泌尿系統(tǒng)疾病56608 課件

泌尿系統(tǒng)疾病UrinarySystemdisease西安交通大學(xué)第一醫(yī)院腎內(nèi)科尹愛萍Nephrology泌尿系統(tǒng)疾病西安交通大學(xué)第一醫(yī)院腎內(nèi)科Nephrology1總論

GeneralIntroductionNephrology總論

GeneralIntroductionN2

SubstanceOvervierwConstitutionandfunctionofurinarysystemThegeneralmanifestationsofurinarysystemThetestsofrenalfunctionDiagnosis,preventionandtherapyProgresandtolookintothefutureNephrologySubstanceOvervierwNephrology3Overvierw泌尿系統(tǒng)主管機(jī)體尿液的生成和排泄，由腎臟、輸尿管、膀胱、尿道及相關(guān)的血管神經(jīng)等組成。腎臟是內(nèi)分泌器官、排泄器官。對(duì)維護(hù)機(jī)體內(nèi)環(huán)境的穩(wěn)定起重要的作用。Overvierw泌尿系統(tǒng)主管機(jī)體尿液的生成和排泄，由腎臟、4

SubstanceOvervierwConstitutionandfunctionofurinarysystemThegeneralmanifestationsofurinarysystemThetestsofrenalfunctionDiagnosis,preventionandtherapyProgresandtolookintothefutureNephrologySubstanceOvervierwNephrology5腎臟(kidney)輸尿管(ureter)膀胱(bladder)尿道(urethra)constitutionofurinarysystem腎臟(kidney)輸尿管(ureter)膀胱(bladde6GrossFeaturesTheweightofeachkidney：100—140g（adultman）（womanlessthanman）Length10.5—11.5cmWidth5—7.2cmThichness2—3cmNephrologyGrossFeaturesTheweightofea7泌尿系統(tǒng)疾病56608課件8Thenephron(腎單位):Thefunctionalunitofthekidneyisthenephron(0.4—1.2×106).attachedtubule(renaltubule)Theglomerulus(enclosedcapillarynetwork)

Bowman'scapsuleglomerulartufts

collectingductproximaltubuleloopofHenledistaltubuleRenalcorpuscleNephrologyThenephron(腎單位):attachedtubu9泌尿系統(tǒng)疾病56608課件10EssentialRenalFunctionsFiltratefunctionattheglomeruluscapillaryReabsorptionandexcretionbyrenaltubuleEndocrinefunctionsoftherenalRegulatingwater,acid-baseandelectrolytebalanceEliminatingmetabolicwasteproductsRegulatingbloodpressure穩(wěn)定內(nèi)環(huán)境內(nèi)分泌功能RAASPGBKSEPO1-hydrooxylaseNephrologyEssentialRenalFunctionsFiltr11(遠(yuǎn)曲小管)(遠(yuǎn)曲小管)12

醛固酮升高血壓視上神經(jīng)核煩渴AGT原AGT-I腎素95%來源于球旁細(xì)胞1-5%來源于致密斑、間質(zhì)細(xì)胞少量來源于腎外組織（子宮、大腦、胎盤）AGT-IIAGT-III轉(zhuǎn)化酶失活腎素血管緊張素醛固酮系統(tǒng)(RAAS)醛固酮升高血壓視上神經(jīng)核煩渴AGT原AGT-I腎素95%來13作用于全身血管平滑肌使血管收縮刺激腎上腺球狀帶產(chǎn)生醛固酮作用于中樞神經(jīng)系統(tǒng)使口渴中樞興奮刺激中樞及周圍交感神經(jīng)系統(tǒng)血管緊張素的生物作用作用于全身血管平滑肌使血管收縮血管緊張素的生物作用14促使腎內(nèi)血管收縮，使腎血流量減少，腎小球?yàn)V過率降低收縮腎小球入球及出球小動(dòng)脈（出大于入）腎血流量重新分布刺激腎小管的Na+、H+交換，使Na+和HCO3

-

重吸收增加刺激腎間質(zhì)NH4+生成和分泌血管緊張素II對(duì)腎的作用促使腎內(nèi)血管收縮，使腎血流量減少，腎小血管緊張素II對(duì)腎的15

緩激肽系統(tǒng)

激肽釋放酶（90%來源于腎皮質(zhì)近端小管細(xì)胞）

激肽原激肽激肽酶失活作用對(duì)抗血管緊張素?cái)U(kuò)張小動(dòng)脈增加腎臟血流量促進(jìn)鈉、水排泄緩激肽系統(tǒng)作16PGE2影響血管平滑肌及系膜細(xì)胞的功能PGI2對(duì)抗血管緊張素、去甲腎上腺素、血管加壓素的作用影響水、鈉代謝：PGE2抑制集合管上皮細(xì)胞對(duì)鈉的吸收抑制抗利尿劑對(duì)集合管的作用Nephrology前列腺素(PG)系統(tǒng)作用PGE2影響血管平滑肌及系膜細(xì)胞的功能Nephrology前171,25-(0H)2VitD32倍(活性)肝VitD25-(OH)-VitD31,25-(0H)2VitD3

羥化酶

羥化酶4倍(活性)無活性有活性1,25-(0H)2VitD3無活性有活性18VitD的作用促進(jìn)小腸對(duì)鈣、磷的吸收促進(jìn)骨鈣的移動(dòng)，不斷更新促進(jìn)腎小管對(duì)磷的重吸收，減少尿磷的排泄VitD的作用促進(jìn)小腸對(duì)鈣、磷的吸收19

