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1、沈阳医学院沈洲医院,Chapter 1 General Introduction,沈阳医学院沈洲医院,Basic structure of kidney,Location,沈阳医学院沈洲医院,Basic structure of kidney,Location:tow sides of spinal column behind peritoneumLift kidney:upper pole T11 low pole L2Right kidney:near the liver upper pole T12 low pole L3Length 10.5-11.5cm Width 5-7.2cmT
2、hickness 2-3cm,沈阳医学院沈洲医院,Basic structure of kidney,Constitute kidney unit juxtaglomerular complex renal interstitium blood vessel nervus,沈阳医学院沈洲医院,Basic structure of kidney,Kidney unit,沈阳医学院沈洲医院,Basic structure of kidney,Kidney unit renal corpuscle:glomerulus renal capsule renal tubule:proximal tubu
3、le thin segment distal tubule connecting tubule,沈阳医学院沈洲医院,Basic structure of kidney,Structure of glomerulus,沈阳医学院沈洲医院,Basic structure of kidney,Structure of glomerulus:endothelium cell glomerular basement membrane podocyte/foot cell,沈阳医学院沈洲医院,沈阳医学院沈洲医院,沈阳医学院沈洲医院,Basic structure of kidney,foot cell s
4、tick to GBM by podocyticprocess stenopaic hole is closed by stenopaic membrane,沈阳医学院沈洲医院,沈阳医学院沈洲医院,Basic structure of kidney,glomerular basement membrane(GBM):1.middle level:compact layer sialoprotein 2.strata externum and endothecium:tectorium heparan sulfate anion 3.collagen protein:basic structur
5、e filling laminin,fibronection,沈阳医学院沈洲医院,GBM function maintain normal structure tired jacent cell constitute filtration barrier,沈阳医学院沈洲医院,constitute filtration barrier size/molecular barrier:limit passing of big molecular charge barrie:restrict filter of negative charge material,沈阳医学院沈洲医院,a 脏层上皮细胞 b
6、 GBM c 内皮细胞 d 系膜 e 副系膜,沈阳医学院沈洲医院,Physiological function of kidney,Excretion of metabolite Regulation of water electrolytes&acid-base balance Maintaining the stableness of internal environment,沈阳医学院沈洲医院,Glomerular filter function,Main form of metabolites excretion which include urea,creatine,hippuric
7、 acid,benzoic acid,amine&uric acid2.GFR indicate if the filter function is normal or not,which is determined by hydrostatic pressure,colloid osmotic pressure,area of filter membrane&filter fraction of capillary。,沈阳医学院沈洲医院,肾小球滤过功能,沈阳医学院沈洲医院,Reabsorption&secretion function of renal tubule,Crude urine(
8、electrolyte components are similar with plasma)180L/d;Urine volume1500ml/d(99%is reabsorbed);Reabsorption&secretion are controlled by renal tubule make water-electrolyte balance.,沈阳医学院沈洲医院,肾小管重吸收和分泌功能,近端小管是重吸收的主要部位，葡萄糖、氨基酸全部被重吸收，排泄有机酸、尿酸、造影剂、抗生素。髓袢细段的尿液浓缩起重要作用。远端小管调节终尿成分的主要场所，重吸收Na，排出K及分泌H、NH4。,沈阳医学
9、院沈洲医院,Endocrine function of kidney,vasoactive hormones acts on kidney regulate physiologically hemodynamics&water-salt metabolism includes renin、angiotensin、prostate group、kinin system non-vasoactive hormones acts on whole body includes 1hydroxylase&erythropoietin,沈阳医学院沈洲医院,Examination of kidney dis
