OutlinesofKidneyDisease英文版医学培训ppt课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。,What is the urinary system composed of?,kidney,ureter,bladder/cyst,urethral,associated vessels and nerves,A Review of Urinary System,What is the urinary system com,1,OutlinesofKidneyDisease英文版医学培训ppt课件,2,The functional unit of the kidney is the nephron.,The nephron include,：,the renal corpuscle,（,glomerulus Bowman capsule),the tubule,The functional unit of the kid,3,OutlinesofKidneyDisease英文版医学培训ppt课件,4,An ability to maintain fluid , electrolyte and acid-base balance,An ability to excrete metabolic substance (mainly nitrogenous wastes),Endocrine function,Kidney function,An ability to maintain fluid ,5,1 strucure:,endothelial,basement membrane,epithelial,2,character,:,size-selective barrier,charge-selective barrier,3 function,：,an ultrafiltrate of plasma.,Glomerolar,1 strucure:,6,OutlinesofKidneyDisease英文版医学培训ppt课件,7,OutlinesofKidneyDisease英文版医学培训ppt课件,8,OutlinesofKidneyDisease英文版医学培训ppt课件,9,Proximal Tubules:,reabsorption 100% Glucose ,amino acid,90% bicarbonate,70% water,natrium,secrete hydrogen,Distal Tubule:,secrete hydrogen, potassium, ammonia,The Limbs of Henles Loop:,urine inspissation and dilution,Tubular function,Proximal Tubules:Tubular func,10,Vasoactive substance,:,Vasoconstriction: renin, angiotensin ,Vasodilatation: kinin,prostaglandin,Non-vasoactive substance,:,erythropoietin,calcitriol,Endocrine function,Vasoactive substance:Endocrine,11,APPROACH TO THE PATIENT WITH RENAL DISEASE,APPROACH TO THE PATIENT WITH,12,A patient will present with renal,disease in one of two ways:,discovered incidentally,with evidence of renal dysfunction,General considerations,A patient will present with re,13,the disease evaluation includes:,an estimation of disease duration,a careful urinalysis,glomerular filtration rate,General considerations,the disease evaluation inc,14,DISEASE DURATION,renal disease may be acute or chronic, for instance,Acute renal failure: worsening of renal,function,over hours to days,chronic renal failure : a loss of renal function,over months to years,DISEASE DURATION renal disea,15,尿液检查,（,uronoscopy,）,尿液检查（uronoscopy）,16,It include:,dipstick examination,:,gravity, pH, protein, hemoglobin,nitrites, ketones,etc.,microscopic examination,: searches for all formed elements-cells, casts, and infecting organisms.,URINALYSIS,It include:URINALYSIS,17,PROTEINURIA,what is proteinuria?,protein in the urine,150mg/24hours,urine protein/urine creatinine,200mg/g,what is microalbuminuria?,urine albumin /urine creatinine,30-300ug/mg,PROTEINURIA,18,Classification of proteinuria:,.functional proteinuria.,cause:,acute illness,exercise,and orthostatic position.,characteristic:,transient,generally,1g/d,Classifi,19, Proteinuria results from overproduction of circulating,such as Bence jones proteins associated with multiple myeloma., Proteinuria results from o,20, glomerular proteinuria:,cause:,abnormalities in the,glomerular filtration barrier,characteristic:,big or middle molecular protein,a large amount of protein,2g/d, glomerular proteinuria:,21,Tubular proteinuria,:,cause:,damaged reabsorption of normally,filtered proteins in the proximal tubule.,characteristic:,small molecular protein,generally,2g/d, Tubular proteinuria:,22,Hematuria,What is hematuria?,3 red cells/HP.,(microscopic examination is essential for diagnosis.),Hematuria What is hematuria?,23,Cause of hematuria,Renal cause,Glomerular disease: a distinctive,dimorphic red cells.,nonglomerular: stones, infection,tuberculosis,etc.,Extrarenal cause:,Cause of hematuriaRenal causeG,24,Glomerular Hematuria,Painless and total hematuria,Proteinuria