3.肾脏病学总论.ppt

NEPHROLOGY (肾脏病学总论） Zhou Fuhua（周富华） The second affiliated hospital of Nanjing Medical University NEPHROLOGY Structure of the kidney(结构) Function of the kidney Clinical manifestation Laboratory Evaluation of Renal Disease Major Renal Syndromes The Nephron (肾单位) Consists of the glomerulus(肾小球) and its attached tubules(肾小管). The functional unit of the kidney (是肾脏的功能单位) Glomerulus(肾小球) Endothelial cells(内皮细胞) Glomerular basement membrane (肾小球基底膜GBM) Podocytes(足突细胞) - Visceral Epithelial Cell Mesangial cellsand matrix (系膜细胞和基质) Parietal epithelium Bowman’s Capsule Juxtaglomerular Apparatus(近球旁器) Vascular component Afferent arteriole Efferent arteriole Extraglomerular mensangial region Tubule component thick ascending limb Mechanism of renin release The macula densa theory changes in the Na+,Cl- concentration The stretch-receptor theory alterations in the volume stretch of the afferent arteriol TUBULAR EPITHELIAL CELLS NEPHROLOGY Structure of the kidney Function of the kidney(功能) Clinical manifestation Laboratory Evaluation of Renal Disease Major Renal Syndromes Nephron Function Glomerular filtration (肾小球滤过功能） Tubule secretion and reabsorption （肾小管重吸收和分泌功能） 肾小球滤过功能（glomerular filtration function） 含氮废物如尿素、肌酐等主要由肾小球滤过排出。马尿酸、苯甲酸、各类胺类及尿酸也有部分经滤过排出 肾小管重吸收和分泌功能（tubular reabsorption and excretion function） 近端小管 重吸收 髓袢 维持髓质高张及尿液的浓缩和稀释 远端小管 AVP作用下,尿素再循环 Nephron Function Water balance(水平衡) Eletrolyte metabolism(电解质代谢) Acid-base balance(酸碱平衡) Urea secretion (代谢产物排泄) Others: 内分泌功能（endocrine function） 球旁器分泌肾素 血管紧张素原→血管紧张素Ⅰ→血管紧张素Ⅱ、血管紧张素Ⅲ RAS系统 Renin-angiotensin system(肾素血管紧张素系统RAS) angiotensinogen angiotensinⅠ angiotensinⅡ Aldosterone AT1,AT2 Angiotensin Ⅱ Increase preglomerular and efferent arterioar resistances Enhance the reabsorption of sodium Effects on vasa vecta Decrease Kf—a decrease in hydraulic conductivity Enhance production o