慢性肾脏病方案.ppt

Etiology Etiology in our country Chronic glomerulonephritis(IgA N) Hypertension nephropathy Diabetic nephropathy Others Etiology in abroad Diabetic nephropathy Hypertension nephropathy Chronic glomerulonephritis Others Pathogenesis CKD进展的共同机制 尿毒症症状的发生机制 1、肾小球血流动力学改变 SNGFR增加导致肾小球“三高” 高灌注 高压力 高滤过 Gastrointestinal Anorexia progressing to nausea and vomitting Stomatitis口炎 gingivitis牙龈炎 and parotitis腮腺炎 Peptic ulcer Gastritis and duodenitis Enterocolitis Pancreatitis Ascites Cardiovascular Hypertension Accelerated artherosclerosis Congestive heart failure Pericarditis Pulmonary Atypical pulmonary edema Pneumonitis Fibrinous pleuritis Neurologic Central Daytime drowsiness and a tendency to sleep,which progresses to increaseing obtundation and,eventually,coma Decreased attentiveness and performance of cognitive tasks Imprecise memory Slurred speech Asterixis and myoclonus Seizures Disorientation and confusion Neurologic Peripheral Sensorimotor peripheral neuropathy,often with burning dysesthesia Singultus(hiccup) Restless leg syndrome Increased muscle fatigability and muscle cramps Dermatologic Pruritus Dystrophic calcification Changes in skin pigmentation Hematologic Anemia Causes: Decreased erythropoietin(EPO) production Shorten the span life of RBC Iron deficiency Low-grade hemolysis and blood loss Altered neutrophilic chemotaxis Depressed lymphocyte function Bleeding diathesis with platelet dysfunction Endocrinologic Secondary hyperparathyroidism Carbohydrate intolerance due to insulin resistance TypeⅥ hyperlipidemia Altered peripheral thyroxine metabolism Testicular atrophy Ovarian dysfunction with amenorrhea,dysmenorrhea,dysfunctional uterine bleeding,cystic ovarian disease Renal Osteodystrophy High bone turnover disease Low bone turnover disease Mixed bone disease Disturbed Water, Electrolytes and Acid-base Balance 高钙血症 Hypercalcemia 病因：甲状旁腺增生，甲状旁腺素分泌增多导致高钙血症。 临床表现:骨痛和转移性钙化，累及心脏可猝死。 高镁血症 H