OutlinesofKidneyDiseasePanLingOutlinesofKidneyDisease英文版醫(yī)學(xué)資料專家講座第1頁Whatistheurinarysystemcomposedof?kidneyureterbladder/cysturethralassociatedvesselsandnervesAReviewofUrinarySystemOutlinesofKidneyDisease英文版醫(yī)學(xué)資料專家講座第2頁OutlinesofKidneyDisease英文版醫(yī)學(xué)資料專家講座第3頁Thefunctionalunitofthekidneyisthenephron.Thenephroninclude：

therenalcorpuscle

（glomerulusBowmancapsule)thetubuleOutlinesofKidneyDisease英文版醫(yī)學(xué)資料專家講座第4頁OutlinesofKidneyDisease英文版醫(yī)學(xué)資料專家講座第5頁Anabilitytomaintainfluid,electrolyteandacid-basebalanceAnabilitytoexcretemetabolicsubstance(mainlynitrogenouswastes)EndocrinefunctionKidneyfunctionOutlinesofKidneyDisease英文版醫(yī)學(xué)資料專家講座第6頁1strucure:

endothelialbasementmembraneepithelial2character:size-selectivebarriercharge-selectivebarrier3function：anultrafiltrateofplasma.GlomerolarOutlinesofKidneyDisease英文版醫(yī)學(xué)資料專家講座第7頁OutlinesofKidneyDisease英文版醫(yī)學(xué)資料專家講座第8頁OutlinesofKidneyDisease英文版醫(yī)學(xué)資料專家講座第9頁OutlinesofKidneyDisease英文版醫(yī)學(xué)資料專家講座第10頁P(yáng)roximalTubules:reabsorption100%Glucose,aminoacid90%bicarbonate70%water,natriumsecretehydrogenDistalTubule:

secretehydrogen,potassium,ammoniaTheLimbsofHenle’sLoop:urineinspissationanddilutionTubularfunctionOutlinesofKidneyDisease英文版醫(yī)學(xué)資料專家講座第11頁Vasoactivesubstance:Vasoconstriction:renin,angiotensinⅡVasodilatation:kinin,prostaglandinNon-vasoactivesubstance:

erythropoietincalcitriolEndocrinefunction

OutlinesofKidneyDisease英文版醫(yī)學(xué)資料專家講座第12頁

APPROACHTOTHEPATIENTWITHRENALDISEASEOutlinesofKidneyDisease英文版醫(yī)學(xué)資料專家講座第13頁Apatientwillpresentwithrenaldiseaseinoneoftwoways:discoveredincidentallywithevidenceofrenaldysfunctionGeneralconsiderationsOutlinesofKidneyDisease英文版醫(yī)學(xué)資料專家講座第14頁

thediseaseevaluationincludes:anestimationofdiseasedurationacarefulurinalysisglomerularfiltrationrateGeneralconsiderationsOutlinesofKidneyDisease英文版醫(yī)學(xué)資料專家講座第15頁DISEASEDURATIONrenaldiseasemaybeacuteorchronic,forinstance,Acuterenalfailure:worseningofrenalfunctionoverhourstodays

chronicrenalfailure:alossofrenalfunctionovermonthstoyearsOutlinesofKidneyDisease英文版醫(yī)學(xué)資料專家講座第16頁尿液檢驗(yàn)

（uronoscopy）

OutlinesofKidneyDisease英文版醫(yī)學(xué)資料專家講座第17頁Itinclude:dipstickexamination:gravity,pH,protein,hemoglobin,nitrites,ketones,etc.microscopicexamination:searchesforallformedelements----cells,casts,andinfectingorganisms.

URINALYSIS

OutlinesofKidneyDisease英文版醫(yī)學(xué)資料專家講座第18頁P(yáng)ROTEINURIA

whatisproteinuria?proteinintheurine＞150mg/24hoursurineprotein/urinecreatinine＞200mg/gwhatismicroalbuminuria?

urinealbumin/urinecreatinine30-300ug/mgOutlinesofKidneyDisease英文版醫(yī)學(xué)資料專家講座第19頁

Classificationofproteinuria:

①.functionalproteinuria.

cause:acuteillness,exercise,andorthostaticposition.

characteristic:transient

generally＜1g/dOutlinesofKidneyDisease英文版醫(yī)學(xué)資料專家講座第20頁

②ProteinuriaresultsfromoverproductionofcirculatingsuchasBencejonesproteinsassociatedwithmultiplemyeloma.OutlinesofKidneyDisease英文版醫(yī)學(xué)資料專家講座第21頁③glomerularproteinuria:

cause:abnormalitiesintheglomerularfiltrationbarrier

characteristic:bigormiddlemolecularproteinalargeamountofprotein﹥2g/dOutlinesofKidneyDisease英文版醫(yī)學(xué)資料專家講座第22頁④Tubularproteinuria:

cause:damagedreabsorptionofnormallyfilteredproteinsintheproximaltubule.

characteristic:smallmolecularproteingenerally＜2g/dOutlinesofKidneyDisease英文版醫(yī)學(xué)資料專家講座第23頁Hematuria

Whatishematuria?

