内科学 肾脏病学总论-顾勇.ppt

General introduction of Nephrology Gu Yong Nephrology department of Huashan Hospital Affiliated to Fudan University Contents Anatomy Physiological function Common etiological factors Symptoms and diagnosis Therapeutics Advancement Renal anatomy Two kidney Nephron: acinus renalis tubules Tubules: Proximal, Henle‘s loop, distal Collecting duct Interstitium Vessels Physiological function General: Maintaining internal homeostasis Excreting metabolic wastes product Regulating water, electrolyte, acid-base balance Endocrine: RAS, PGs, kinin system, EPO and Vit D Glomerular filtration Tubular reabsorption Tubular excretion SNGFR=Kf(ΔP-Δ∏) =Kf[(PGc-Pt)-(∏Gc-∏t)] Kf: capillary permeability, filtration area Daily glomerular filtration: 180L Urinary volume: 1000-2000ml Proximal tubule Reabsorption (isotonic) Glucose: 100% Amino acid: 100% HCO3-: 80% H2O: 70% NaCl: 70% Excretion: Organic acid Drugs Henles loop Countercurrent multiplication Distal tubule To determine final composition of the urine Urea recirculation Common causes of renal diseases Connective tissue diseases, allergy Infection: bacterium, TB, virus, etc Renal vascular disease Metabolism: DM, uric acid Heritage: hereditary nephritis polycystic kidney disease Drug poisoning Circulatory failure Others Symptoms of renal diseases Acute nephritic syndrome Nephrotic syndrome Symptomless urine abnormality Acute renal failure syndrome Acute urinary tract infection syndrome Chronic urinary tract infection syndrome Tubular interstitial diseases syndrome Chronic renal failure syndrome Examination and diagnosis of renal diseases Urine Renal function Renal biopsy Others Urine Urine volume Proteinuria Haematuria Cast leucocyturia Bacteruria Others: color, taste, crystal Urine volume Normal urine volume: 1000---2000ml/24h average：1500ml/24h