and casts,dimorphic red cells,Glomerular Hematuria,25,OutlinesofKidneyDisease英文版医学培训ppt课件,26,Leukocyturia (pyuria),Conception:,5 white cells/HP,urinary tract infection,interstitial nephritis,Lupus nephritis,Leukocyturia (pyuria) Concepti,27,Estimation of glomerular filtration rate (GFR),Definition:,the amount of plasma ultrafiltered across the glomerular capillaries in a certain time.,Creatinine clearance (Ccr) is a indicator of GFR,Normal range of Ccr:,90-110mL/min/1.73m,2,Estimation of glomerular filtr,28,Influences factors of GFR,Glomerular hydraulic pressure,Colloid osmotic pressure,Fitration surface area,Influences factors of GFR,29,IMAGING STUDIES,Ultrasonography,Intravenous Urography(IVP),Computed Tomography(CT),Magnetic resonance imaging(MRI),Arteriography , venography,Radionuclide Studies,IMAGING STUDIESUltrasonography,30,IMAGING STUDIES,Ultrasonography:,used widely in renal disease.,it can identify the renal cortex, medulla,pyramids,and a distended collection system or ureter.,IMAGING STUDIESUltrasonography,31,Ultrasonography:,identify Kidney size,identify hydronephrosis,renal mass lesions, polycystic kidney disease.,Localize the kidney for a percutaneous invasive procedure.,Assess postvoiding bladder residual.,Ultrasonography:identify Kidne,32,RENAL BIOPSY,A renal biopsy can be obtained to help establish the diagnosis, suggest prognosis,or direct therapy.,Means for histologic study:,Light microscopic studies,Immunofluorescence techniques,Electron microscopy,RENAL BIOPSYA renal biopsy can,33,OutlinesofKidneyDisease英文版医学培训ppt课件,34,RENAL BIOPSY,Indications:,Unexplained acute renal failure of chronic renal insufficiency,Acute nephritic syndromes,Unexplained proteinuria,RENAL BIOPSY,35,RENAL BIOPSY,Indications:,Previously identified and treated lesions to plan future therapy,Systemic diseases associated with kidney dysfunction,Suspected transplant rejection,RENAL BIOPSY,36,RENAL BIOPSY,Contraindications :,a solitary or ectopic kidney,uncorrected bleeding disorder,Severe uncontrolled hypertension,Renal infection,RENAL BIOPSY,37,RENAL BIOPSY,Contraindications :,Hydronephrosis,End-stage renal disease,Renal neoplasm, congenital anomalies, multiple cysts, or an uncooperative patient.,RENAL BIOPSYContraindications,38,Syndrome of renal disease,Nephrotic Syndrome,heavy proteinuria:,3.5g/d,hypoalbuminemia,：,30g/L,edema,hyperlipidemia,Syndrome of renal disease Neph,39,Syndrome of renal disease,Nephritic Syndrome,proteinuria,hematuria,hypertension,1 year acute nephritic syndrom,1 year chronic nephritic syndrom,Renal failure within weeks to months,acute rapidly progressive nephritic syndrom,Syndrome of renal disease Neph,40,OutlinesofKidneyDisease英文版医学培训ppt课件,41,crescent,crescent,42,Syndrome of renal disease,Asymptomatic Urinalysis Abnormal,no symptom is present, yet Urinalysis,Abnormal exists.,Hemauria,Leukocyturia,proteinuria,Syndrome of renal disease,43,Syndrome of renal disease,Acute Renal Failure Syndrome,a sudden decrease in renal function(within few days),acute tubular necrosis cause by,Sepsis,Nephrotoxic drugs,Shock,Syndrome of renal diseaseAcute,44,光镜,光镜,45,Syndrome of renal disease,Chronic Renal Failure Syndrome,progressive renal dysfunction,over months to years.,Syndrome of renal disease,46,To take home points,Talking about the,Kidney function.,What is the strucure of glomerolar basement,membrance? When it was hurt,the clinical presentation?,What is GFR and its influences factors,?,Talking about the proteinuria and its cause?,To take home pointsTalking abo,47,复习思考题,试述肾脏的生理功能。,试述,肾脏疾病常见的综合征。,试述,肾小球滤过膜的构成和作用及其受损时表现。,何谓,肾小球滤过率及其影响因素。,何谓蛋白尿和发生蛋白尿的原因有哪些？,复习思考题试述肾脏的生理功能。,48,