醫(yī)學(xué)精品課件：英文班泌尿系統(tǒng)疾病-總論(PPT 48頁)

1、Chapter 1 General Introduction沈陽醫(yī)學(xué)院沈洲醫(yī)院第1頁，共48頁。Basic structure of kidneyLocation 沈陽醫(yī)學(xué)院沈洲醫(yī)院第2頁，共48頁。Basic structure of kidneyLocation: 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-

2、7.2cmThickness 2-3cm 沈陽醫(yī)學(xué)院沈洲醫(yī)院第3頁，共48頁。Basic structure of kidneyConstitute kidney unit juxtaglomerular complex renal interstitium blood vessel nervus沈陽醫(yī)學(xué)院沈洲醫(yī)院第4頁，共48頁。Basic structure of kidneyKidney unit 沈陽醫(yī)學(xué)院沈洲醫(yī)院第5頁，共48頁。Basic structure of kidneyKidney unit renal corpuscle: glomerulus renal capsule

3、 renal tubule: proximal tubule thin segment distal tubule connecting tubule 沈陽醫(yī)學(xué)院沈洲醫(yī)院第6頁，共48頁。Basic structure of kidneyStructure of glomerulus沈陽醫(yī)學(xué)院沈洲醫(yī)院第7頁，共48頁。Basic structure of kidneyStructure of glomerulus: endothelium cell glomerular basement membrane podocyte / foot cell沈陽醫(yī)學(xué)院沈洲醫(yī)院第8頁，共48頁。沈陽醫(yī)學(xué)院沈

4、洲醫(yī)院第9頁，共48頁。沈陽醫(yī)學(xué)院沈洲醫(yī)院第10頁，共48頁。Basic structure of kidneyfoot cell stick to GBM by podocyticprocess stenopaic hole is closed by stenopaic membrane 沈陽醫(yī)學(xué)院沈洲醫(yī)院第11頁，共48頁。沈陽醫(yī)學(xué)院沈洲醫(yī)院第12頁，共48頁。Basic structure of kidneyglomerular basement membrane (GBM): 1. middle level: compact layer sialoprotein 2.strata ex

5、ternum and endothecium: tectorium heparan sulfate anion 3. collagen protein :basic structure filling laminin, fibronection沈陽醫(yī)學(xué)院沈洲醫(yī)院第13頁，共48頁。GBM function maintain normal structure tired jacent cell constitute filtration barrier沈陽醫(yī)學(xué)院沈洲醫(yī)院第14頁，共48頁。constitute filtration barrier size /molecular barrier:

6、 limit passing of big molecular charge barrie: restrict filter of negative charge material沈陽醫(yī)學(xué)院沈洲醫(yī)院第15頁，共48頁。a 臟層上皮細胞 b GBM c 內(nèi)皮細胞 d 系膜 e 副系膜沈陽醫(yī)學(xué)院沈洲醫(yī)院第16頁，共48頁。Physiological function of kidneyExcretion of metabolite Regulation of water electrolytes & acid-base balance Maintaining the stableness of i

7、nternal environment沈陽醫(yī)學(xué)院沈洲醫(yī)院第17頁，共48頁。Glomerular filter functionMain form of metabolites excretion which include urea, creatine, hippuric acid, benzoic acid, amine & uric acid2. GFR indicate if the filter function is normal or not, which is determined by hydrostatic pressure, colloid osmotic pressur

8、e, area of filter membrane & filter fraction of capillary。沈陽醫(yī)學(xué)院沈洲醫(yī)院第18頁，共48頁。腎小球濾過功能沈陽醫(yī)學(xué)院沈洲醫(yī)院第19頁，共48頁。Reabsorption & secretion function of renal tubuleCrude urine (electrolyte components are similar with plasma)180L/d; Urine volume1500ml/d (99% is reabsorbed); Reabsorption & secretion are controlle

9、d by renal tubule make water-electrolyte balance. 沈陽醫(yī)學(xué)院沈洲醫(yī)院第20頁，共48頁。腎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，排泄有機酸、尿酸、造影劑、抗生素。髓袢細段的尿液濃縮起重要作用。遠端小管調(diào)節(jié)終尿成分的主要場所，重吸收Na，排出K及分泌H、NH4。沈陽醫(yī)學(xué)院沈洲醫(yī)院第21頁，共48頁。Endocrine function of kidneyvasoactive hormones acts on kidney regulate physiologically hemodynamics & wate

