肾脏病学总论优质PPT.ppt
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肾脏病学总论优质PPT.ppt
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PGE2,I2,A2,F2,TXA2(前列腺素族)Bradykinin(缓激肽)Erythropietin,(促红细胞生成素EPO)1,25-dihydroxycholecalciferol(活性)1,25-(OH)2D3(1羟化酶)Decomposeorgan:
insulinTargetorgan:
PTH,TH,CA,ADHEGF,PDGF,IGF-1,TGF,NEPHROLOGYStructureofthekidneyFunctionofthekidneyClinicalmanifestation(临床症状临床症状)LaboratoryEvaluationofRenalDiseaseMajorRenalSyndromesClinicalmanifestationEdema(水肿)Hypertension高血压Proteinuria蛋白尿Hematuria血尿Lossofrenalfunction肾功能丧失Painintheflankarea:
renalcolicChangesinurinevolumeOthersNEPHROLOGYStructureofthekidneyFunctionofthekidneyClinicalmanifestationLaboratoryEvaluationofRenalDiseaseMajorRenalSyndromes尿液检查(uronoscopy)U/AChemistry(DipStick)ProteinGlucoseHemoglobinKetonespHBilirubinUrobilinogenNitriteLeukocyteesteraseMOREIMPORTANTLESSIMPORTANTU/AChemistryHoldhereDipuptohereThereactionsaretimedandthecolorschangeifanalysesarepresent.CompareSticktocolorsonDipStickBottleandgrade0,1+,2+,3+,4+;
thedarkerthecolor,thegreaterthegrade!
pHProteinGlucoseHgbETC.Proteinuria蛋白尿定义定义:
持续持续超过150mg/日尿蛋白/肌酐200mg/g微量白蛋白尿:
30-300mg/d尿白蛋白/肌酐17-250mg/g(male)25-355mg/g(female大量蛋白尿:
超过3.5g/1.73m2/日或50mg/kg/日。
按发病机制分类按发病机制分类按发病机制分类按发病机制分类1Glomerulardisease肾小球性蛋白尿:
肾小球滤过膜损伤或通透性增高机械屏障受损:
滤过膜孔径异常增大或断裂电荷屏障受损:
滤过膜负电荷减少按分子量分类:
按分子量分类:
(1)选择性蛋白尿:
(2)非选择性蛋白尿:
按发病机制分类按发病机制分类2Tubuledisease肾小管性蛋白尿:
肾小管重吸收,由小分子蛋白构成:
2-MG、溶菌酶。
2g/日3Spillover溢出性蛋白尿:
血中异常蛋白增多(免疫球蛋白轻链、血红蛋白)Proteinuria功能性蛋白尿:
发热、寒冷、运动、淤血、直立。
3.5gm/day)Hypoalbuminemia(30g/L)EdemaHyperlipidemaLipiduria急性肾炎综合征AcuteNephriticSyndromeSuddenonsetofhematuriawithRBCcastsandrenalfailure(days-weeks)RBCcastsnotlistedinthebook!
Butthisiscritical!
Proteinuria(mildtomoderatebutNOTNephroticRange)HypertensionHallmarkDisease:
PostStreptococcalGlomerulonephritis急进性肾炎综合征RapidlyProgressiveGlomerulonephritisNephronalhematuriaRenalfailuredevelopingoverweekstomonthsDiffuseglomerularcrescentformation.无症状性尿异常AsymptomaticHematuriaorProteinuriaHematuriawithorwithoutRBCcastsand/orProteinuriausually2.0gm/dayNORENALFAILURENONEPHROTICSYNDROME急性肾衰竭综合征AcuteRenalFailureOliguria(400ml/day)RarelyanuriaRecentOnsetofAzotemia(hours/days)慢性肾衰竭综合征ChronicRenalFailureUremiaFinalCommonPathofAllChronicRenalDiseases尿路感染综合征UrinaryTractInfectionBacteriuriaandPyuriaDysuria,Frequency,UrgencyPyelonephritisorCystitisWBCcasts=PyelonephritisTheBookMissesthisone!
FeverTheBookMissesthisone!
肾石症NephrolithiasisRenalstonesRenalcolic-OOOUUUCCCHHH!
Severe,CrampyPainintheflankareaHematuria(NotRBCcasts!
)肾脏疾病的诊断根据患者的病史、症状及体征,并辅以实根据患者的病史、症状及体征,并辅以实验室检查和特殊检查,作出正确诊断验室检查和特殊检查,作出正确诊断病因诊断病因诊断部位诊断部位诊断病理诊断病理诊断功能诊断功能诊断去除病因去除病因抑制免疫反应及炎症反应抑制免疫反应及炎症反应对症治疗对症治疗防治并发症防治并发症延缓肾脏疾病进展延缓肾脏疾病进展肾脏替代治疗肾脏替代治疗
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