肾功能检查英文ppt课件

Kidney diseaseLaboratory examinationsunflower1Kidney diseaseLaboratory examKidney functionGeneration urineDrain water,metabolites,waste and keep useful materialRegulating water and osmotic pressureRegulating electrolyte and acid-base balanceMake some important physiological active substances,such as renin,EPO.2Kidney functionGeneration urinThe first sectionglomerularFunction testing3The first sectionglomerularF4455Glomerular filtration rate(GFR)is reflected glomerular filtration function objective index,with unit time two renal generated ultrafiltrate quantity namely former urine generation to saidRenal clearance is refers to the double kidney in unit time(min)inside,can how much ml plasma contains a substance to clear all,results to ml/min or L/24 h6Glomerular filtration rate(GF1.The endogenous creatinine clearanceprinciplePlasma creatinine categories:endogenous and exogenousPlasma creatinine metabolism:mostly from the glomerular filtration,not by renal tubule heavy absorption,and renal tubule of shedding capacity is very few71.The endogenous creatinine c1.The endogenous creatinine clearance Condition:in the strict control diet and muscle activity under the condition of relatively stable,plasma creatinine of generation and in the urine discharge is constant,the content change is mainly affected by the influence of the endogenous creatinine81.The endogenous creatinine c1.The endogenous creatinine clearance Endogenous creatinine clearance rate(Ccr):refers to the renal unit time,clear how many ml plasma of endogenous creatinine91.The endogenous creatinine cThe preparation for the patient The patient continuous eating low protein food 3 days,every protein intake 40 g,fast meat,forbidden to drink strong tea,coffee,avoid strenuous exerciseMethods10The preparation for the patienSpecimen collection(标本收集标本收集)The fourth day morning 8 start collecting 24 hour urine(join toluene anticorrosive),the blood in any time 2 ml and urine(measurement of urine volume)at the same time clearedCalculation formula（计算公式计算公式）Every minute creatinine clearance=urine creatinine concentration every minute urine volume/plasma creatinine concentration(unit:ml/min)MethodsIt takes a long time11MethodsIt takes a long time11Normal Range Adult:80-120 ml/min Neonatal:40 65 ml/minIncreased in and decreased decreased inin.Page278Acute or chronicrenal failure,decreased renal blood flow(shock,hemorrhage,dehydration,CHF).drugs:nephrotoxic drugs.12Acute or chronicrenal failure,Clinical significance 1.Are early reflect glomerular filtration function of the sensitive index.(the majority of acute glomerulonephritis Ccr low to normal below 80%,but serum BUN,Cr is still in the normal range)13Clinical significance132.Preliminary appraisal renal damage70 51 ml/min mild damage 50 31 ml/min moderate damage 30 ml/min severe damageChronic renal failure patients Ccr if:20 11 ml/min early renal failure10 6 ml/min advanced renal failure 5 ml/min end-stage renal failure142.Preliminary appraisal renal3.Guide therapy(指导治疗指导治疗)30 40 ml/min should limit protein intake 30 10 ml/min thiazide diuretics treatment often invalid 10 ml/min should dialysis In addition,renal failure by renal metabolism or all the renal discharge drug can reduce degree according to the Ccr to adjust the use quantity and decided to use time.153.Guide therapy(指导治疗)152.BUN and ScrPrinciple（原理）（原理）Blood urea nitrogen(BUN)and serum creatinine(Scr)mainly by glomerular filtration and urine,in the renal parenchyma damaged,glomerular filtration rate is reduced,cause BUN and Scr increasing concentration in blood162.BUN and ScrPrinciple（原理）16Normal RangeBUN:1.78 7.14 mmol/LScr:Male 44 132 mol/L,Female 70 106 mol/L17Normal RangeBUN:1.78 7.14 mClinical significance All kinds of serious kidney disease Reduces kidney function.Upper gastrointestinal bleeding,severe infections and dietary protein is overmuch,can also lead to a temporary increase in BUN;18Clinical significance18Clinical significance Because of serum creatinine by other effects are smaller,more can reflect renal patients,Cr increased significantly(明显地明显地),indicating that the prognosis（预后）（预后）is poor.19Clinical significance Beca3.Blood uric acid(UA)principle UA is an end product of,most of the glomerular filtration,in proximal renal tubule in 98-100%is absorped,the normal circumstances of UA lower clearance 203.Blood uric acid(UA)principNormal Range Males:150416 mol/L Females:89357 mol/L Normal person the uric acid in the formation and excretion rate is constant.For smaller solubility,the body content when too much can form urinary stones or gout.21Normal Range21Clinical significance Increase in:gout,acute or chronic leukemia,multiple myeloma(MM),pernicious anemia(恶性贫血恶性贫血),kidney failure,liver failure,erythrocytosis,gravid reaction,acuteness activity and high fat after dinner.22Clinical significance22Gout harm1.Can cause high blood fat high blood glucose2.Cause atherosclerosis3.Cause gout attacks4.The influence of renal function23Gout harmCan cause high blood 24THANKS24