10、r-salt metabolism includes renin、angiotensin、prostate group、kinin system non-vasoactive hormones acts on whole body includes 1hydroxylase &erythropoietin沈陽醫(yī)學(xué)院沈洲醫(yī)院第22頁，共48頁。Examination of kidney disease沈陽醫(yī)學(xué)院沈洲醫(yī)院第23頁，共48頁。Urinalysis1、 proteinuria urine protein150mg/d, qualitative analysis (+), urine p

11、rotein/ creatinine200mg/g proteinuria urine protein30300mg/d minimal urine protein沈陽醫(yī)學(xué)院沈洲醫(yī)院第24頁，共48頁。Classification of proteinuriaReasons:(1)Physiologic proteinuria functional positional (2) Glomerular proteinuria ： selective nonselective 沈陽醫(yī)學(xué)院沈洲醫(yī)院第25頁，共48頁。Classification of proteinuria(3) tubule pr

12、oteinuria : 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 沈陽醫(yī)學(xué)院沈洲醫(yī)院第26頁，共48頁。Urinalysis2 hematuriagross & microscopic 。新鮮尿離心沉渣每高倍視野紅細胞超過

13、個，稱為鏡下血尿。尿外觀呈洗肉水樣、血樣、醬油樣或有血凝塊時，稱肉眼血尿。沈陽醫(yī)學(xué)院沈洲醫(yī)院第27頁，共48頁。尿液檢查沈陽醫(yī)學(xué)院沈洲醫(yī)院第28頁，共48頁。尿液檢查鑒別腎小球源性血尿：a新鮮尿沉渣鏡檢 變形紅細胞為腎小球源性; 原因: GBM斷裂,紅細胞通過受血管內(nèi)壓力擠出受損, 其后通過腎小管各段時受滲透壓變化和PH作用,呈現(xiàn)變形紅細胞血尿，紅細胞體積表小、破裂。 均一形態(tài)正常紅細胞尿為非腎小球源性沈陽醫(yī)學(xué)院沈洲醫(yī)院第29頁，共48頁。尿液檢查鑒別腎小球源性血尿b 尿紅細胞容積分布曲線 腎小球源性血尿呈非對稱曲線， 其 峰值紅細胞容積小于靜脈峰值紅細胞容積 非腎小球源性血尿呈對稱曲線，其峰

14、值紅細胞容積大于靜脈峰值沈陽醫(yī)學(xué)院沈洲醫(yī)院第30頁，共48頁。50 100 150 200a50 100 150 200b50 100 150 20050 100 150 200c50 100 150 200d沈陽醫(yī)學(xué)院沈洲醫(yī)院第31頁，共48頁。尿液檢查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、腎小球或腎小管性疾病 2、炎癥、藥物刺激使

15、粘蛋白分泌少而形成 沈陽醫(yī)學(xué)院沈洲醫(yī)院第32頁，共48頁。沈陽醫(yī)學(xué)院沈洲醫(yī)院第33頁，共48頁。尿液檢查4 leucocyturia、pyuria、bacteriurialeucocyturia ：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；沈陽醫(yī)學(xué)院沈洲醫(yī)院第34頁，共48頁。GFR

16、determinationGFR: the ability of renal clearance of plasma substances per unit time Endogenous 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. 沈陽醫(yī)學(xué)院沈洲醫(yī)院第35頁，共48頁。Im

17、aging tests ultrasonography CT &MRI arteriography & venography radionuclide,沈陽醫(yī)學(xué)院沈洲醫(yī)院第36頁，共48頁。沈陽醫(yī)學(xué)院沈洲醫(yī)院第37頁，共48頁。沈陽醫(yī)學(xué)院沈洲醫(yī)院第38頁，共48頁。沈陽醫(yī)學(xué)院沈洲醫(yī)院第39頁，共48頁。Common syndromes of renal diseases1.Nephrotic syndrome: protein in urine 3.5g/d protein in plasma30g/d edema hyperlipemia沈陽醫(yī)學(xué)院沈洲醫(yī)院第40頁，共48頁。腎臟疾病常見綜合

18、征2.Nephritis syndrome: proteinuria, hematuria, hypertension;3.Asymptomatic urine abnormality: 4.Acute renal failure & rapidly progressive renal failure syndrome:5.Chronic renal failure syndrome: progressive irreversibly renal functional failure .沈陽醫(yī)學(xué)院沈洲醫(yī)院第41頁，共48頁。Evaluation of renal diseasesEtiology diagnose：primary or secondarypathology diagnose ：Nephritis, NS,AKI,proteinuria, hematuria, percutaneous renal biopsy function diagnose ：AKI、CKDcomplication diagnose ：ARF、CRF沈陽醫(yī)學(xué)院沈洲醫(yī)院第42頁，共48頁。Prevention & cure:Principle Wipe off inducement; Common treatment; Inhi