蛋白尿的诊断与注意事项课件

蛋白尿的诊断治疗与注意事项2021/7/132021/7/131 1蛋白尿的诊断治疗与注意事项2021/7/131basic structurebehind two sides of peritoneum11 cm 6 cm 3 cmWt.100-140 g2021/7/132021/7/132 2basic structure2021/7/1322021/7/132021/7/133 32021/7/1332021/7/132021/7/134 42021/7/1342021/7/132021/7/135 52021/7/1352021/7/132021/7/136 62021/7/136肾小球旁器肾小球旁器（1）球旁细胞球旁细胞 afferent arteriole中膜内的肌上皮样中膜内的肌上皮样细胞。分泌细胞。分泌renin。（2）系膜细胞系膜细胞afferent 和和 efferent arteriole 之间的间之间的间质细胞群。吞噬功能。质细胞群。吞噬功能。（3）致密斑致密斑:调节调节juxtaglomerular cell释放释放renin。2021/7/132021/7/137 7肾小球旁器（1）球旁细胞 afferent arteriol*（一）肾小球滤过率（一）肾小球滤过率 GFR：单单位位时时间间内内（每每分分钟）钟）两肾生成的原尿量。两肾生成的原尿量。GFR与与体体表表面面积积成成正正比比。每每 日日 滤滤 过过 量量 是是 全全 身身 total plasma volume 的的60倍倍，即即kidney 每每日日净净化化处处理理全全身身plasma 60次。次。判断肾功能的指标判断肾功能的指标-肾小球滤过率肾小球滤过率l GFR取取 决决 于于：effective filtration pressure 和和 filtration membrane 通透性通透性2021/7/132021/7/138 8*（一）肾小球滤过率 判断肾功能的指标-肾小球滤过率 影响滤过率的因素lfiltration membraneleffective filtration pressure2021/7/132021/7/139 9影响滤过率的因素filtration membrane2022021/7/132021/7/1310102021/7/1310滤过膜的结构滤过膜的结构 1.内内层层毛毛细细血血管管壁壁的的内内皮皮细细 胞胞：有有50100 nm的的窗窗孔孔，血血细胞不能通过。细胞不能通过。2.中中层层基基膜膜：有有48 nm的的纤纤维维网网孔孔，蛋蛋白白质质和和脂脂质质不不能能通通过。（主要）过。（主要）3.外外层层肾肾小小囊囊的的上上皮皮细细胞胞：裂裂隙隙膜膜上上有有414 nm的的孔孔，大大分子蛋白质不能通过。分子蛋白质不能通过。2021/7/132021/7/1311112021/7/1311水分子水分子阳离子阳离子葡萄糖葡萄糖小分子阴离子小分子阴离子蛋白质蛋白质滤过膜通透作用的选择性滤过膜通透作用的选择性 滤滤过过膜膜的的机机械械屏屏障障作作用用：glomerular filtration membrane上上大小不等的孔道大小不等的孔道，阻止大分子物质通过。（起主要作用），阻止大分子物质通过。（起主要作用）半径半径3.6 nm 不能通过，如不能通过，如plasma globulin，fibrinogen。2021/7/132021/7/131212水分子阳离子葡萄糖小分子阴离子蛋白质滤过膜通透作用的选择性 有效滤过压有效滤过压 l有有效效滤滤过过压压:是是glomerular filtration的的动力。动力。l肾肾小小球球有有效效滤滤过过压压肾肾小小球球毛毛细细血血管管血压（血浆胶体渗透压囊内压）血压（血浆胶体渗透压囊内压）2021/7/132021/7/131313有效滤过压 有效滤过压:是glomerular filtAfferent arteriole端端EFP45（252510）10 mmHg Efferent arteriole端端EFP 45（353510）0 mmHg 由此可见，由此可见，glomerular capillary不是全段都有滤过作用。不是全段都有滤过作用。2021/7/132021/7/131414Afferent arteriole端EFP45（25 肾小球毛细血管压肾小球毛细血管压 平均动脉压（舒张压平均动脉压（舒张压+1/3脉压差）：脉压差）：BP 80180 mmHg 肾小球毛细血管压维持稳定肾小球毛细血管压维持稳定 GFR基本不变基本不变。BP 4080 mmHg 肾小球毛细血管压肾小球毛细血管压 滤过压滤过压 GFR。BP 40 mmHg GFR 0 无尿。无尿。入球动脉入球动脉 和和 出球动脉出球动脉 的口径：的口径：入球动脉收缩入球动脉收缩肾小球毛细血管压肾小球毛细血管压 有效滤过压有效滤过压 GFR。出球动脉收缩出球动脉收缩肾小球毛细血管压肾小球毛细血管压 有效滤过压有效滤过压 GFR 。2021/7/132021/7/131515 肾小球毛细血肾小管和集合管的转运功能肾小管和集合管的转运功能 包括：包括：reabsorption、secretion、excretion2021/7/132021/7/131616肾小管和集合管的转运功能 包括：reabsorptionProteinuria 2021/7/132021/7/131717Proteinuria 2021/7/1317What is proteinuria?Proteinuria means the appearance of protein in the urine.24-hour urine Microalbuminuria 30-150 mg Mild 150-500 mg Moderate 500-1000 mg Heavy 1000-3000 mg Nephrotic range more than 3500 mg2021/7/132021/7/131818What is proteinuria?ProteinurSIGNS AND SYMPTOMSfoamy urine edema Hypoalbuminemia and