病理生理學(xué)課件：Chronic Renal Failure - for self-study

WhatarethemajordifferencesfromARF?ConceptPathogenesisAlterationsofmetabolism&functionsTreatmentsandprognosisUremiaConceptUremictoxins?Alterationsofmetabolism&functionsChronicRenalFailure—forself-studyCaseAnalysis

Mr.Shi,male68yearold,hospitalizedinJan.18,1988Maincomplains:Tired,lumbagofor3years,nauseaandvomit,littleurinatefor10days.

Present:Diuresisandnocturiasince3years,backpain,tired,noedema.Feeldizzy,boneache,limp.Proteinsandcastsweredetectedinurine,andthesituationwasworsedaybyday.Recently,feelnausea,vomitanditcheverywhere,insomnia,decreasememoryretention,faintreactionandgraduallybecamecomatose.Nosebleedtwice,diarrheawithblood,theurinevolumewasdecreasingandabout100ml/dayintherecent2days.

CaseAnalysis

History:Hypertensionfor13year.

PE:anemia,severesicklook,T37℃,R30/min,deep,P90/min,Bp160/90mmHg,coma,halitosis,gumredandbleeding,ulcerinmouthmucus,leftheartenlarged,noedemaofthelowerlimbs.Laboratoryexaminations:RBC20,000/cm3,Hb6g%,pletelet1.28thousand/cm3,BUN92.2mg%,Pcr11.2mg%,CO2CP30Vol%,K+5.9mEq/L,Na+123mEq/L,Ca2+7mg/L,P7mg/dL,urineS.G1.010,protein(++)Whatisthediagnosisofthedisease?DifferenceoftheclinicprogressionfromARF?Whyfromdiuresistooliguria?Whythestateoftheillnesswasaggravatingyear-by-year?Mechanismsforthehypertension?Mechanismfortheanemia?DiscussionMechanismsfornausea,vomiting,halitosisandulcerofalimentarytract?Whythepatienthadnorenaledema?Whythepatientshowednotwitchwithhypocalcemia?Mechanismsforlumbagoandboneaches?12.Mechanismsforskinitching?13.Mechanismsfordimmedreactionandcoma?14.