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1、泌尿系统疾病Urinary System disease,西安交通大学第一医院肾内科 尹爱萍,Nephrology,总 论 General Introduction,Nephrology,Substance,OvervierwConstitution and function of urinary systemThe general manifestations of urinary systemThe tests of renal function Diagnosis,prevention and therapyProgres and to look into the future,Neph
2、rology,Overvierw,泌尿系统主管机体尿液的生成和排泄，由肾脏、输尿管、膀胱、尿道及相关的血管神经等组成。肾脏是内分泌器官、排泄器官。对维护机体内环境的稳定起重要的作用。,Substance,OvervierwConstitution and function of urinary systemThe general manifestations of urinary systemThe tests of renal function Diagnosis,prevention and therapyProgres and to look into the future,Nephro
3、logy,肾脏(kidney),输尿管(ureter),膀胱(bladder),尿道(urethra),constitution of urinary system,Gross Features,The weight of each kidney：100140g（adult man）（woman less than man）Length 10.511.5cmWidth 57.2cmThichness 23cm,Nephrology,The nephron(肾单位):The functional unit of the kidney is the nephron(0.41.2106).,atta
4、ched tubule(renal tubule),The glomerulus(enclosed capillary network),Bowmans capsule glomerular tufts,collecting duct,proximal tubule loop of Henle distal tubule,Renal corpuscle,Nephrology,Essential Renal Functions,Filtrate function at the glomerulus capillaryReabsorption and excretion by renal tubu
5、leEndocrine functions of the renal,Regulating water,acid-base and electrolyte balanceEliminating metabolic waste productsRegulating blood pressure,稳定内环境,内分泌功能,RAASPG BKSEPO 1-hydrooxylase,Nephrology,(远曲小管),醛固酮,升高血压,视上神经核烦渴,AGT原,AGT-I,肾素,95%来源于球旁细胞1-5%来源于致密斑、间质细胞少量来源于肾外组织（子宫、大脑、胎盘）,AGT-II,AGT-III,转化酶
6、,失活,肾素血管紧张素醛固酮系统(RAAS),作用于全身血管平滑肌使血管收缩 刺激肾上腺球状带产生醛固酮作用于中枢神经系统使口渴中枢兴奋刺激中枢及周围交感神经系统,血管紧张素的生物作用,促使肾内血管收缩，使肾血流量减少，肾小 球滤过率降低收缩肾小球入球及出球小动脉（出大于入）肾血流量重新分布刺激肾小管的Na+、H+交换，使Na+和HCO3-重吸收增加刺激肾间质NH4+生成和分泌,血管紧张素II对肾的作用,缓激肽系统 激肽释放酶（90%来源于肾皮质 近端小管细胞）激肽原 激肽 激肽酶 失活,作用,对抗血管紧张素 扩张小动脉 增加肾脏血流量 促进钠、水排泄,PGE2影响血管平滑肌及系膜细胞的功能
7、PGI 2 对抗血管紧张素、去甲肾上腺素、血管加压素 的作用 影响水、钠代谢：PGE 2 抑制集合管上皮细胞对钠的吸收 抑制抗利尿剂对集合管的作用,Nephrology,前列腺素(PG)系统,作用,1,25-(0H)2VitD3 2倍(活性)肝 VitD 25-(OH)-VitD3 1,25-(0H)2VitD3 羟化酶 羟化酶 4倍(活性),无活性,有活性,VitD的作用,促进小肠对钙、磷的吸收促进骨钙的移动，不断更新促进肾小管对磷的重吸收，减少尿磷的排泄,促红细胞生成素(EPO)促红细胞细胞生成因子 促红细胞生成素原 促红细胞生成素（EPO）促骨髓红系统生成RBC,红细胞祖细胞原始红细胞幼
8、稚红细胞成熟红细胞,EPO,Nephrology,Substance,OvervierwConstitution and function of urinary systemThe general manifestations of urinary systemThe tests of renal function Diagnosis,prevention and therapyProgres and to look into the future,Nephrology,泌 尿 系 统 常 见 临 床 表 现 The general manifestations of urinary syst
