医学类资料：少尿、无尿和多尿.pptVIP

Oliguria，anuria and polyuria少尿、无尿和多尿 Slide * Oliguria，anuria and polyuria Definition Causes and classification Mechanism Diagnosis Oliguria and anuria Slide * Definition of Oliguria and anuria Oliguria Urine Output400ml/d or 17ml/hr 正常状况下，每人平均从尿中排出约600mOsm/l的溶质 肾的最大浓缩能力是1200mOsm/l 若UO少于500ml，代谢产生废物则不能完全从尿中排出 少于400ml即意味着肾功能受损 Anuria UO100ml/d Indicates obstruction of the urinary tract Rarely, renal infarction or cortical necrosis Slide * Urine Output Glomerular filtration rate Renal blood flow Area of filtration membrane Introglomerular pressure Reabsorption and excretion in renal collecting tube Renal tubular structure and function ADH（抗利尿激素） ALD （醛固酮） Urine flow pathway Slide * Causes of Acute Oliguria Three categories: 肾前性 (prerenal):肾脏低灌注 Decrease renal blood flow , introglomerular pressure 肾性 (intrarenal):肾脏本身疾病 Damage to the areaof filtration membrane or tubules structure and function 肾后性(postrenal): 尿路梗阻Obstruct urine flow Slide * Causes of Prerenal Oliguria Decrease in effective blood volume hemorrhage, severe dehydration,, cirrhosis, gastrointestinal fluid loss, trauma, surgery or burns Cardiovascular diseases（心搏出量下降） shock, congestive heart failure, cardiac tamponade, or AMI… Renal artery or renal vein occlusion thrombosis, thromboembolism, severe stenosis Slide * Causes of intrarenal oliguria Glomerular Disease immunologically mediated and result in disrupted glomerular filtration. Interstitial Disease an inflammatory process (toxic, metabolic, infectious, immunee) interstitial edema---- GFR↓--- oliguria Acute Tubular Necrosis renal parenchymal Ischemia，hypoxia---epithelial cell necrosis--- obstruction of renal tube, GFR↓--- oliguria Renal vascular disorders Slide * Causes of postrenal oliguria Ureter obstruction Stone, tumor, clots, abscess mass, or chronic infection(TB) , Papillary tip necrosis Urethra obstruction Stone, tumor, BPH, prostate tumor Slide * Urolithiasis Slide * Diagnostic Evaluation of the P