肾功能检验--医药类课件

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,*,*,Laboratory tests of renal function,Laboratory tests of renal func,Anatomy of Kidney,Anatomy of Kidney,Functions of the kidney,Excretion of,Metabolite Waste:urea,uric acid,creatinine,Urine Production,regulation of homeostasis,water,acid base balance,Endocrine Function:renin,erythropoietin,1,25-dihydroxycholecalciferol,Functions of the kidneyExcreti,Renal function tests,Detect renal damage,Monitor functional damage,Distinguish between impairment and failure,Renal function testsDetect ren,Kidney Function,A plumbers view,Kidney FunctionA plumbers view,How do you know its broken?,NO Urine!,Clinical symptoms,Tests,How do you know its broken?NO,Where can it break?,Pre-renal,Renal,Post-renal,Where can it break?Pre-renal,Laboratory tests of renal function,Glomerular Function Tests,Renal Tubular Function Tests,Laboratory tests of renal func,Section 1 Investigation of Glomerular Function,Renal Blood Flow:1200-1400ml/min,Renal Plasma:600-800ml/min,20%of plasma:glomerular filtration,GFR:Glomerular Filtrtion Rate,Concept,Section 1 Investigation of Gl,Renal Clerance,Concept,Virtual volume of plasma from which the substance in question has been completely removed during a given time interval.,C=UV/P,U:urine concentrtion P:plasma con.,V:urine flow rate,Renal CleranceConcept,Usefulness of Renal Clerance,Freely filtrated,neither secreted,nor reabsorbed:Inulin:GFR Determination,Freely Filtrated,small amounts secreted,without re,absorption,:Cretinine:GFR,Free filtrated,completely reabsorption:Glucose,Tubular Maxima Reabsorption Rate,Usefulness of Renal CleranceFr,Inulin Clerance,Polymer of fructose,MW:5500,Free filtration,without secretion and reabsorption,GFR,Method,Reference Interval:2.0-2.3ml/min,Inulin ClerancePolymer of fruc,Endogenous Creatinine Clearance,100g,98%stored in musle,MW:113,Cretine phosphate-cretinecretinine,Freely filtration,small mounts:secretion,Exogenous and Endogenous Creatinine,Grossly Investigate the GFR,Endogenous Creatinine Clearanc,Method,24h urine collection method,modified 4h urine collection method,Clerance Correction,：,Ccr x SBSA/IBSA,Method,Plasma urea,Secreted and reabsorbed by tubules,freely filtrated,quick,simple measurement,wide reference range 3-8 mmol/L,sensitive but non-specific index of illness,Plasma ureaSecreted and reabs,肾功能检验-医药类课件,Urea excretion,filtered at glomerulus,about 40%filtered urea is reabsorbed by renal tubules in health,more urea is reabsorbed if rate of tubular flow is slow,tubular flow rate is slow when there is renal hypoperfusion,Urea excretionfiltered at glom,Increased plasma urea,GI bleed,trauma,renal hypoperfusiondecreased RBFdecreased ECFV,acute renal impairment,chronic renal disease,post-renal obstructioncalculustumour,Increased plasma ureaGI bleeda,Urea,Useful test but must be interpreted with great care,Always consider input,output and patients fluid volume,UreaUseful test but must be in,Plasma creatinine,50-140 umol/L,increases in concentration as GFR decreases,analytical interferences,(acetoacetate-DKA),NOT,proportional to renal damage,Plasma creatinine50-140 umol,Plasma Creatinine,GFR,pCreat,140 mL/min,0 mL/min,Change within an individual patient is usually more important than the absolute value,Plasma CreatinineGFRpCreat14,Plasma creatinine in chronic renal disease,May increase to 1000 umol/L,Plot of recipricol of plasma creatinine concentration predicts when intervention is required in end stage renal failure,Time,1/pCreat,Plasma creatinine in chronic r,Plasma Uric Acid,20%:foods;80%:purine metabolism,Small amounts:conjugated with albumin,Free Filtrated,98%-100%:reabsorbed,Plasma UA concentration:depend on glomerular filtration and tubular reabsorption,Plasma Uric Acid20%:foods;80%:,Progression of chronic renal disease,Progression of chronic renal d,Plasma Cystatin C,Cysteine proteinase inhibitor,Produced by nucleated cells,MW:13000,free filtration,reabsorbed and metabolized by tubules,Plasma CysC concentrtion:depend on glomerular filtration,Plasma Cystatin CCysteine prot,Carbamylated hemoglobin,UreabloodcyanateHb carbamylatedCarHb,ARF,：,no changes(1 weeks),CRF:increase,Carbamylated hemoglobinUreab,Laboratory tests of renal function,glomerular filtration rate,impractical,creatinine clearance,unreliable,plasma creatinine,specific but insensitive,plasma urea,subject to problems,urine volume,often forgotten!,Laboratory tests of renal func,Section 2 Investigation of Tubular Function,Distal nephron Function tests,1.Mosenthal test,Concentration dilution test,8 AM:Voiding and Discarded,10,12,14,16,18,20:00 and 8:00 next day:,collecting urine samples,Determing the urine volume and gravity,Section 2 Investigation of Tub,2.Urine Osmolarity,3.Acute Oliguria,Prenal?,Renal?,2.Urine Osmolarity,Proximal tubular Function tests,1.Low MW proteins in urine,2.Tubular maximal glucose reabsorption,3.Tubular maximal PAH secretion,4.Amino acide in urine,Fanconi Syndrome,Proximal tubular Function test,Section 3 Effective Renal Blood Fl