionBasicstructureofkidneyglomeGBMfunction
maintainnormalstructuretiredjacentcellconstitutefiltrationbarrierGBMfunctionconstitutefiltrationbarrier
size/molecular
barrier:limitpassingofbigmolecularchargebarrie:restrictfilterofnegativechargematerialconstitutefiltrationbarriera臟層上皮細(xì)胞bGBMc內(nèi)皮細(xì)胞d系膜e副系膜a臟層上皮細(xì)胞bGBMc內(nèi)皮細(xì)胞d系膜PhysiologicalfunctionofkidneyExcretionofmetabolite
Regulationofwaterelectrolytes&acid-basebalance
MaintainingthestablenessofinternalenvironmentPhysiologicalfunctionofkidnGlomerularfilterfunctionMainformofmetabolitesexcretionwhichincludeurea,creatine,hippuricacid,benzoicacid,amine&uricacid2.GFR
indicateifthefilterfunctionisnormalornot,whichisdeterminedbyhydrostaticpressure,colloidosmoticpressure,areaoffiltermembrane&filterfractionofcapillary。GlomerularfilterfunctionMain腎小球?yàn)V過(guò)功能腎小球?yàn)V過(guò)功能Reabsorption&secretionfunctionofrenaltubuleCrudeurine(electrolytecomponentsaresimilarwithplasma)→180L/d;
Urinevolume→1500ml/d(99%isreabsorbed);
Reabsorption&secretionarecontrolledbyrenaltubule→makewater-electrolytebalance.Reabsorption&secretionfunct腎小管重吸收和分泌功能近端小管是重吸收的主要部位,葡萄糖、氨基酸全部被重吸收,排泄有機(jī)酸、尿酸、造影劑、抗生素。髓袢細(xì)段的尿液濃縮起重要作用。遠(yuǎn)端小管調(diào)節(jié)終尿成分的主要場(chǎng)所,重吸收Na,排出K及分泌H、NH4。腎小管重吸收和分泌功能近端小管是重吸收的主要部位,葡萄糖、氨Endocrinefunctionofkidney①vasoactivehormones→actsonkidney→regulatephysiologicallyhemodynamics&water-saltmetabolism→includesrenin、angiotensin、prostategroup、kininsystem②non-vasoactivehormones→actsonwholebody→includes
1α—hydroxylase&erythropoietinEndocrinefunctionofkidney①vExaminationofkidneydiseaseExaminationofkidneydiseaseUrinalysis1、proteinuria
urineprotein>150mg/d,qualitativeanalysis(+),urineprotein/creatinine>200mg/g→proteinuriaurineprotein>30~300mg/d→minimalurineproteinUrinalysis1、proteinuriaClassificationofproteinuriaReasons:(1)Physiologic
proteinuria①functional~②positional~(2)Glomerularproteinuria
:
selective~nonselective~
ClassificationofproteinuriaRClassificationofproteinuria(3)tubuleproteinuria
:proteinreabsorptiondefectofproximaltubule→β2-microglobulin、lysozymeinurine;≤2g/d.(4)overflowproteinuria:abnormalprotein(Hb/myoglobin/lightchainproteinofmultiplemyeloma)oflowmolecularweight↑Classificationofproteinuria(Urinalysis2hematuriagrossµscopic~。新鮮尿離心沉渣每高倍視野紅細(xì)胞超過(guò)3個(gè),稱為鏡下血尿。尿外觀呈洗肉水樣、血樣、醬油樣或有血凝塊時(shí),稱肉眼血尿。Urinalysis2hematuria尿液檢查尿液檢查尿液檢查鑒別腎小球源性血尿:a新鮮尿沉渣鏡檢