促紅細(xì)胞生成素(EPO)促紅細(xì)胞細(xì)胞生成因子促紅細(xì)胞生成素原促紅細(xì)胞生成素（EPO）

促骨髓紅系統(tǒng)生成RBC紅細(xì)胞祖細(xì)胞原始紅細(xì)胞幼稚紅細(xì)胞成熟紅細(xì)胞EPONephrology促紅細(xì)胞生成素(EPO)紅細(xì)胞祖細(xì)胞EPONephrolo20

SubstanceOvervierwConstitutionandfunctionofurinarysystemThegeneralmanifestationsofurinarysystemThetestsofrenalfunctionDiagnosis,preventionandtherapyProgresandtolookintothefutureNephrologySubstanceOvervierwNephrology21

泌尿系統(tǒng)常見臨床表現(xiàn)

Thegeneralmanifestationsofurinarysystem

EdemaHypertensionLoinpainBladdersymptomsUrinaryabnormalities泌尿系統(tǒng)常見臨床表現(xiàn)

Thegene22腎炎性水腫腎病性水腫EdemaThegeneralmanifestations腎炎性水腫腎病性水腫EdemaThegeneralman23nephroticedema(腎病性水腫)

：

hypoproteinemia(低白蛋白血癥)RAASADH↑nephriticedema(腎炎性水腫)

：GFR↓，dysequilibriuminglomus-tubule(球-管平衡失調(diào))腎小球?yàn)V過分?jǐn)?shù)下降

（腎小球?yàn)V過率/腎血漿流量）nephroticedema(腎病性水腫)：24按發(fā)病部位按發(fā)病機(jī)理Hypertension容量依賴型高血壓腎素依賴型高血壓腎血管性高血壓腎實(shí)質(zhì)性高血壓Thegeneralmanifestations按發(fā)病部位Hypertension容量依賴型高血壓腎血管性25Loinpain

intherenalareaThegeneralmanifestationsRenalcolic------ObstructionofthekidneyorurinarytractDullpainintherenalarea------InflamationofthekidneyorurinarytractExquisitepainintherenalarea-----AcutedisordersofrenalbloodvesselLoinpaininThegeneralmanife26尿急、尿頻、尿痛----Bladdersymptoms泌尿系感染Thegeneralmanifestations尿急、尿頻、尿痛----Bladder泌尿系感染The27Urinaryabnormalities尿量異常Oliguria≤400ml/dAnuria≤100ml/dPolyuria≥2500ml/d

腎源性CIN非腎源性DMDINephrologyThegeneralmanifestations尿質(zhì)異常尿成分異常Urinaryabnormalities尿量異常Olig28尿成分異常蛋白尿Proteinuria血尿Hematuria白細(xì)胞尿Leucocyturia菌尿bacteriuria管型尿cylinderuria膿尿pyuria尿成分異常蛋白尿血尿白細(xì)胞尿菌尿管型尿膿尿29蛋白尿腎小球性腎小管性溢出性組織性分泌性腎小球病變腎盂腎炎間質(zhì)性腎炎多發(fā)性骨髓瘤24h尿蛋白定量>150mg蛋白尿腎小球性腎小管性溢出性組織性分泌性腎小球病變腎盂腎炎多30血尿泌尿系統(tǒng)疾病功能性臨近器官全身性疾病結(jié)石、腫瘤、外傷、腎炎、畸形、腎梗塞血友病、傳染病過勞、腎下垂新鮮晨尿離心后>3/HP或尿細(xì)胞計(jì)數(shù)>10萬/h或>50萬/12h血尿泌尿系統(tǒng)疾病功能性臨近器官全身性疾病結(jié)石、腫瘤、外傷、血31白細(xì)胞尿膿尿菌尿新鮮晨尿離心后>5/HP或尿細(xì)胞計(jì)數(shù)>40萬/h或>100萬/12h蛻變未離心尿涂片≥1/HP或細(xì)菌培養(yǎng)>105/ml白細(xì)胞尿膿尿菌尿新鮮晨尿離心后>5/HP蛻未離心尿涂片≥1/32上皮細(xì)胞管型白細(xì)胞管型顆粒管型紅細(xì)胞管型管型尿急性腎小球腎炎腎盂腎炎間質(zhì)性腎炎多種腎小球疾病腎小管損傷急性腎小管壞死活動(dòng)性腎小球腎炎上皮細(xì)胞白細(xì)胞顆粒紅細(xì)胞管型尿急性腎小球腎炎腎盂腎炎多種急33紅細(xì)胞管型白細(xì)胞管型紅細(xì)胞管型白細(xì)胞管型34

SubstanceovervierwconstitutionandfunctionofurinarysystemThegeneralmanifestationsofurinarysystemThetestsofrenalfunction

Diagnosis,preventionandtherapyProgresandtolookintothefutureNephrologySubstanceovervierwNephrology35Thetestsofrenalfunction腎小球?yàn)V過功能

重吸收近曲腎小管分泌

遠(yuǎn)曲集合管CCr血β2-MGBUNScr尿β2-MGPSP季氏試驗(yàn)?zāi)驖B透壓Thetestsofrenalfunction腎小球36Nephrology

SubstanceovervierwconstitutionandfunctionofurinarysystemThegeneralmanifestationsofurinarysystemThetestsofrenalfunctionDiagnosis,preventionandtherapyProgresandtolookintothefutureNephrologyNephrologySubstanceovervierwN37Diagnosis,preventionandtherapydiagnosis原發(fā)性繼發(fā)性Causingdiagnosis病因診斷Positionaldiagnosis部位診