内科学慢性肾功能衰竭(英文).pptx

Chronic Renal Failure;;Chronic renal failure;Definition;Definition;※ Stages;estimated Glomerular Filtration Rate (eGFR);Etiology;Etiology;;Causes of end-stage renal disease in the United States. ?(USRDS 2005 Annual Data Report) ;Etiology;;;;Pathogenesis;Pathogenesis;Pathogenesis; hyperperfusion GCP?;Pathogenesis;Middle molecular weight solutes: MW 500-5000 PTH uremic peripheral neuropathy, disorder of lipid metabolism, renal osteodystrophy, CVD Others: β-MG,Vit A;Endocrine – metabolic disorder;Pathogenesis;25 50 75 100;Gastroenterologic manifestations prominent and frequently encountered anorexia nausea, vomiting,diarrhea uremic gastroenteritis peptic ulcer, bleeding unpleasant , metallic taste (uremic fetor) ;Manifestations;Manifestations;Cardiovascular and pulmonary disease main cause of death for patients with chronic kidney disease and ESRD hypertension congestive heart failure pericarditis atherosclerosis respiratory system symptoms ;Manifestations;Hematologic anemia (GFR 30-40 ml/min) EPO,inhibitor factor,shorten of RBC life span, short of materials, loss bleeding diathesis gastrointestinal, vaginal, pericardial, intracranial leukocyte abnormalities Dermatologic manifestations pallor, hyperpigmentation, pruritus ;Manifestations;Renal osteodystrophy high-bone turnover dis: osteitis fibrosa cystica, osteoporosis, osteosclerosis low-bone turnover dis: osteomalacia, osteopenia mixed;;Manifestations;Fluid, electrolyte and acid-base disturbance sodium and water potassium metabolic acidosis abnormalities of calcium, phosphate and vitamin D metabolism;Metabolic disturbance carbohydrate metabolism glucose tolerance is reduced insulin resistance hyperlipidemia: triglyceride ;Manifestations;Diagnosis Differential diagnosis;General Recommendations (1);General Recommendations (2);Diet therapy;Treatment of complications ;Heart