上海交通大学医学院儿科学临床医学八年一贯制课件 泌尿系统.ppt

urinary system 上海交通大学医学院附属新华医院 儿内科教研室 卫敏江 urinary system Urinary system includes the kidney、ureter、bladder and urethra . The kidney is an important excretory organ , also , it is an essential adjuster and endocrine organ to maintain a precise balance of internal environment .  anatomical character neonate larger，inmature，small glomerulus ，short tubule infant Ureter is much longer and incurvater, tube muscles and elastic fibers are dysontogenesis . Ureter close to the bladder is straighter and shorter, it is poor to prevent urine reverse flow. female infant has a shorter urethra? ,but male infant often has capistration physiologic character ◆ glomerular filtration commences in the metanephric kidney at about 9 to 12 weeks of gestation， the full complement of nephrons is present at 36 weeks of gestation . ◆ low reserve capacity ，inmature regulatory mechanism，easy to dysfunction? 。 ◆ the renal function(calculated by body weight or body surface area) reaches a value comparable to adult at 1 to 2 years of age. glomerular filtration rate ◆neonate the first week of birth : glomerular filtration↓ 2 –year-old: adult level ◆pathology extra moisture?and solute?can not excretion in time →edema   natrium neonate aldosterone ↑→natrium positive balance ◆ glomerular filtration rate ↓ → natrium load↑ → natriume excretion ↓ →edema ◆ infant of low-birth weight natriume duction ↑ →if natriume intake ↓（3mmol/kg/d）→hyponatremia →shock or convulsion potassium because Na-K-ATP enzyme system of renal tubules epithelium is inmature， neonate potassium excretion↓in 10 ays→hyperkalemia tendency。 acid-base balance ◆kidney→excret H＋、reabsorb HCO3－ → acid-base balance ◆at 2 weeks after birth the urine PH get the adult level ◆ at 2 years old the capability of ammonia excretion close to adult level ◆ renal threshold of HCO3