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1、Chapter 1 General IntroductionBasic structure of kidneyLocation Basic structure of kidneyLocation:tow sides of spinal column behind peritoneumLift kidney:upper pole T11 low pole L2Right kidney:near the liver upper pole T12 low pole L3Length 10.5-11.5cm Width 5-7.2cmThickness 2-3cm Basic structure of
2、 kidneyConstitute kidney unit juxtaglomerular complex renal interstitium blood vessel nervusBasic structure of kidneyKidney unit Basic structure of kidneyKidney unit renal corpuscle:glomerulus renal capsule renal tubule:proximal tubule thin segment distal tubule connecting tubule Basic structure of
3、kidneyStructure of glomerulusBasic structure of kidneyStructure of glomerulus:endothelium cell glomerular basement membrane podocyte/foot cellBasic structure of kidneyfoot cell stick to GBM by podocyticprocess stenopaic hole is closed by stenopaic membrane Basic structure of kidneyglomerular basemen
4、t membrane(GBM):1.middle level:compact layer sialoprotein 2.strata externum and endothecium:tectorium heparan sulfate anion 3.collagen protein:basic structure filling laminin,fibronectionGBM function maintain normal structure tired jacent cell constitute filtration barrierconstitute filtration barri
5、er size/molecular barrier:limit passing of big molecular charge barrie:restrict filter of negative charge materiala 脏层上皮细胞 b GBM c 内皮细胞 d 系膜 e 副系膜Physiological function of kidneyExcretion of metabolite Regulation of water electrolytes&acid-base balance Maintaining the stableness of internal environm
6、entGlomerular filter function1.Main form of metabolites excretion which include urea,creatine,hippuric acid,benzoic acid,amine&uric acid2.GFR indicate if the filter function is normal or not,which is determined by hydrostatic pressure,colloid osmotic pressure,area of filter membrane&filter fraction
7、of capillary。肾小球滤过功能Reabsorption&secretion function of renal tubuleCrude urine(electrolyte components are similar with plasma)180L/d;Urine volume1500ml/d(99%is reabsorbed);Reabsorption&secretion are controlled by renal tubule make water-electrolyte balance.肾小管重吸收和分泌功能近端小管是重吸收的主要部位，葡萄糖、近端小管是重吸收的主要部位，
8、葡萄糖、氨基酸全部被重吸收，排泄有机酸、尿氨基酸全部被重吸收，排泄有机酸、尿酸、造影剂、抗生素。酸、造影剂、抗生素。髓袢细段的尿液浓缩起重要作用。髓袢细段的尿液浓缩起重要作用。远端小管调节终尿成分的主要场所，重远端小管调节终尿成分的主要场所，重吸收吸收NaNa，排出，排出K K及分泌及分泌H H、NH4NH4。Endocrine function of kidneyvasoactive hormones acts on kidney regulate physiologically hemodynamics&water-salt metabolism includes renin、angiot
9、ensin、prostate group、kinin system non-vasoactive hormones acts on whole body includes 1hydroxylase&erythropoietinExamination of kidney diseaseUrinalysis1、proteinuria urine protein150mg/d,qualitative analysis(+),urine protein/creatinine200mg/g proteinuria urine protein30300mg/d minimal urine proteinC