hypotension pre-renal acute renal failurehyperlipidemia Infection 2021/7/132021/7/131919SIGNS AND SYMPTOMSfoamy urine Mechanisms of ProteinuriaBenign Proteinuria Glomerular Proteinuria Primary or secondary glomerulopathy Tubular Proteinuria Tubular or interstitial disease Overflow Proteinuriaas in multiple myeloma secretory(post glomerular)2021/7/132021/7/132020Mechanisms of ProteinuriaBenig2021/7/132021/7/1321212021/7/1321Primary glomerulonephropathy -Minimal change disease MsPGNIdiopathic membranous glomerulonephritis Focal segmental glomerulonephritis Membranoproliferative glomerulonephritis IgA nephropathy 2021/7/132021/7/132222Primary glomerulonephropathy MCD2021/7/132021/7/132323MCD2021/7/1323MsPGN2021/7/132021/7/132424MsPGN2021/7/13242021/7/132021/7/1325252021/7/13252021/7/132021/7/1326262021/7/1326IgAN2021/7/132021/7/132727IgAN2021/7/1327IgAN2021/7/132021/7/132828IgAN2021/7/1328IgAN2021/7/132021/7/132929IgAN2021/7/1329MPGN2021/7/132021/7/133030MPGN2021/7/13302021/7/132021/7/1331312021/7/1331Secondary glomerulonephropathy Diabetes mellitus Collagen vascular disorders(e.g.,lupus nephritis)Amyloidosis Preeclampsia先兆子痫Infection(e.g.,HIV,hepatitis B and C,poststreptococcal illness,syphilis,malaria and endocarditis)Gastrointestinal and lung cancers Lymphoma,chronic renal transplant rejection 2021/7/132021/7/133232Secondary glomerulonephropathySLE LN2021/7/132021/7/133333SLE LN2021/7/1333淀粉样变2021/7/132021/7/133434淀粉样变2021/7/1334DN2021/7/132021/7/133535DN2021/7/1335DN2021/7/132021/7/133636DN2021/7/1336DN2021/7/132021/7/133737DN2021/7/1337Tubular Hypertensive nephrosclerosis Tubulointerstitial disease due to:Uric acid nephropathy Acute hypersensitivity interstitial nephritis Fanconi syndrome Heavy metals Sickle cell disease NSAIDs,antibiotics 2021/7/132021/7/133838Tubular Hypertensive nephroscAcute pyelonephritis2021/7/132021/7/133939Acute pyelonephritis2021/7/13AINS2021/7/132021/7/134040AINS2021/7/1340AIN2021/7/132021/7/134141AIN2021/7/1341CRF 2021/7/132021/7/134242CRF 2021/7/1342Overflow-Hemoglobinuria Myoglobinuria Multiple myeloma Amyloidosis 2021/7/132021/7/134343Overflow-Hemoglobinuria 2021Diagnostic Evaluation of Proteinuria Age health and family history physical examination Urinalysis Blood analysis kidney biopsy 2021/7/132021/7/134444Diagnostic Evaluation of ProteHow is proteinuria treated?Dietary regulation Controlling hypertension is essential in reducing proteinuria.ACEI or ARBs immunosuppression Treating hypercholesterolemia others2021/7/132021/7/134545How is proteinuria treated?Di注：注：文档文档资料素材和料素材和资料部分来自料部分来自网网络，如不慎侵犯了您的，如不慎侵犯了您的权益，益，请联系文系文库客服，我客服，我们将做将做删除除处理，理，感感谢您的理解。您的理解。注：文档资料素材和资料部分来自网络，如不慎侵犯了您的权益，请