第十七章 肾功能不全
DESCRIPTION
第十七章 肾功能不全. ( renal insufficiency). 肾的功能解剖结构示意图. Peritubular capillary. Renal tubule. H 2 O. H 2 O. H 2 O. Renal corpuscle. 肾小球滤过 Glomerular filtration. Flow of filtrate. 肾小管重吸收 Tubular reabsorption. 肾小管分泌 Tubular secretion. Urine. - PowerPoint PPT PresentationTRANSCRIPT
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(renal insufficiency)
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Urine Glomerular filtration Tubular reabsorption Tubular secretionFlow of filtrateRenal corpuscle
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The fundamental unit for renal filtration and resorption
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:: (renin)(EPO)PGs VitD
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PGs EPO 125-(OH ) 2VD3
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1234
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Excretion filtration, resorption and secretion, to maintain the balance in water, electrolytes, acid and alkali Endocrine renin, prostaglandins, erythropoietin, 1,25 (OH)2VitD3 Inactivation PTH, pepsinReview of normal renal function
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Inferior vena cavaAdrenal glandKidneyAortaUreter Bladder Urethra
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Net Filtration Pressure60 out(25 mmHg)=-(-)60 mmHg10 mmHg25 mmHg
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GFR
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123
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1--renin-angiotensia-aldosterone systemRAAS)2erythropoietenEPO3125-D3125-dihydroxyvitamin D,1,25-OH2VD34--kallikrein-kinin-prostaglandin-systemKKPGS5
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hyperthrophy of remaining nephrons Normal glomeruli, LM 390xGlomerulus from patient with unilat. kidney agenesis, LM 390x
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(acute renal failureARF)
GFR
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1(ATN) 1 2 3 2 GFR
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GFRADH
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1(ATN) 1 2 3 2 GFR
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HgCL2 200
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HgCL2 200
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1 1 2 3 42
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RBFGFR 80~160mmHgRBFGFR50~70mmHgRBFGFR1/2~2/340mmHgRBFGFR80mmHg
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RPFGFR80180405.3
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1- 2RAS34GFR
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()1234DIC
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12 12GFR GFR
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RAA - PGE2 ; Ca2+ GFR
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:,:, GFR AngADHGFR ,,,
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Normal Cell Apoptotic cell Cell undergoing apoptosis
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(1) (2)mTAL(S3) (3)mTAL (4) () NO (HO)(CO) /HO ARF
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1ATPNa+-K+-ATP 2OFR Na+-K+-ATPCa2+-ATPATP
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3GSH4GSH GSH AAPGSLTS 56
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Na+K+-ATP Ca2+ - ATP Ca2+ATP OFR GSH PGsLTs
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(1) (2) (3) (4) ATP N450
200 CHSP70
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400ml/d100ml/d 1.010~1.020 > 40mmol/L
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KfGFRATN
- ARI ARI >1.020 500 401
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water intoxication
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GFR
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BUN3.57 ~ 5.25mmol/L 10~15mgBUN azotemia
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GER
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chronic renal insufficiencyCRI
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GFR
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%
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() 1 2trade-off PTH
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GFR PTHD3GFR
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() 1 2 (1)-(2) (3) (4) GFR
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1 1nocturia
2polyuria242000ml 3 400ml
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100210351020
10081012266~300mmolL360~1450mmol/L
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1proteinuria
2
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lBUN GFR2 = 3 GFR(NPN>40mg/dl GFR
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GFR PTH D
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GFR PTHD3GFR
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1GFR2PTHCAH+HCO3-3NH3 H+
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1 2
3 PGA2E2
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PGA2PGE2GFR
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l 2D3 3
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ADP 1 2
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12 345 RBCRBCATPRBCRBCRBCRBCMPS
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1.PTH: 2.: 3.4. 5.500~50006.
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PTH
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+ + + -+
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PTH
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kussmaul
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1 ARF2345678910ARF11 ARF12
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,68++1.01564 mmol/L809 ummol/L16.2 mmol/LClinical Example
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2. Questions3.
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35201 6104-52000ml/BP19.3/13.3kPaHb40-70g/LRBC1.3-1.761012/L+RBCWBC0-2/HP33000ml/1.01010 T37R20P120BP20/13kPaRBC1.49 1012/LHb47g/LWBC9.6 109/L1.9mmol/L1.3mmol/L+RBC10-15/HpWBC0-2/Hp0-2/Hp2-3/LPX
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1922 965 363