變形紅細(xì)胞為腎小球源性;原因:GBM斷裂,紅細(xì)胞通過(guò)受血管內(nèi)壓力擠出受損,其后通過(guò)腎小管各段時(shí)受滲透壓變化和PH作用,呈現(xiàn)變形紅細(xì)胞血尿,紅細(xì)胞體積表小、破裂。均一形態(tài)正常紅細(xì)胞尿?yàn)榉悄I小球源性尿液檢查鑒別腎小球源性血尿:尿液檢查鑒別腎小球源性血尿b尿紅細(xì)胞容積分布曲線腎小球源性血尿呈非對(duì)稱曲線,其峰值紅細(xì)胞容積小于靜脈峰值紅細(xì)胞容積非腎小球源性血尿呈對(duì)稱曲線,其峰值紅細(xì)胞容積大于靜脈峰值尿液檢查鑒別腎小球源性血尿50100150200a50100150200b5010015020050100150200c50100150200d50100150尿液檢查3.cylinderuria:castinurine→proteincoagulationintubule→cell/manygranularcasts&proteinuriaappearinthemeantimeismeaningfulinclinic原因:1、腎小球或腎小管性疾病
2、炎癥、藥物刺激使粘蛋白分泌少而形成尿液檢查3.cylinderuria:castinu內(nèi)科學(xué)教學(xué)課件:英文班泌尿系統(tǒng)疾病總論尿液檢查4leucocyturia、pyuria、bacteriurialeucocyturia
:pyuria→>5WBC/HPoffreshcentrifugalurine/>40millionsWBC/1hrsoffreshurine/>100millionsWBC/12hrs;pyuria
bacteriuria
:bacteriaineveryHP/culturedbacteriacolonies>105/ml;尿液檢查4leucocyturia、pyuria、bactGFRdeterminationGFR:theabilityofrenalclearanceofplasmasubstancesperunittime
EndogenousCcr(creatinineclearancerate)inclinicistheusualmeansofestimatingGFR→Recently,K/DOQIclinicalpracticeguiderecommend2formulastocalculateGFR:Cokcroff-Gault&MDRD.GFRdeterminationGFR:theabilImagingtests
ultrasonography
CT&MRIarteriography&venographyradionuclide,Imagingtests內(nèi)科學(xué)教學(xué)課件:英文班泌尿系統(tǒng)疾病總論內(nèi)科學(xué)教學(xué)課件:英文班泌尿系統(tǒng)疾病總論內(nèi)科學(xué)教學(xué)課件:英文班泌尿系統(tǒng)疾病總論Commonsyndromesofrenaldiseases1.Nephroticsyndrome:proteininurine>3.5g/dproteininplasma<30g/dedemahyperlipemiaCommonsyndromesofrenaldise腎臟疾病常見(jiàn)綜合征2.Nephritissyndrome:proteinuria,hematuria,hypertension;3.Asymptomaticurineabnormality:4.Acuterenalfailure&rapidlyprogressiverenalfailuresyndrome:5.Chronicrenalfailuresyndrome:progressiveirreversiblyrenalfunctionalfailure.腎臟疾病常見(jiàn)綜合征2.Nephritissyndrome:EvaluationofrenaldiseasesEtiologydiagnose:primaryorsecondarypathologydiagnose:Nephritis,NS,AKI,proteinuria,
hematuria,percutaneousrenalbiopsy
functiondiagnose:AKI、CKDcomplicationdiagnose:ARF、CRFEvaluationofrenaldiseasesEtPrevention&cure:Principle*Wipeoffinducement;
*Commontreatment;
*Inhibitimmune&inflammationreactions;
*Preventionandcurecomplication;
*Postponetheprogressofrenaldiseases;
*RenalsubstitutivetherapyPrevention&cure:PrincipleRenalsubstitutivetherapy→onlyeffectivewayforpatientsofterminalrenalfailure→includes:hemodialysis,peritonealdialysis,kidneytransplantation;Renalsubstitutivetherapy→onPertonealdialysis
腹膜透析交換Pertonealdialysis
腹膜透析交換hemodialysishemodialysisprogression&prospectPathogenesisofrenaldiseases;
Prevention&treatmentofchronickidneydiseases(CKD);
Dialysistherapy&kidneytransplantation;progression&prospectPat思考題腎臟的結(jié)構(gòu)與功能。腎臟疾病常見(jiàn)的臨床表現(xiàn)。腎臟疾病的診斷要求。思考題腎臟的結(jié)構(gòu)與功能。Chapter1
GeneralIntroduction
Chapter1
