复旦大学临床医学专业：《内科学》课程教学资源（课件讲义，双语版）Chronic Renal Insufficiency（陆福明）

Chronic Renal Insufficiency Lu fuming Division of Nephrology, Huashan Hospital, Fudan University

1 Chronic Renal Insufficiency Lu Fuming Division of Nephrology,Huashan Hospital,Fudan University

Chronic Renal Insufficiency Pathogen and pathogenesis Manifestation Laboratory examination Diagnosis and differential diagnosis Treatment

2 Chronic Renal Insufficiency • Pathogen and pathogenesis • Manifestation • Laboratory examination • Diagnosis and differential diagnosis • Treatment

Etiology primary glomerular diseases hypertensive nephrosclerosis dia betic nephropathy chronic pyelonephritis multicystic kidney systemic lupus nephritis

3 Etiology • primary glomerular diseases • hypertensive nephrosclerosis • diabetic nephropathy • chronic pyelonephritis • multicystic kidney • systemic lupus nephritis

Pathogenesis Mechanism associated with exacerbation of renal function Mechanism associated with uremic symptom

4 Pathogenesis • Mechanism associated with exacerbation of renal function • Mechanism associated with uremic symptom

Mechanism associated with exacerbation of renal function Hyperfiltration theory Effect of proteinuria Trade-off hypothesis in acidosis Disturbance of lipid metabolism Tubulointerstitial injury Renal hypoxia

5 Mechanism Associated With Exacerbation of Renal Function • Hyperfiltration theory • Effect of proteinuria • Trade-off hypothesis in acidosis • Disturbance of lipid metabolism • Tubulointerstitial injury • Renal hypoxia

Mechanism Associated With Uremic Symptom · Uremic toxins · malnutrition trade-off hypothesis Endocrine dysfunction

6 Mechanism Associated With Uremic Symptom • Uremic toxins • malnutrition • trade-off hypothesis • Endocrine dysfunction

Manifestation of the Uremic Syndrome Gastrointestinal · Neurologic Cardiovascular · Dermatologic Hematologic Endocrinologic Pulmonary · ophthalmic

7 Manifestation of the Uremic Syndrome • Gastrointestinal • Cardiovascular • Hematologic • Pulmonary • Neurologic • Dermatologic • Endocrinologic • ophthalmic

Gastrointestinal manifestation Anorexia progressing to nausea and vomiting Stomatitis and gingivitis Parotitis Peptic ulcer diathesis Gastritis duodenitis and enterocolitis Pancreatitis · Ascites

8 Gastrointestinal Manifestation • Anorexia progressing to nausea and vomiting • Stomatitis and gingivitis • Parotitis • Peptic ulcer diathesis • Gastritis , duodenitis and enterocolitis • Pancreatitis • Ascites

Cardiovascular manifestation Accelerated atherosclerosis · Cardiomyopathy pericarditis

9 Cardiovascular Manifestation • Accelerated atherosclerosis • Cardiomyopathy • pericarditis

Hematologic Manifestation · Anemia Altered neutrophilic chemotaxis Depressed lymphocyte function Platelet dysfunction

10 Hematologic Manifestation • Anemia • Altered neutrophilic chemotaxis • Depressed lymphocyte function • Platelet dysfunction