10、ease,沈阳医学院沈洲医院,Urinalysis,1、proteinuria urine protein150mg/d,qualitative analysis(+),urine protein/creatinine200mg/g proteinuria urine protein30300mg/d minimal urine protein,沈阳医学院沈洲医院,Classification of proteinuria,Reasons:(1)Physiologic proteinuria functional positional(2)Glomerular proteinuria：sele
11、ctive nonselective,沈阳医学院沈洲医院,Classification of proteinuria,(3)tubule proteinuria:protein reabsorption defect of proximal tubule 2microglobulin、lysozyme in urine;2g/d.(4)overflow proteinuria:abnormal protein(Hb/myoglobin/light chain protein of multiple myeloma)of low molecular weight,沈阳医学院沈洲医院,Urinal
12、ysis,2 hematuriagrossµscopic。新鲜尿离心沉渣每高倍视野红细胞超过个，称为镜下血尿。尿外观呈洗肉水样、血样、酱油样或有血凝块时，称肉眼血尿。,沈阳医学院沈洲医院,尿液检查,沈阳医学院沈洲医院,尿液检查,鉴别肾小球源性血尿：a新鲜尿沉渣镜检 变形红细胞为肾小球源性;原因:GBM断裂,红细胞通过受血管内压力挤出受损,其后通过肾小管各段时受渗透压变化和PH作用,呈现变形红细胞血尿，红细胞体积表小、破裂。均一形态正常红细胞尿为非肾小球源性,沈阳医学院沈洲医院,尿液检查,鉴别肾小球源性血尿b 尿红细胞容积分布曲线 肾小球源性血尿呈非对称曲线，其 峰值红细胞容积小于静脉
13、峰值红细胞容积 非肾小球源性血尿呈对称曲线，其峰值红细胞容积大于静脉峰值,沈阳医学院沈洲医院,a,b,c,d,沈阳医学院沈洲医院,尿液检查,3.cylinderuria：cast in urine protein coagulation in tubule cell/many granular casts&proteinuria appear in the meantime is meaningful in clinic原因：1、肾小球或肾小管性疾病 2、炎症、药物刺激使粘蛋白分泌少而形成,沈阳医学院沈洲医院,沈阳医学院沈洲医院,尿液检查,4 leucocyturia、pyuria、bacte
14、riurialeucocyturia：pyuria5WBC/HP of fresh centrifugal urine/40 millions WBC/1hrs of fresh urine/100 millions WBC/12hrs;pyuria bacteriuria：bacteria in every HP/cultured bacteria colonies 105/ml；,沈阳医学院沈洲医院,GFR determination,GFR:the ability of renal clearance of plasma substances per unit time Endogeno
15、us Ccr(creatinine clearance rate)in clinic is the usual means of estimating GFR Recently,K/DOQI clinical practice guide recommend 2 formulas to calculate GFR:Cokcroff-Gault&MDRD.,沈阳医学院沈洲医院,Imaging tests ultrasonography CT&MRI arteriography&venography radionuclide,沈阳医学院沈洲医院,沈阳医学院沈洲医院,沈阳医学院沈洲医院,沈阳医学院沈
16、洲医院,Common syndromes of renal diseases,1.Nephrotic syndrome:protein in urine 3.5g/d protein in plasma30g/d edema hyperlipemia,沈阳医学院沈洲医院,肾脏疾病常见综合征,2.Nephritis syndrome:proteinuria,hematuria,hypertension;3.Asymptomatic urine abnormality:4.Acute renal failure&rapidly progressive renal failure syndrome:
17、5.Chronic renal failure syndrome:progressive irreversibly renal functional failure.,沈阳医学院沈洲医院,Evaluation of renal diseases,Etiology diagnose：primary or secondarypathology diagnose：Nephritis,NS,AKI,proteinuria,hematuria,percutaneous renal biopsy function diagnose：AKI、CKDcomplication diagnose：ARF、CRF,
18、沈阳医学院沈洲医院,Prevention&cure:,Principle Wipe off inducement;Common treatment;Inhibit immune Renal substitutive therapy,沈阳医学院沈洲医院,Renal substitutive therapy only effective way for patients of terminal renal failure includes:hemodialysis,peritoneal dialysis,kidney transplantation;,沈阳医学院沈洲医院,Pertoneal dialysis,腹膜透析交换,沈阳医学院沈洲医院,hemodialysis,沈阳医学院沈洲医院,progression&prospect,Pathogenesis of renal diseases;Prevention,沈阳医学院沈洲医院,思考题,肾脏的结构与功能。肾脏疾病常见的临床表现。肾脏疾病的诊断要求。,
