慢性肾功能衰竭Chronic Renal Failure（CRF）课件.pptVIP

Chronic Renal Failure(CRF) Shanghai Ruijin Hospital affiliated to Shanghai Second Medical University, Dept.of Nephrology Qian Ying CRF Definition: final stage of numorous renal diseases resulting from progressive loss of glomerular, tubular and endocrine function in both kidneys. This leads to disturbed excretion of end products of metabolism disturbed elimination of electrolytes and water disturbed secretion of hormones(eg. Erythropoietin, renin, prostaglandins, active form of vitamin D) CRF Regional and racial incidence of CRF Britain 70-80/per million China 100/per million USA 60-70/per million CRF Etiology diabetic nephropathy, hypertensive glomerular sclerosis, chronic GN chronic GN, obstructive nephropathy, diabetic nephropathy CRF Pathogenesis (unknown) uremic toxins small molecular weight: urea, creatinine, uric acid, guanidine, phenol, amines, indoles middle molecular weight: PTH large molecular weight: ?2-MG CRF Major hypothesis intact nephron hypothesis final common pathway (hemodynamically mediated glomerular injury) CRF CRF Trade-off hypothesis CRF ? Calcium? phostate? ?PTH ? ?SHPT ? bone,heart,blood,nerves injury Hypertension and compensatory hypertrophy of glomeruli Hypermetabolism of renal tubuli cytokines and lipid disturbances CRF Stage 1: the normal stage of renal function GFR70 ml/min, BUN6.5 mmol/L, Scr110 umol/L Stage 2:imcompensation stage of renal GFR 50-70 ml/min, 6.5 BUN 9 mmol/L, 110 Scr 178 umol/L no any signs and symptoms except for the underlying disorders CRF Stage 3: azotemic stage GFR50 ml/min,BUN9 mmol/L Scr178 umol/L there may be slight fatigue,anorexia and anemia Stage 4: uremic stage GFR25 ml/min,BUN20 mmol/L Scr445 umol/L a constellation of uremic syndrome may appear in this stage CRFSigns and symptoms of uremia