常用肾脏功能实验室检测选读.pptVIP

诊断学 肾功能检查ASSESSMENT OF RENAL FUNCTION 山东大学 刘运芳 提要 Urine Tests: Cheap and convenient; For screening and following Renal Functions Immunological Test Imaging Examination Renal Biopsy 3 When or for What Kidney diseases or injuries Other diseases induced kidney function injuries Diabetes mellitus Hypertension Shock or extensive burn Auto-immunological diseases Drug toxicity 4 Structure of Kidney 5 肾单位 集合管 肾小体 肾小管 肾小球 肾小囊 近曲小管 远曲小管 髓袢 肾小球功能检查 GLOMERULAR FUNCTION ASSESSMENT 6 Structure and Function GFR: the volume of fluid filtered from the glomerular capillaries into the Bowmans capsule per unit time 120-160ml/min Contents Serum Creatinine (sCr) Serum urea (SU) Creatinine Clearance Rate, Ccr Cystatin C Microalbumin (MA) 、 Transferrinuria (TRU)、uric acid、urine Ig…… Serum Creatinine (sCr) Endogenous a waste product produced by muscle metabolism 9 Serum Creatinine (sCr) A small molecule, filtrated by glomerular completely, and not reabsorbed by tubule sCr: rise if the filtering of the kidney is deficient, Normal Value: Serum Cr: male: 44-132μmol/L female: 70-106μmol/L 10 Stage of renal failure (male) 11 Scr Clinical Significance of sCr increase 12 rise only with marked damage to nephrons filtration Serum urea (SU) also named as BUN Influence factors Protein intake Protein degradation Liver function Glomerular filtration Normal value: Adults: 1.8-7.1mmol/L Children or infants: 1.8-6.5mmol/L 13 Urea or ornithine cycle in liver Clinical Significance of SU Renal damage: Chronic renal failure Compensatory stage: SU9mmol/L Decompensatory stage: SU9mmol/L Failure stage: SU20mmol/L Uremia: SU28.6mmol/L Acute renal disease 14 Clinical Significance Physical: ↑：high protein diet ↓：pregnancy Pre-renal: High fever, Shock, Upper gastrointestinal hemorrhage, extensive burn，severe trauma…… Post-renal: Obstruction in urinary tract 15 SU/Cr ratio: BUN: 7-20 mg/dL Urea: 2.5-10.7 mmol/L sCr: 0.7-1.2 mg/dL sCr: 70-106 μmol/L BUN:Cr Urea:Cr Locatio