肾功能检查重点分析.ppt

Renal Function Test肾功能检查 p349 Kidney diseases Urine tests: urinalysis and others Cheap and convenient; For screening and following Renal biopsy Renal functions Glomerulus: filtration Tubule: reabsorption and acidification Imaging Examination Immunological test When and for What Kidney diseases or injuries Overall checkup Kidney function assessment with other diseases Diabetes mellitus Hypertension Shock or extensive burn Auto-immunological diseases Drug toxicity Structure of Kidney FUNCTIONS OF KIDNEY Excrete metabolic products/wastes Keep the balance of water, acid-base and electrolyte Endocrine function: EPO (erythropoietin):RBC product 1,25(OH)2 D3: Calcium and phosphorus renin: bood pressure regulation Related concepts 急性肾衰AFR 肾前性Pre-renal：休克早期、大面积烧伤、脱水等 功能性 肾性 renal：器质性 肾小管上皮细胞坏死 肾脏本身：肾小球肾炎、肾盂肾炎、狼疮肾炎 肾动脉血栓、栓塞 肾后性post renal：结石、肿瘤、前列腺肥大等尿路梗阻 Related concepts Stages for renal failure： 代偿期compensatory stage 失代偿期decompensatory stage : 氮质血症Azotemia：血中尿素氮BUN或肌酐sCR超出正常范围 肾性 肾前性 肾后性 衰竭期Failure stage 尿毒症期Uremia Stage：综合症候群，“尿潴留在血中”而引起的中毒 Related concepts Common symptoms of AFR 少尿期oliguria stage： Oliguria or anuria, Hematuria, Proteinuria and some kinds of casts Water intoxication Hyperpotassemia Metabolic acidosis Azotemia 多尿期polyuria stage 恢复期recovery stage Related concepts Common symptoms of CFR Early stage： polyuria, Nocturia, Hematuria, Proteinuria and some kinds of casts Azotemia Water intoxication Metabolic acidosis (moderate) Hypopotassemia Late stage: as above, Uremia, hyperpotassemia, hypertension, Osteodystrophy, anemia, bleeding tendency…… Tests of glomerular function肾小球功能检查 Tests of Glomerular Function Glomerular Filtration Rate, GFR Endogenous Creatinine Clearance Rate, Ccr Serum Creatinine, Scr Blood Urea Nitrogen, BUN Serum β2-microglobulin Cystatin C Glomerular Filtration Renal blood flow ： 1200-1400ml/min， 占20%-25%心血流量 Crude urine ：即肾小球滤过液,120-160ml/min 影响因素： renal blood flow effective filtration pressu