《病理生理学》课程教学资源（PPT课件讲稿）Chapter 16 肾衰竭 Renal Failure

Chapter 18 Renal failure

1 Chapter 18 Renal Failure

Section工 Introduction

2 Section I . Introduction

Kidneys are the principal excretive organs Not only excrete waste metabolic products to remove various harmful substances But also regulate a variety of material in plasma to maintain the homeostasis of internal environment (osmolality and acid-base balance Besides, kidneys also produce some bioactive substances renin, prostaglandins(regulation of blood pressure erythropoietin(formation of matured RBCs)

3 But also regulate a variety of material in plasma to maintain the homeostasis of internal environment (osmolality and acid-base balance) Kidneys are the principal excretive organs Not only excrete waste metabolic products to remove various harmful substances, Besides, kidneys also produce some bioactive substances renin, prostaglandins (regulation of blood pressure) erythropoietin (formation of matured RBCs) active vitamin D (metabolism of calcium and phosphorus)

Kidneys are the principal excretive organs excrete waste metabolic products regulate a variety of material in plasma produce some bioactive substances

4 But also regulate a variety of material in plasma to maintain the homeostasis of internal environment (osmolality and acid-base balance) Kidneys are the principal excretive organs Not only excrete waste metabolic products to remove various harmful substances, Besides, kidneys also produce some bioactive substances renin, prostaglandins (regulation of blood pressure) erythropoietin (formation of matured RBCs) active vitamin D (metabolism of calcium and phosphorus)

The following pathologic process is termed"renal failure": Various causes Severely impair renal function Glomerular filteration rate Retention of metabolic wastes Disturbanc of internal environment a serial of clinical manifestations Renal failure Acute renal failure(arF (CRF) Cronic renal failure Uremia

5 The following pathologic process is termed ''renal failure'': Glomerular filteration rate↓ Retention of metabolic wastes, Disturbanc of internal environment Uremia Renal Failure Acute renal failure (ARF) (CRF) Cronic renal failure a serial of clinical manifestations Various causes Severely impair renal function

1. Causes of renal dysfunction (1) Primary renal disease (2) Renal injury secondary to systemic diseases

6 1. Causes of renal dysfunction (1) Primary renal disease (2) Renal injury secondary to systemic diseases

1. Causes of renal dysfunction (1) Primary renal disease (2) Renal iniurv secondarv to eases 1)Glomerular disease glomerulonephritis; nephrotic syndrome 2)Renal tubular disease renal glucosuria aminoaciduria. renal tubular acidosis 3)Interstitial nephritis acute or chronic interstitial inflammation 4)Others: renal injury, tumor, calculus obstructive nephropathy vascular nephropathy

7 1. Causes of renal dysfunction (1) Primary renal disease (2) Renal injury secondary to systemic diseases. 1) Glomerular disease 2) Renal tubular disease 3) Interstitial nephritis 4) Others: glomerulonephritis; nephrotic syndrome renal glucosuria; aminoaciduria, renal tubular acidosis acute or chronic interstitial inflammation renal injury, tumor, calculus; obstructive nephropathy; vascular nephropathy

1. Causes of renal dysfunction (1) Primary renal disease (2)Renal injury secondary to systemic diseases 1)Circulatory system diseases: Shock, As, thrombosis, etc 2) Auto-immune and connective tissue diseases: Lupus nephritis renal injury by rheumatoid arthritis, etc 3)Metabolic diseases: Nephropathy caused by amyloidosis, diabetic or hyperuricemia 4)Hematological diseases: Renal injury by plasmacyte disease multiple myeloma or leukemia 5)Others: Heart failure, hepatic disease, endocrine disease and malignant tumors

8 1. Causes of renal dysfunction (1) Primary renal disease (2) Renal injury secondary to systemic diseases . 1) Circulatory system diseases: 2) Auto-immune and connective tissue diseases: 3) Metabolic diseases: 4) Hematological diseases: 5) Others: Shock, AS, thrombosis, etc. Lupus nephritis, renal injury by rheumatoid arthritis, etc Nephropathy caused by amyloidosis, diabetic or hyperuricemia Renal injury by plasmacyte disease, multiple myeloma or leukemia Heart failure, hepatic disease, endocrine disease and malignant tumors

2. The basic manifestation of rf The anatomic and functional unit of kidney is nephron, which consists of glomerulus and renal tubule. Each human kidney has approximately I million nephrons. The glomerular function is to form original urine by filtration, while the tubule perto reabsorption and secretion. The basic presentation of rF include O Dysfunction of glomerule (2)Dysfunction of renal tubules (3 )Dysfunction of renal endocrine

9 The anatomic and functional unit of kidney is nephron, which consists of glomerulus and renal tubule. Each human kidney has approximately 1 million nephrons. The glomerular function is to form original urine by filtration, while the tubule perform reabsorption and secretion. The basic presentation of RF include: 2. The basic manifestation of RF (l) Dysfunction of glomerule (2) Dysfunction of renal tubules (3) Dysfunction of renal endocrine

DYsfunction of glomerule 20% of CI Renal blood flowV Effective filtration pressure of the glomerule v Kf(LPxA, permeability and total filtration area)\ GFR↓→ Alteration of urinary quantity 125ml/min Permeability↑ (of glomerular filtration membrane Abnormality of urinary quality To urine (hematuria proteinuria) 1.5L/day 10

10 Renal blood flow Effective filtration pressure of the glomerule  Kf (LPA, permeability and total filtration area)  125ml/min 180L/day 1.5L/day 99% 20% of CI Abnormality of urinary quality Alteration of urinary quantity (l) Dysfunction of glomerule Permeability  (of glomerular filtration membrane) GFR  (hematuria & proteinuria)