GeneralIntroductioBasicstructureofkidneyLocationBasicstructureofkidneyLocatBasicstructureofkidneyLocation:towsidesofspinalcolumnbehindperitoneumLiftkidney:upperpoleT11lowpoleL2Rightkidney:neartheliverupperpoleT12lowpoleL3Length10.5-11.5cmWidth5-7.2cmThickness2-3cmBasicstructureofkidneyLocatBasicstructureofkidneyConstitute
kidneyunitjuxtaglomerularcomplexrenalinterstitiumbloodvesselnervusBasicstructureofkidneyConstBasicstructureofkidneyKidneyunitBasicstructureofkidneyKidneBasicstructureofkidneyKidneyunitrenalcorpuscle:glomerulusrenalcapsulerenaltubule:proximaltubule thinsegmentdistaltubuleconnectingtubuleBasicstructureofkidneyKidneBasicstructureofkidneyStructureofglomerulusBasicstructureofkidneyStrucBasicstructureofkidneyStructureofglomerulus:
endotheliumcellglomerularbasementmembranepodocyte/footcellBasicstructureofkidneyStruc內(nèi)科學(xué)教學(xué)課件:英文班泌尿系統(tǒng)疾病總論內(nèi)科學(xué)教學(xué)課件:英文班泌尿系統(tǒng)疾病總論Basicstructureofkidneyfootcell
sticktoGBMbypodocyticprocessstenopaicholeisclosedbystenopaicmembraneBasicstructureofkidneyfoot內(nèi)科學(xué)教學(xué)課件:英文班泌尿系統(tǒng)疾病總論Basicstructureofkidneyglomerularbasementmembrane(GBM):
1.middlelevel:compactlayersialoprotein2.strataexternumandendothecium:tectoriumheparansulfateanion3.Ⅳcollagenprotein:basicstructurefillinglaminin,fibronectionBasicstructureofkidneyglomeGBMfunction
maintainnormalstructuretiredjacentcellconstitutefiltrationbarrierGBMfunctionconstitutefiltrationbarrier
size/molecular
barrier:limitpassingofbigmolecularchargebarrie:restrictfilterofnegativechargematerialconstitutefiltrationbarriera臟層上皮細(xì)胞bGBMc內(nèi)皮細(xì)胞d系膜e副系膜a臟層上皮細(xì)胞bGBMc內(nèi)皮細(xì)胞d系膜PhysiologicalfunctionofkidneyExcretionofmetabolite
Regulationofwaterelectrolytes&acid-basebalance
MaintainingthestablenessofinternalenvironmentPhysiologicalfunctionofkidnGlomerularfilterfunctionMainformofmetabolitesexcretionwhichincludeurea,creatine,hippuricacid,benzoicacid,amine&uricacid2.GFR
indicateifthefilterfunctionisnormalornot,whichisdeterminedbyhydrostaticpressure,colloidosmoticpressure,areaoffiltermembrane&filterfractionofcapillary。GlomerularfilterfunctionMain腎小球?yàn)V過(guò)功能腎小球?yàn)V過(guò)功能Reabsorption&secretionfunctionofrenaltubuleCrudeurine(electrolytecomponentsaresimilarwithplasma)→180L/d;
Urinevolume→1500ml/d(99%isreabsorbed);
Reabsorption&secretionarecontrolledbyrenaltubule→makewater-electrolytebalance.Reabsorption&secretionfunct腎小管重吸收和分泌功能近端小管是重吸收的主要部位,葡萄糖、氨基酸全部被重吸收,排泄有機(jī)酸、尿酸、造影劑、抗生素。髓袢細(xì)段的尿液濃縮起重要作用。遠(yuǎn)端小管調(diào)節(jié)終尿成分的主要場(chǎng)所,重吸收Na,排出K及分泌H、NH4。腎小管重吸收和分泌功能近端小管是重吸收的主要部位,葡萄糖、氨Endocrinefunctionofkidney①vasoactivehormones→actsonkidney→regulatephysiologicallyhemodynamics&water-saltmetabolism→includesrenin、angiotensin、prostategroup、kininsystem②non-vasoactivehormones→actsonwholebody→includes
