肾内科课件 outline教学材料.pptVIP

Outlines of Kidney Disease;The functional unit of the kidney is the nephron. The nephron include： the renal corpuscle （glomerulus Bowman capsule) the tubule;;An ability to maintain fluid , electrolyte and acid-base balance An ability to excrete metabolic substance (mainly nitrogenous wastes) Endocrine function;1 strucure: endothelial basement membrane epithelial 2 character : size-selective barrier charge-selective barrier 3 function：an ultrafiltrate of plasma. ;;Proximal Tubules: reabsorption 100% Glucose ,amino acid 90% bicarbonate 70% water,natrium secrete hydrogen Distal Tubule: secrete hydrogen, potassium, ammonia The Limbs of Henle’s Loop: urine inspissation and dilution ;Vasoactive substance: Vasoconstriction: renin, angiotensin Ⅱ Vasodilatation: kinin,prostaglandin Non-vasoactive substance: erythropoietin renal 1-alpha hydroxylase(calcitriol); APPROACH TO THE PATIENT WITH RENAL DISEASE; A patient will present with renal disease in one of two ways: discovered incidentally with evidence of renal damage ; the disease evaluation includes: an estimation of disease duration a careful urinalysis glomerular filtration rate other datas ;DISEASE DURATION;Evaluating kidney damage by laboratory?and instrumental examination;It include: dipstick examination: gravity, pH, protein, hemoglobin, nitrites, ketones,etc. microscopic examination: searches for all formed elements----cells, casts, and infecting organisms. ;尿液检查（uronoscopy） ;PROTEINURIA ; ; ② Proteinuria results from overproduction of circulating such as Bence jones proteins associated with multiple myeloma. ;③ glomerular proteinuria: cause: abnormalities in the glomerular filtration b