山东大学基础医学院：《病理生理学 Pathophysiology》课程PPT教学课件（7年制）13 Renal failure 肾衰竭

Renal failure s

1 Renal failure

患儿女,11月。因呕吐、腹泻伴发热9天,无尿5天入院。 9天前无诱因出现腹泻,每天3~4次,伴频繁呕吐,非喷射状,量 较多;同时发热,体温最高41℃。给予口服抗生素治疗,三天后 腹泻、呕吐次数减少,但体温仍在38~39℃之间。近5天一直无尿。 体检 呼吸60次分,脉搏120次分,血压85/54mmHg 昏睡状态。双眼睑及球结膜水肿,睑结膜稍苍白,口唇干裂,咽 充血,颈无抵抗;呼吸深大。 实验室检查: 便常规正常;血钾8.6mmol,血钠128mmoL,氯化物100mmol 血钙1.98mmoL,血磷233mmo,尿素氮3712mmo血肌酐 80444moL;血气分析:pH717PCO24.5 mmHg, CO 8. 6mmol/L SBE183mmoL;心电图:室内传导阻滞,T波高尖。 2

2 • 患儿女，11月。因呕吐、腹泻伴发热9天，无尿5天入院。 • 9天前无诱因出现腹泻，每天3～4次，伴频繁呕吐，非喷射状，量 较多；同时发热，体温最高41℃。给予口服抗生素治疗，三天后 腹泻、呕吐次数减少，但体温仍在38～39℃之间。近5天一直无尿。 体检： 呼吸60次/分，脉搏120次/分，血压85/54mmHg。 昏睡状态。双眼睑及球结膜水肿，睑结膜稍苍白，口唇干裂，咽 充血，颈无抵抗；呼吸深大。 • 实验室检查： 便常规正常；血钾8.6mmol/L，血钠128mmol/L,氯化物100mmol/L, 血钙1.98mmol/L，血磷2.33mmol/L, 尿素氮37.12mmol/L,血肌酐 804.44μmol/L；血气分析：pH7.17, PCO2 24.5mmHg, HCO3 - 8.6mmol/L, • SBE -18.3mmol/L；心电图：室内传导阻滞，T波高尖

§1| ntroduction Normal function of the kidney Renal insufficiency Causes Basic manifestation of renal insufficiency

3 §1 Introduction • Normal function of the kidney • Renal insufficiency • Causes • Basic manifestation of renal insufficiency

Normal function of the kidney 1. Excretion Remove waste product from the body Regulate electrolyte and acid-base balance 2. Endocrine Produce renin、EPo、1,25(OH)2D3and prostaglandins Inactivate gastrin PTH

4 Normal function of the kidney Remove waste product from the body； Regulate electrolyte and acid-base balance. 1.Excretion Produce renin、EPO、1,25(OH)2D3 and prostaglandins； Inactivate gastrin、PTH. 2. Endocrine

Renal insufficiency Diseases→ Dysfunction Symptoms of excretion and signs and endocrine Edema, hy pertension, oliguric polyuria, hematuria, proteinuria, anemia, osteodystrophy

5 Renal insufficiency Diseases Dysfunction of excretion and endocrine Symptoms and signs Edema, hypertension, oliguric, polyuria, hematuria, proteinuria, anemia, osteodystrophy

Causes 1 Primary renal diseases Primary glomerular diseases, Primary tubular diseases, Interstitial nephritis, et al 2 Secondary renal lesion Circulatory system diseases, immunity siseases, metabolic diseases, hematopathy, et al

6 Causes: 1 Primary renal diseases Primary glomerular diseases, Primary tubular diseases, Interstitial nephritis, et al. 2 Secondary renal lesion Circulatory system diseases, immunity siseases, metabolic diseases, hematopathy, et al

Basic manifestation of renal insufficiency 1 Glomerular dysfunction 2 Tubular dysfunction 3 Endocrine dysfunction

7 • 1 Glomerular dysfunction • 2 Tubular dysfunction • 3 Endocrine dysfunction Basic manifestation of renal insufficiency

1 Glomerular dysfunction ①GFR i blood flow L ii net filtration pressure L li Kf ·② Glomerular permselectivity

8 1 Glomerular dysfunction • ①GFR – ⅰblood flow – ⅱnet filtration pressure – ⅲ Kf • ② Glomerular permselectivity

Kidney H&E proximal tubules c <y macula densa capsular space h

9

2 Tubular dysfunction ① proximal tubule Renal glycosuria, aminoaciduria, renal tubular acidosis, hypophosphatemia ②| pop of Henle Hypotonic or isotonic urine, polyuria ③ dista| tubule Acid-base and electrolyte disorders, polyuria 10

10 2 Tubular dysfunction ①proximal tubule Renal glycosuria, aminoaciduria, renal tubular acidosis, hypophosphatemia ②loop of Henle Hypotonic or isotonic urine, polyuria ③distal tubule Acid-base and electrolyte disorders, polyuria