＞3redcells/HP.(microscopicexaminationisessentialfordiagnosis.)

OutlinesofKidneyDisease英文版醫(yī)學(xué)資料專家講座第24頁Causeofhematuria

RenalcauseGlomerulardisease:adistinctivedimorphicredcells.nonglomerular:stones,infection,tuberculosis,etc.Extrarenalcause:OutlinesofKidneyDisease英文版醫(yī)學(xué)資料專家講座第25頁GlomerularHematuriaPainlessandtotalhematuriaProteinuriaandcastsdimorphicredcells

OutlinesofKidneyDisease英文版醫(yī)學(xué)資料專家講座第26頁OutlinesofKidneyDisease英文版醫(yī)學(xué)資料專家講座第27頁Leukocyturia(pyuria)

Conception:

＞5whitecells/HPurinarytractinfectioninterstitialnephritisLupusnephritis

OutlinesofKidneyDisease英文版醫(yī)學(xué)資料專家講座第28頁Estimationofglomerularfiltrationrate(GFR)

Definition:

theamountofplasmaultrafilteredacrosstheglomerularcapillariesinacertaintime.Creatinineclearance(Ccr)isaindicatorofGFRNormalrangeofCcr:90-110mL/min/1.73m2

OutlinesofKidneyDisease英文版醫(yī)學(xué)資料專家講座第29頁

InfluencesfactorsofGFRGlomerularhydraulicpressureColloidosmoticpressureFitrationsurfacearea

OutlinesofKidneyDisease英文版醫(yī)學(xué)資料專家講座第30頁IMAGINGSTUDIESUltrasonographyIntravenousUrography(IVP)ComputedTomography(CT)Magneticresonanceimaging(MRI)

Arteriography,venographyRadionuclideStudiesOutlinesofKidneyDisease英文版醫(yī)學(xué)資料專家講座第31頁IMAGINGSTUDIESUltrasonography:usedwidelyinrenaldisease.itcanidentifytherenalcortex,medulla,pyramids,andadistendedcollectionsystemorureter.OutlinesofKidneyDisease英文版醫(yī)學(xué)資料專家講座第32頁Ultrasonography:identifyKidneysizeidentifyhydronephrosis,renalmasslesions,polycystickidneydisease.Localizethekidneyforapercutaneousinvasiveprocedure.Assesspostvoidingbladderresidual.OutlinesofKidneyDisease英文版醫(yī)學(xué)資料專家講座第33頁RENALBIOPSYArenalbiopsycanbeobtainedtohelpestablishthediagnosis,suggestprognosis,ordirecttherapy.Meansforhistologicstudy:LightmicroscopicstudiesImmunofluorescencetechniquesElectronmicroscopyOutlinesofKidneyDisease英文版醫(yī)學(xué)資料專家講座第34頁OutlinesofKidneyDisease英文版醫(yī)學(xué)資料專家講座第35頁RENALBIOPSYIndications:UnexplainedacuterenalfailureofchronicrenalinsufficiencyAcutenephriticsyndromesUnexplainedproteinuriaOutlinesofKidneyDisease英文版醫(yī)學(xué)資料專家講座第36頁RENALBIOPSYIndications:PreviouslyidentifiedandtreatedlesionstoplanfuturetherapySystemicdiseasesassociatedwithkidneydysfunctionSuspectedtransplantrejection

OutlinesofKidneyDisease英文版醫(yī)學(xué)資料專家講座第37頁RENALBIOPSYContraindications:

asolitaryorectopickidneyuncorrectedbleedingdisorderSevereuncontrolledhypertensionRenalinfectionOutlinesofKidneyDisease英文版醫(yī)學(xué)資料專家講座第38頁RENALBIOPSYContraindications:HydronephrosisEnd-stagerenaldiseaseRenalneoplasm,congenitalanomalies,multiplecysts,oranuncooperativepatient.OutlinesofKidneyDisease英文版醫(yī)學(xué)資料專家講座第39頁Syndromeofrenaldisease

NephroticSyndrome

heavyproteinuria:＞3.5g/dhypoalbuminemia：＜30g/LedemahyperlipidemiaOutlinesofKidneyDisease英文版醫(yī)學(xué)資料專家講座第40頁Syndromeofrenaldisease

NephriticSyndrome

proteinuriahematuriahypertension＜1yearacutenephriticsyndrom＞1yearchronicnephriticsyndromRenalfailurewithinweekstomonthsacuterapidlyprogressivenephriticsyndromOutlinesofKidneyDisease英文版醫(yī)學(xué)資料專家講座第41頁OutlinesofKidneyDisease英文版醫(yī)學(xué)資料專家講座第42頁crescentOutlinesofKidneyDisease英文版醫(yī)學(xué)資料專家講座第43頁Syndromeofrenaldisease

AsymptomaticUrinalysisAbnorm