10、lassification of proteinuriaReasons:(1)(1)Physiologic proteinuria functional positional(2)(2)Glomerular proteinuria：selective nonselective Classification of proteinuria(3)(3)tubule proteinuria:protein reabsorption defect of proximal tubule 2microglobulin、lysozyme in urine;2g/d.(4)(4)overflow protein
11、uria:abnormal protein(Hb/myoglobin/light chain protein of multiple myeloma)of low molecular weight Urinalysis2 2 hematuriagrossµscopic 。新新鲜鲜尿尿离离心心沉沉渣渣每每高高倍倍视视野野红红细细胞胞超超过过个个，称为镜下血尿。称为镜下血尿。尿尿外外观观呈呈洗洗肉肉水水样样、血血样样、酱酱油油样样或或有有血血凝凝块时，称肉眼血尿。块时，称肉眼血尿。尿液检查尿液检查鉴别肾小球源性血尿鉴别肾小球源性血尿：a a新鲜尿沉渣镜检新鲜尿沉渣镜检 变形红细胞为肾小球
12、源性变形红细胞为肾小球源性;原因原因:GBM:GBM断裂断裂,红细胞通过受血管内压力挤出红细胞通过受血管内压力挤出受损受损,其后通过肾小管各段时受渗透其后通过肾小管各段时受渗透压变化和压变化和PHPH作用作用,呈现变形红细胞血呈现变形红细胞血尿，红细胞体积表小、破裂。尿，红细胞体积表小、破裂。均一形态正常红细胞尿为非肾小球源均一形态正常红细胞尿为非肾小球源性性尿液检查鉴别肾小球源性血尿鉴别肾小球源性血尿b b 尿红细胞容积分布曲线尿红细胞容积分布曲线 肾小球源性血尿呈非对称曲线，肾小球源性血尿呈非对称曲线，其其 峰值红细胞容积小于静脉峰值红细胞峰值红细胞容积小于静脉峰值红细胞容积容积 非肾小球
13、源性血尿呈对称曲线，其峰非肾小球源性血尿呈对称曲线，其峰值红细胞容积大于静脉峰值值红细胞容积大于静脉峰值50 100 150 200a50 100 150 200b50 100 150 20050 100 150 200c50 100 150 200d尿液检查3.3.cylinderuria ：cast in urine protein coagulation in tubule cell/many granular casts&proteinuria appear in the meantime is meaningful in clinic原因：原因：1 1、肾小球或肾小管性疾病、肾小球或
14、肾小管性疾病 2 2、炎症、药物刺激使粘蛋白分泌少而、炎症、药物刺激使粘蛋白分泌少而形成形成 尿液检查4 4 leucocyturia、pyuria、bacteriurialeucocyturia ：pyuria5WBC/HP of fresh centrifugal urine/40 millions WBC/1hrs of fresh urine/100 millions WBC/12hrs;pyuria bacteriuria ：bacteria in every HP /cultured bacteria colonies 105/ml；GFR determinationGFR:the
15、 ability of renal clearance of plasma substances per unit time Endogenous Ccr(creatinine clearance rate)in clinic is the usual means of estimating GFR Recently,K/DOQI clinical practice guide recommend 2 formulas to calculate GFR:Cokcroff-Gault&MDRD.Imaging tests ultrasonography CT&MRI arteriography&
16、venography radionuclide,Common syndromes of renal diseases1.Nephrotic syndrome:protein in urine 3.5g/d protein in plasma30g/d edema hyperlipemia肾脏疾病常见综合征2.Nephritis syndrome:proteinuria,hematuria,hypertension;3.Asymptomatic urine abnormality:4.Acute renal failure&rapidly progressive renal failure sy
17、ndrome:5.Chronic renal failure syndrome:progressive irreversibly renal functional failure .Evaluation of renal diseasesEtiology diagnose：primary or secondarypathology diagnose：Nephritis,NS,AKI,proteinuria,hematuria,percutaneous renal biopsy function diagnose：AKI、CKDcomplication diagnose：ARF、CRFPreve
18、ntion&cure:Principle Wipe off inducement;Common treatment;Inhibit immune&inflammation reactions;Prevention and cure complication;Postpone the progress of renal diseases;Renal substitutive therapyRenal substitutive therapy only effective way for patients of terminal renal failure includes:hemodialysis,peritoneal dialysis,kidney transplantation;Pertoneal dialysis腹膜透析交换hemodialysisprogression&prospect Pathogenesis of renal diseases;Prevention&treatment of chronic kidney diseases(CKD);Dialysis therapy&kidney transplantation;思考题肾脏的结构与功能。肾脏疾病常见的临床表现。肾脏疾病的诊断要求。