1α—hydroxylase&erythropoietinEndocrinefunctionofkidney①vExaminationofkidneydiseaseExaminationofkidneydiseaseUrinalysis1、proteinuria
urineprotein>150mg/d,qualitativeanalysis(+),urineprotein/creatinine>200mg/g→proteinuriaurineprotein>30~300mg/d→minimalurineproteinUrinalysis1、proteinuriaClassificationofproteinuriaReasons:(1)Physiologic
proteinuria①functional~②positional~(2)Glomerularproteinuria
:
selective~nonselective~
ClassificationofproteinuriaRClassificationofproteinuria(3)tubuleproteinuria
:proteinreabsorptiondefectofproximaltubule→β2-microglobulin、lysozymeinurine;≤2g/d.(4)overflowproteinuria:abnormalprotein(Hb/myoglobin/lightchainproteinofmultiplemyeloma)oflowmolecularweight↑Classificationofproteinuria(Urinalysis2hematuriagrossµscopic~。新鮮尿離心沉渣每高倍視野紅細(xì)胞超過(guò)3個(gè),稱為鏡下血尿。尿外觀呈洗肉水樣、血樣、醬油樣或有血凝塊時(shí),稱肉眼血尿。Urinalysis2hematuria尿液檢查尿液檢查尿液檢查鑒別腎小球源性血尿:a新鮮尿沉渣鏡檢
變形紅細(xì)胞為腎小球源性;原因:GBM斷裂,紅細(xì)胞通過(guò)受血管內(nèi)壓力擠出受損,其后通過(guò)腎小管各段時(shí)受滲透壓變化和PH作用,呈現(xiàn)變形紅細(xì)胞血尿,紅細(xì)胞體積表小、破裂。均一形態(tài)正常紅細(xì)胞尿?yàn)榉悄I小球源性尿液檢查鑒別腎小球源性血尿:尿液檢查鑒別腎小球源性血尿b尿紅細(xì)胞容積分布曲線腎小球源性血尿呈非對(duì)稱曲線,其峰值紅細(xì)胞容積小于靜脈峰值紅細(xì)胞容積非腎小球源性血尿呈對(duì)稱曲線,其峰值紅細(xì)胞容積大于靜脈峰值尿液檢查鑒別腎小球源性血尿50100150200a50100150200b5010015020050100150200c50100150200d50100150尿液檢查3.cylinderuria:castinurine→proteincoagulationintubule→cell/manygranularcasts&proteinuriaappearinthemeantimeismeaningfulinclinic原因:1、腎小球或腎小管性疾病
2、炎癥、藥物刺激使粘蛋白分泌少而形成尿液檢查3.cylinderuria:castinu內(nèi)科學(xué)教學(xué)課件:英文班泌尿系統(tǒng)疾病總論尿液檢查4leucocyturia、pyuria、bacteriurialeucocyturia
:pyuria→>5WBC/HPoffreshcentrifugalurine/>40millionsWBC/1hrsoffreshurine/>100millionsWBC/12hrs;pyuria
bacteriuria
:bacteriaineveryHP/culturedbacteriacolonies>105/ml;尿液檢查4leucocyturia、pyuria、bactGFRdeterminationGFR:theabilityofrenalclearanceofplasmasubstancesperunittime
EndogenousCcr(creatinineclearancerate)inclinicistheusualmeansofestimatingGFR→Recently,K/DOQIclinicalpracticeguiderecommend2formulastocalculateGFR:Cokcroff-Gault&MDRD.GFRdeterminationGFR:theabilImagingtests
ultrasonography
CT&MRIarteriography&venographyradionuclide,Imagingtests內(nèi)科學(xué)教學(xué)課件:英文班泌尿系統(tǒng)疾病總論內(nèi)科學(xué)教學(xué)課件:英文班泌尿系統(tǒng)疾病總論內(nèi)科學(xué)教學(xué)課件:英文班泌尿系統(tǒng)疾病總論Commonsyndromesofrenaldiseases1.Nephroticsyndrome:proteinin
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