内科学 肾脏病学总论-顾勇.ppt

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,*,General introduction of,Nephrology,Gu Yong,Nephrology department of Huashan Hospital,Affiliated to Fudan University,Contents,Anatomy,Physiological function,Common etiological factors,Symptoms and diagnosis,Therapeutics,Advancement,Renal anatomy,Two kidney,Nephron:acinus renalis&tubules,Tubules:,Proximal,Henles loop,distal,Collecting duct,Interstitium,Vessels,Physiological function,General:,Maintaining internal homeostasis,Excreting metabolic wastes product,Regulating water,electrolyte,acid-base balance,Endocrine:RAS,PGs,kinin system,EPO and Vit D,Glomerular filtration,Tubular reabsorption,Tubular excretion,SNGFR=Kf(,P-,),=Kf(PGc-Pt)-(Gc-t),Kf:capillary permeability,filtration area,Daily glomerular filtration:180L,Urinary volume:1000-2000ml,Proximal tubule,Reabsorption(isotonic),Glucose:100%,Amino acid:100%,HCO,3,-,:80%,H,2,O:70%,NaCl:70%,Excretion:,Organic acid,Drugs,Henles loop,Countercurrent multiplication,Distal tubule,To determine final composition of the urine,Urea recirculation,Common causes of renal diseases,Connective tissue diseases,allergy,Infection:bacterium,TB,virus,etc,Renal vascular disease,Metabolism:DM,uric acid,Heritage:hereditary nephritis,polycystic kidney disease,Drug poisoning,Circulatory failure,Others,Symptoms of renal diseases,Acute nephritic syndrome,Nephrotic syndrome,Symptomless urine abnormality,Acute renal failure syndrome,Acute urinary tract infection syndrome,Chronic urinary tract infection syndrome,Tubular interstitial diseases syndrome,Chronic renal failure syndrome,Examination and diagnosis of renal diseases,Urine,Renal function,Renal biopsy,Others,Urine,Urine volume,Proteinuria,Haematuria,Cast,leucocyturia,Bacteruria,Others:color,taste,crystal,Urine volume,Normal urine volume:1000-2000ml/24h,average,：,1500ml/24h,Hypourocrinia,oliguria,：,400ml/24h,anuria,：,2500ml/24h,Hypourocrinia,Prerenal:,Decreased effective circulation volume,Renal:,Glomerular,tubular and interstitial diseases,Postrenal:urinary obstruction,polyuria,Decreased ADH production:,Central diabetes insipidus,Renal insensitivity to ADH,：,Nephrogenic diabetes insipidus,Impaired hypertonicity in the medulla,：,Primary urine is hypertonic,：,osmotic diuresis,Psychogenic polydipsia,Pathogenesis of proteinuria,Filter membrane damage,Change of electric charge,Change of haemodynamics,Significance of proteinuria,Physiological,100/mg/d,，,postural,，,functional,Reflect disease state,Accelerate progression of renal diseases,Classification of proteinuria,Glomerular proteinuria,：,Middle molecule&Macromolecule proteinuria,Tubuloproteinuria,：,Micromolecule proteinuria,Overflow proteinuria,：,Bence-Jones Protein,Haematoglobin,Myohemoglobin,Excretory proteinuria,：,IgA,，,T-H protein,Tissue proteinuria,Haematuria,Naked eye,Microscope,：,3-5/HP,Three-glass test,Glomerular/Nonglomerular,Causes of haematuria,Systemic disease,Organs close to urinary tract,Kidney,Urinary tract,Reasons unknown,Cylindruria,Coagulation and deposition of protein in tubules,Type,：,Hyaline cast,granular cast,Cellular cast:epithelial cell cast,red cell cast,white cell cast,Fatty cast,，,renal failure cast,Leucocyturia,Microscope,：,5/HP,Excretory rate account,Pathogen,Staining microscope,Bacterial culture,Specific pathogen:tuberculosis,etc,Determination of GFR,Inulin extraction ratio,Ccr,Isotope,E-GFR:MDRD,Others,Renal blood flow determination,Aminohippuric acid clearance,Doppler ultrasound,PET,Concentration&dilution function,Urine specific gravity,Urine osmotic pressure,Free water clearance,：,V-UosmxV,Posm,Urine acidification,Urinary pH,Urinary acid excretion,：,Titratable acid,NH4,HCO,3,-,Urinary AG,Others,Radiation:,Plain film,KUB+IVP,angiography,Isotope,：,nephrogram,scanning,CT,MRI,Molecular biology,Renal biopsy,Renal pathology,Light microscope:,HE,PAS,PASM,Masson,IF:Direct immunofluorescence,IgM,IgA,IgG,C3,C4,C1q,Fg,lamda,kappa,HBsAg,Electron microscope,Common stainings,HE,Masson,PASM,PAS,Classification of Primary Glomerular,Diseases(WHO,1995),Minor glomerular abnormalities (including minimal change disease),Focal segmental glomerulosclerosis(FSGS),Diffuse glomerulonephritis,Membranous nephropathy,Proliferative glomerulonephritis,Mesangial proliferative glomerulonephritis,Endocapillary proliferative glomerulonephritis,Mesangiocapillary glomerulonephritis,（,Membranoproliferative glomerulonephritis),Crescentic glomerulonephritis,Sclerosing glomerulonephritis,Unclassified glomerulonephritis,Diagnosis,Causes,Function,Complication,Therapeutics of renal diseases,Etilogical treatment,Slowing the progression of diseases,Handling complication,Renal replacement,Prospect of nephrology,Pathogenesis,CKD progression Mechanism,Chronic complication Mechanism,Improvement of blood purification,Renal transplantation,Renal development and regeneration,Molecular pathogenesis of hereditary disease,Large-scale RCT,Prospect:Relevance,Immunology,Biochemics,Physiology,Cell,biology,Genetics,Molecular biology,Pharmacology,Materials,Electric,Engineering,Evidence based medicine,