肾功能检查1全解课件

,LOGO,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Renal Function Test,肾功能检查,p349,Renal Function Test肾功能检查 p,Kidney diseases,Urine tests:urinalysis and others,Cheap and convenient;,For screening and following,Renal biopsy,Renal functions,Glomerulus:filtration,Tubule:reabsorption and acidification,Imaging Examination,Immunological test,Kidney diseasesUrine tests:ur,When and for What,Kidney diseases or injuries,Overall checkup,Kidney function assessment with other diseases,Diabetes mellitus,Hypertension,Shock or extensive burn,Auto-immunological diseases,Drug toxicity,When and for WhatKidney diseas,Structure of Kidney,肾单位,集合管,肾小体,肾小管,肾小球,肾小囊,近曲小管,远曲小管,髓袢,Structure of Kidney肾单位集合管肾小体肾小,FUNCTIONS OF KIDNEY,Excrete metabolic products/wastes,Keep the balance of water,acid-base and electrolyte,Endocrine function:,EPO(erythropoietin):RBC product,1,25(OH)2 D3,:,Calcium and phosphorus,renin:bood pressure regulation,FUNCTIONS OF KIDNEYExcrete met,Related concepts,急性肾衰,AFR,肾前性,Pre-renal,：休克早期、大面积烧伤、脱水等,功能性,肾性,renal,：,器质性,肾小管上皮细胞坏死,肾脏本身：肾小球肾炎、肾盂肾炎、狼疮肾炎,肾动脉血栓、栓塞,肾后性,post renal,：结石、肿瘤、前列腺肥大等尿路梗阻,Related concepts急性肾衰AFR,Stages for renal failure,：,代偿期,compensatory stage,失代偿期,decompensatory stage:,氮质血症,Azotemia,：血中尿素氮,BUN,或肌酐,sCR,超出正常范围,肾性,肾前性,肾后性,衰竭期,Failure stage,尿毒症期,Uremia Stage,：综合症候群，“尿潴留在血中”而引起的中毒,Related concepts,Stages for renal failure：Relat,Related concepts,Common symptoms of AFR,少尿期,oliguria stage,：,Oliguria or anuria,Hematuria,Proteinuria and some kinds of casts,Water intoxication,Hyperpotassemia,Metabolic acidosis,Azotemia,多尿期,polyuria stage,恢复期,recovery stage,Related conceptsCommon symptom,Related concepts,Common symptoms of CFR,Early stage,：,polyuria,Nocturia,Hematuria,Proteinuria and some kinds of casts,Azotemia,Water intoxication,Metabolic acidosis(moderate),Hypopotassemia,Late stage:,as above,Uremia,hyperpotassemia,hypertension,Osteodystrophy,anemia,bleeding tendency,Related conceptsCommon symptom,Tests of glomerular function,肾小球功能检查,肾小球滤过功能,Tests of glomerular function肾,Tests of Glomerular Function,Glomerular Filtration Rate,GFR,Endogenous Creatinine Clearance Rate,Ccr,Serum Creatinine,Scr,Blood Urea Nitrogen,BUN,Serum,2,-microglobulin,Cystatin C,Tests of Glomerular FunctionGl,Renal blood flow,：,1200-1400ml/min,，,占,20%-25%,心血流量,Crude urine,：即肾小球滤过液,120-160ml/min,影响因素：,renal blood flow,effective filtration pressure,Filtration area,membrane permeability,Glomerular Filtration,Renal blood flow：1200-1400m,Renal Clearance Rate,肾清除率,肾小球滤过率（,GFR),：单位时间内（分钟）经肾小球滤出的血浆量,即单位时间内产生的原尿量,正常值：,120-160ml/min,肾清除率：指在单位时间（,min,）内，肾脏能将多少毫升血浆中含有的某种物质全部加以清除，结果以,ml/min,表示,常用：菊粉清除率、内生肌酐清除率来反映肾小球滤过率,Renal Clearance Rate 肾清除率肾小球滤,Endogenous Creatinine,肌酐,内源性肌酐,外源性肌酐,肌肉活动中肌酸代谢产物,来自于鱼类、肉类等食物和咖啡、茶等饮料,Endogenous Creatinine肌酐内源性肌酐外源,Endogenous Creatinine Clearance Rate,Ccr,Definition,：,Ccr is the volume of blood plasma with creatinine that is cleared by kidneys per unit time.,即：单位时间内,肾脏可全部清除多少毫升血浆中的内生肌酐,计算公式：,Normal value：80-120 ml/min,Endogenous Creatinine Clearanc,Clinical Significance,Pathological decrease,Sensitive for kidney injury,GFR50ml/min,decompensatory,：,20-50ml/min,failure,：,10-19ml/min,uremia,：,10ml/min,For treatment,30-40:limited protein diets,diuretic,30 diuretic:not available,10 replacement therapy,Physiologiccal：related with sports,diets,age,Clinical SignificancePathologi,Serum Creatinine,Scr,血肌酐测定,肌肉活动稳定、外源性肌酐来源不变的情况下，,Scr,浓度主要取决于肾小球的滤过能力。,Normal Value:,Serum or Plasma Cr:,male:53-106mol/L,female:44-97mol/L,Serum Creatinine,Scr 血肌酐测,Clinical Significance of Scr increase,Glomerular Filtration Injury,Chronic renal failure,Compensatory stage:Scr178,mol/L,Failure stage:Scr445mol/L,Clinical Significance of Scr i,Acute renal failure,Compensatory,Decompensatory,Failure,Acute renal failureCompensator,Clinical Significance of Scr increase,Differential diagnosis of prerenal and renal azotemia,Prerenal oliguria:,Scr200,mol/L,Clinical Significance of Scr i,Clinical Significance,Excessive intake of protein and proteolysis:,High protein diet,，,High fever,Upper gastrointestinal hemorrhage,extensive burn,，,severe trauma,hyperthyroidism,Clinical SignificanceExcessive,Blood urea nitrogen,BUN,Influence factors,Protein intake,Protein degradation,Liver function,Glomerular filtration,Normal value:,Adults:3.2-7.1mmol/L,Children or infants:,1.8-6.5mmol/L,Urea or ornithine cycle in liver,Blood urea nitrogen,BUNInflue,Clinical Significance,Renal damage:,Acute renal failure,Compensatory,Clinical SignificanceRenal dam,Clinical Significance,Renal damage:,Chronic renal failure,Compensatory stage:BUN9mmol/L,Failure stage:BUN20mmol/L,Excessive intake of protein and proteolysis:,high protein diet,，,high fever,Upper gastrointestinal hemorrhage,extensive burn,，,severe trauma,hyperthyroidism,Clinical SignificanceRenal dam,Clinical Significance of BUN/Cr,Prerenal oliguria:,BUN,升高更明显，,BUN/Cr,明显升高,prerenal azotemia,Renal failure:,BUN/Cr,变化不大,Clinical Significance of BUN/C,Stage of kidney