腎功能不全課件

2.患者少尿、無尿是如何發(fā)生的？患者少尿、無尿的原因是什么？Questions3.少尿、無尿?qū)C體有什么影響？AcuteRenalFailure(ARF)PeritubularcapillaryRenaltubuleH2OH2OH2OUrine

腎小球濾過

Glomerularfiltration

腎小管重吸收

Tubularreabsorption

腎小管分泌

TubularsecretionFlowoffiltrateRenalcorpuscleI.DefinitionofARF

各種原因?qū)е履I臟泌尿功能在短期內(nèi)急劇降低，引起水、電解質(zhì)、酸堿平衡的紊亂以及代謝廢物的蓄積，這種綜合征被稱為急性腎功能衰竭。Ⅱ.Causes&Classification腎前因素（PrerenalCauses)腎前性急性腎功能衰竭(PrerenalARF)腎性因素（IntrarenalCauses)腎性急性腎功能衰竭(IntrarenalARF)腎后因素（PostrenalCauses)腎后性急性腎功能衰竭(PostrenalARF)InferiorvenacavaAdrenal

glandKidneyAortaUreter

BladderUrethra

Ⅲ.MechanismofOliguria

腎血流量

腎小球有效濾過壓

腎小球毛細血管膜通透性和面積GlomerularFiltrationRate(GFR)NetFiltrationPressureBloodhydrostaticpressure(BHP)60mmHgoutColloidosmoticpressure(COP)-32mmHginCapsularpressure(CP)-18mmHginNetfiltrationpressure(NFP)10mmHgoutNFPBHP60outCOP32inCP10out18in1.RenalIntoxication腎小管阻塞

TubularObstruction原尿反流

RefluxofUrine(1)TubularObstruction腎毒物急性腎小管壞死

GFR↓腎小管阻塞Oliguria原尿排出受阻

NFP↓UrineflowDenudedtubularmembraneInjuredtubularcellsObstructionfromdebrisandnecroticcells(2)RefluxofUrine

間質(zhì)水腫原尿反流至腎間質(zhì)少尿壓迫管周Cap.腎小管供血↓急性腎小管壞死基底膜斷裂腎毒物壓迫腎小管加重腎小管阻塞Cap.:capillaryRenalIntoxication

AcuteTubularNecrosisTubularObstructionRefluxofUrineCapsularPressure↑NFP↓GFR↓Oliguria腎活檢病理：腎小球無明顯病變，腎小管上皮細胞重度彌漫性變性、崩解，并有再生，管腔內(nèi)可見細胞碎片和管型，腎間質(zhì)彌漫性水腫。ClinicalExample(Cont?d)NephrotoxicdrugsEdema,azotemiaAcutetubularnecrosisTubularobstructionRefluxofurineDisorderoftubularreabsorption

Oliguria,anuriaProteinuriaUrineNa+↑AnalysisOnline