泌尿系统整合PBL课件.pptxVIP

余先生怎么了泌尿系统PBL第二组肾小球正常结构杨佳妮、肾单位（Nephron）血管球毛细血管（有孔毛细管）：有孔（70nm左右，最大100nm） 无隔膜 内皮细胞游离面细胞衣 负电荷肾脏基膜（Renal Basement Membrane）? 连续结构? 由毛细血管内皮细胞 与足细胞共同产生足细胞（podocyte)：突起（process）裂孔（slit pore)裂孔膜 (slit membrane)Glomerulus Function张家旭Glomerular filtrationGlomerular filtration barrierNeutral solutes:Solutes smaller than 2 nanometers in radius are freely filteredSolutes greater than 4.2 nanometers do not filterSolutes between 2 and 4.2 nm are filtered to various degreesGlomerular filtration rate?(GFR) is the volume of fluid filtered from the?renal?(kidney)?glomerular?capillaries into the?Bowmans capsule?per unit time.≈125ml/minEFRKf?is the filtration coefficient – a proportionality constantPgc?is the glomerular capillary?hydrostatic pressurePbc?is the Bowmans capsule hydrostatic pressureπgc?is the glomerular capillary?oncotic pressureπbc?is the Bowman‘s capsule oncotic pressure = 01.Changes in renal blood flow2.Changes in glomerular capillary hydrostatic P - changes in systemic BP - afferent or efferent arteriolar constriction3.Changes in hydrostatic P in Bowman’s capsule - ureteral obstruction, renal edema 4. Changes in glomerular capillary?oncotic pressure5.Changes in Kf - Reduction in effective filtration surface area - Changes in glomerular capillary permeabilityRegulation of Glomerular FiltrationTwo mechanisms control the GFR Renal autoregulation Nervous and humoral regulationUnder normal conditions (MAP =80-180mmHg) renal autoregulation maintains a nearly constant glomerular filtration rate Two mechanisms are in operation for autoregulation: Myogenic mechanismTubuloglomerular feedback尿常规刘逸馨项目理学检验（ physical exam） ：尿量、尿气味、尿外观、比重（SG）化学检验（ chemical exam） pH、蛋白质、葡萄糖、酮体、胆红素、尿胆原、血红蛋白/隐血、亚硝酸盐、白细胞酯酶、维生素C、微量白蛋白显微镜检验（ microscopic exam） 细胞（RBC、WBC）、管型、结晶、微生物 尿量（Vol）正常： 成人600～2000ml/24h少尿（oliguria）： 尿量400ml/d，常伴脱水，如呕吐、 腹泻、 流汗、 烧伤。无尿（anuria）：尿量100ml/d，肾严重损伤或肾血流量减少，使尿流停止。多尿（polyuria）： 尿量2500ml/d，如糖尿病、尿崩症、使用利尿剂、咖啡因和乙醇尿气味（Odor）正常： 芳香味， 与摄入食物中挥发酸有关异常： 提示病理情况、 标本处理或贮存不当外观尿色(Col)正常