OutlinesofKidneyDiseasePanLing第1頁Whatistheurinarysystemcomposedof?kidneyureterbladder/cysturethralassociatedvesselsandnervesAReviewofUrinarySystem第2頁第3頁Thefunctionalunitofthekidneyisthenephron.Thenephroninclude：

therenalcorpuscle

（glomerulusBowmancapsule)thetubule第4頁第5頁Anabilitytomaintainfluid,electrolyteandacid-basebalanceAnabilitytoexcretemetabolicsubstance(mainlynitrogenouswastes)EndocrinefunctionKidneyfunction第6頁1strucure:

endothelialbasementmembraneepithelial2character:size-selectivebarriercharge-selectivebarrier3function：anultrafiltrateofplasma.Glomerolar第7頁第8頁第9頁第10頁ProximalTubules:reabsorption100%Glucose,aminoacid90%bicarbonate70%water,natriumsecretehydrogenDistalTubule:

secretehydrogen,potassium,ammoniaTheLimbsofHenle’sLoop:urineinspissationanddilutionTubularfunction第11頁Vasoactivesubstance:Vasoconstriction:renin,angiotensinⅡVasodilatation:kinin,prostaglandinNon-vasoactivesubstance:

erythropoietincalcitriolEndocrinefunction

第12頁

APPROACHTOTHEPATIENTWITHRENALDISEASE第13頁Apatientwillpresentwithrenaldiseaseinoneoftwoways:discoveredincidentallywithevidenceofrenaldysfunctionGeneralconsiderations第14頁

thediseaseevaluationincludes:anestimationofdiseasedurationacarefulurinalysisglomerularfiltrationrateGeneralconsiderations第15頁DISEASEDURATIONrenaldiseasemaybeacuteorchronic,forinstance,Acuterenalfailure:worseningofrenalfunctionoverhourstodays

chronicrenalfailure:alossofrenalfunctionovermonthstoyears第16頁尿液檢查

（uronoscopy）

第17頁Itinclude:dipstickexamination:gravity,pH,protein,hemoglobin,nitrites,ketones,etc.microscopicexamination:searchesforallformedelements----cells,casts,andinfectingorganisms.

URINALYSIS

第18頁PROTEINURIA

whatisproteinuria?proteinintheurine＞150mg/24hoursurineprotein/urinecreatinine＞200mg/gwhatismicroalbuminuria?

urinealbumin/urinecreatinine30-300ug/mg第19頁

Classificationofproteinuria:

①.functionalproteinuria.

cause:acuteillness,exercise,andorthostaticposition.

characteristic:transient

generally＜1g/d第20頁

②ProteinuriaresultsfromoverproductionofcirculatingsuchasBencejonesproteinsassociatedwithmultiplemyeloma.第21頁③glomerularproteinuria:

cause:abnormalitiesintheglomerularfiltrationbarrier

characteristic:bigormiddlemolecularproteinalargeamountofprotein﹥2g/d第22頁④Tubularproteinuria:

cause:damagedreabsorptionofnormallyfilteredproteinsintheproximaltubule.

characteristic:smallmolecularproteingenerally＜2g/d第23頁Hematuria

Whatishematuria?

＞3redcells/HP.(microscopicexaminationisessentialfordiagnosis.)

第24頁Causeofhematuria

RenalcauseGlomerulardisease:adistinctivedimorphicredcells.nonglomerular:stones,infection,tuberculosis,etc.Extrarenalcause:第25頁GlomerularHematuriaPainlessandtotalhematuriaProteinuriaandcastsdimorphicredcells

第26頁第27頁Leukocyturia(pyuria)

Conception:

＞5whitecells/HPurinarytractinfectioninterstitialnephritisLupusnephritis

第28頁Estimationofglomerularfiltrationrate(GFR)

Definition:

theamountofplasmaultrafilteredacrosstheglomerularcapillariesinacertaintime.Creatinineclearance(Ccr)isaindicatorofGFRNormalrangeofCcr:90-110mL/min/1.73m2

第29頁

InfluencesfactorsofGFRGlomerularhydraulicpressureColloidosmoticpressureFitrationsurfacearea

第30頁IMAGINGSTUDIESUltrasonographyIntravenousUrography(IVP)ComputedTomography(CT)Magneticresonanceimaging(MRI)

Arteriography,venographyRadionuclideStudies第31頁IMAGINGSTUDIESUltrasonography:usedwidelyinrenaldisease.itcanidentifytherenalcortex,medulla,pyramids,andadistendedcollectionsystemorureter.第32頁Ultrasonography:identifyKidneysizeidentifyhydronephrosis,renalmasslesions,polycystickidneydisease.Localizethekidneyforapercutaneousinvasiveprocedure.Assesspostvoidingbladderresidual.第33頁RENALBIOPSYArenalbiopsycanbeobtainedtohelpestablishthediagnosis,suggestprognosis,ordirecttherapy.Meansforhistologicstudy:LightmicroscopicstudiesImmunofluorescencetechniquesElectronmicroscopy第34頁第35頁RENALBIOPSYIndications:UnexplainedacuterenalfailureofchronicrenalinsufficiencyAcutenephriticsyndromesUnexplainedproteinuria第36頁RENALBIOPSYIndications:PreviouslyidentifiedandtreatedlesionstoplanfuturetherapySystemicdiseasesassociatedwithkidneydysfunctionSuspectedtransplantrejection

第37頁RENALBIOPSYContraindications:

asolitaryorectopickidneyuncorrectedbleedingdisorderSevereuncontrolledhypertensionRenalinfection第38頁RENALBIOPSYContraindications:HydronephrosisEnd-stagerenaldiseaseRenalneoplasm,congenitalanomalies,multiplecysts,oranuncooperativepatient.第39頁Syndromeofrenaldisease

NephroticSyndrome

heavyproteinuria:＞3.5g/dhypoalbuminemia：＜30g/Ledemahyperlipidemia第40頁Syndromeofrenaldisease

NephriticSyndrome

proteinuriahematuriahypertension＜1yearacutenephriticsyndrom＞1yearchronicnephriticsyndromRenalfailurewithinweekstomonthsacuterapidlyprogressivenephriticsyndrom第41頁第42頁crescent第43頁Syndromeofrenaldisease

AsymptomaticUrinalysisAbnormalnosymptomispresent,yetUrinalysisAbnormalexists.HemauriaLeukocyturia