Beruflich Dokumente
Kultur Dokumente
Zhao Mingyao
BMC. ZZU
2006.05
Functions of kidney
Excretion
maintain
Regulation
homeostasis
Endocrine
renal failure?
renal failure
Excretion
Regulation Homeostasis
Endocrine disorder
Three types of RF
Nephron damage
Body self
CRF intoxication
calyces
pelvis
urethra.
Causes of ARF in hospitalized pts
• 45% ATN
Ischemia, Nephrotoxins
• 21% Prerenal
CHF, volume depletion, sepsis
• 10% Urinary obstruction
• 4% Glomerulonephritis or vasculitis
• 2% AIN( acuteinterstitial nephritis )
• 1% Atheroemboli
classification of ARF
1.urinary volume
oliguric ~
nonoliguric
2. structure states
functional
parenchyma
3.Damaged site
prerenal
intrarenal
postrenal
Section 2 pathogenesis o f ARF
1.renal hemodynamic alteration
(1)renal perfusion pressure ↓
(2)renal vasoconstriction
(3)renal vascular endothelial swelling
(4)intrarenal DIC
2.renal glomerular injury
renal glomerular injury
3.renal tubular injury
• Recovery ~
1.Oliguric stage
• (1) urinary alteration
volume: oliguria and anuria
specific gravity: hyposthenuria and
isosthenuria
component: Na+, Pro, cell debris, cast
(2)water intoxication
• Endogenous Water
• Water intake
• Renal excretion
(3) hyperkalemia
• Excreting K
• [K+]c release
• Acidosis
• Hyponatremia: Na+-K+↓
• K+ origin: storage blood, food
( 4 ) metabolic acidosis
• GFR
• Excreting H+, NH3 and reabsorbing
NaHCO3-
• Catabolism
(5)azotemia
• BUN 10~15mg%
• NPN > normal level
Brief summary
• (1) urinary alteration
• (2) water intoxication
• (3) hyperkalemia
• (4) metabolic acidosis
• (5) azotemia
2.Polyuric stage
Mechanism of polyuria
1. reperfusion of damaged nephron
2. tubular obstruction released : Interstitial
edema faded and casts rushed out
3. the function of neonatalrenal tubule is
incomplete
4.osmotic diuresis of urea
3. Recovery stage
• Most normal
• Tubular function recovery in end
• Few convert CRF
Why does not urinary volume
decrease in some ARF?
Comparison between normal person and nonoliguria RF
Nonoliguria 90 98 1.8
9 80 1.8
Section 4 Prevention and
treatment
• Treatment of primary disease
• Protect nephrons
• Treatment according to symptoms
• dialysis
Part 3 chronic renal failure(CRF)
Section 1 etiology and clinical
courses
• Chronic renal failure and ESRD affect more than
2 out of 1,000 people in the U.S.
• Diabetes and hypertension (high blood pressure)
are the two most common causes and account
for approximately two-thirds of the cases of
CRF. Other major causes include the following:
• Glomerulonephritis of any type (one of the
most common causes)
• Polycystic kidney disease
1.Etiology of CRF
(1)prerenal
(2)intrarenal: chronic
glomerulonephritis(50~60%) before;
diabetic nephropathy and hypertensive
nephrosclerosis
(3)postrenal
2. Clinical courses
(1) silent (compensatory):GFR
>50ml/min
(2)renal insufficiency: GFR25 ~50 /min
(3) renal failure:GFR5 ~25 /min
(4)end stage renal failure (uremia):GFR
<5 /min
Course of CRF
Na+ dependent
Renal-deprived vaso-dilating
substances↓
5.renal osteodystrophy
acidosis
6.hemorrhagic tendency
• Plt amount nor, function
7.renal anemia
erythropoietin ↓
loss↑
Section 3 Alteration of
metabolism and function
• 1.alteration of urine
• 2.azotemia
• 3.water, electrolytes and acid-base
imbalance
• 4.renal hyper tension
• 5.renal osteodystrophy
• 6.hemorrhagic tendancy
• 7.renal anemia
Section 4 prevention and
treatment
• See in uremia
Part 4 Uremia
• End stage renal disease
• Many toxins
Section 1 pathogenesis o f
uremia
• 200 metabolites and toxin uremia toxin
• ( PTH ( guanidine compound )
urea amines )
Uremic toxins
• Protein control in the diet
• Dialysis relief
• Uremic plasma cellular toxicity
(1)retained metabolic products
Asymmetric dimethylarginine
(ADMA)
(2)overproduction of counter-regulation
hormone
(3)underproduction of renal hormone
Section 2 functional and
metabolic alteration
• (1)nervous system
major manifestation
homeostasis disorder
denaturalization of nerve cell
brain edema
Central neurologic system Lethargy, irritability, frank encephalopathy,
asterixis, and seizures
Peripheral neurologic system
Symmetric sensory neuropathy in a glove-and-stocking distribution
• (2)digestive system
the earliest symptom
observed easily
uretic fetor
Cellular immune
T cell
NP chemotaxis
infection
(6)skin changes(dermatologic
abnormalities)
• Pallor
• Pruritus and excoriation
• Uretic frost
• Gray discoloration
• Ecchymosis and hematomas
(7) metabolic disorders
• glucose
glucose tolerance
• Protein
Negative nitrogen balance
• Fat
triglyceride hyperlipidemia
Section 3 prevention and
treatment
• 1.treat primary disease
• 2.control and prevent aggravating factors
• 3.dialysis
• 4.other treatment
( end )