西安交通大学医学院泌尿系统疾病课件 CRFzhengshijiangyi.pptVIP

Chronic Renal Failure General introduction Etiology Pathogenesis Clinical findings Complications Diagnosis D.D. Treatment General introduction 1. CRF is defined as a progressive and irreversible loss of renal function. It is a serious stage of renal insufficiency. General introduction General introduction Renal function declines retention of metabolite imbalance of fluid electrolyte and acid-base disorder harms to other organs(almost every system) General introduction CRF is artificially divided into 3 stages according to glomerular filtration rate (GFR NR 80~120ml/min). Serum creatinine , BUN may reflect GFR in some extent. Etiology Any urinary system disease that can impair the structure and function of the kidney may cause CRF. China Primary CGN Obstructive nephropathy Diabetic nephropathy Lupus nephritis Hypertensive nephropathy Policystic disease Western Diabetic nephropathy Hypertensive nephropathy Primary CGN Policystic disease Pathogenesis Progressive deterioration of renal function chronic renal disease is rarely reversable and leads to progressive decline in renal function.this occur even after an inciting event has been removed. Mechanism of uremic symptoms Pathogenesis Intact nephron hypothesis The “trade off” hypothesis Glomerular hyperfiltration hypothesis Tubular hypertrophy hypothesis Others:lipid disorder,Coagulation disorder,etc. Pathogenesis Intact nephron hypothesis considerable amount of nephrons has been impaired,remaining nephrons still work,but reduction in renal mass leads to hypertrophy of the remaining nephrons to meet the body’s need. Unfortunately these adaptations place a burden on the remaining nephrons and leads to progressive glomerular sclerosis and interstitial fibrosis. Pathogenesis ?? The “trade off” hypothesis Pathogenesis GFR Pathogenesis hypertrophy of the remaining nephrons high filtration, high perfusion and high pressure in glomeruli which will lead to glomerular s