9、em,EdemaHypertensionLoin painBladder symptomsUrinary abnormalities,肾炎性水肿,肾病性水肿,Edema,The general manifestations,nephrotic edema(肾病性水肿)：hypoproteinemia(低白蛋白血症)RAAS ADHnephritic edema(肾炎性水肿)：GFR，dysequilibrium in glomus-tubule(球-管平衡失调)肾小球滤过分数下降（肾小球滤过率/肾血浆流量）,按发病部位按发病机理,Hypertension,容量依赖型高血压 肾素依赖型高血压,肾
10、血管性高血压肾实质性高血压,The general manifestations,Loin pain in the renal area,The general manifestations,Renal colic-Obstruction of the kidney or urinary tract,Dull pain in the renal area-Inflamation of the kidney or urinary tract,Exquisite pain in the renal area-Acute disorders of renal blood vessel,尿急、尿频、尿
11、痛-,Bladder symptoms,泌尿系感染,The general manifestations,Urinary abnormalities,尿量异常,Oliguria 400ml/d Anuria 100ml/d Polyuria 2500ml/d,肾源性 CIN非肾源性 DM DI,Nephrology,The general manifestations,尿质异常,尿成分异常,尿成分异常,蛋白尿Proteinuria,血尿Hematuria,白细胞尿Leucocyturia,菌尿bacteriuria,管型尿cylinderuria,脓尿pyuria,蛋白尿,肾小球性,肾小管性,
12、溢出性,组织性,分泌性,肾小球病变,肾盂肾炎间质性肾炎,多发性骨髓瘤,24h尿蛋白定量150mg,血尿,泌尿系统疾病,功能性,临近器官,全身性疾病,结石、肿瘤、外伤、肾炎、畸形、肾梗塞,血友病、传染病,过劳、肾下垂,新鲜晨尿离心后3/HP或尿细胞计数10万/h或50万/12h,白细胞尿,脓尿,菌尿,新鲜晨尿离心后5/HP或尿细胞计数40万/h或100万/12h,蜕变,未离心尿涂片1/HP或细菌培养105/ml,急性肾小球肾炎,肾盂肾炎 间质性肾炎,多种肾小球疾病肾小管损伤,急性肾小管坏死 活动性肾小球肾炎,红细胞管型,白细胞管型,Substance,overvierwconstitution
13、and function of urinary systemThe general manifestations of urinary systemThe tests of renal function Diagnosis,prevention and therapyProgres and to look into the future,Nephrology,The tests of renal function,肾小球滤过功能 重吸收 近曲肾小管 分泌 远曲集合管,CCr 血2-MG,BUN Scr,尿2-MG,PSP,季氏试验 尿渗透压,Nephrology,Substance,overv
14、ierwconstitution and function of urinary systemThe general manifestations of urinary systemThe tests of renal function Diagnosis,prevention and therapyProgres and to look into the future,Nephrology,Diagnosis,prevention and therapy,diagnosis,原发性继发性,Causing diagnosis病因诊断,Positional diagnosis 部位诊断,Path
15、ologic diagnosis 病理诊断,Functional diagnosis功能诊断,诊断：原发性肾病综合症 膜性肾病 慢性肾功能衰竭（氮质血症期）,例,去除病因抑制免疫性疾病的免疫及炎症反应过程和调节机体免疫性对症处理控制感染替代治疗和器官移植,防治原则,肾病综合征肾炎综合征具有蛋白尿、血尿、高血压急性肾炎综合征急进性肾炎综合征慢性肾炎综合征隐匿性肾炎综合征尿路感染综合征,常见的临床综合征,Nephrology,Substance,OvervierwConstitution and function of urinary systemThe general manifestations of urinary systemThe tests of renal function Diagnosis,prevention and therapyProgres and to look into the future,Nephrology,肾脏病的发展动态,总 结,肾脏的生理功能 尿 内分泌功能常见的临床表现 浮肿 高血压 肾区痛 腰痛 排尿异常肾功能检查泌尿系统的诊断和防治常见的综合征,Nephrology,
