肾病知识(初级)

1、 肾病知识（初级）第一题：肾脏在人体中的作用有哪些？I. What are the functions of the kidneys?肾脏是维持机体内环境稳定的重要器官：Kidney is the important organ, which is maintaining the stability of internal environment: 1、 排泄代谢终产物 1. Excretion of the end product of metabolism of the body.2、 调节血容量2. Regulation of blood volume. 3、 维持电解质和酸碱平衡3.

2、Maintenance of balance of electrolyte and pH. 4、 分泌多种活性物质，以保证机体的正常生理功能。4. Secretion of various active substance to guarantee normal physiological fun-*.ctions of the body. 第二题：肾脏的解剖结构？II. Anatomy of the Kidney?肾脏解剖结构分为肾皮质和肾髓质：1. Anatomical structure of the kidney may divided into the cortex and the

3、medulla:1、肾皮质：位于表层，占肾脏的外1/3，肾皮质的厚度为1.0cm，皮质内富含血管和皮质肾单位，其中除有肾小球、肾小囊外，还有部分远端肾小管和皮质集合管，皮质间质含量较少，约占13%。2. The renal cortex refers to the outer region, which accounts for 1/3 of the kidney, and is 1.0 in thickness. This part is rich in blood vessels and cortical nephron, in which there are section of dis

4、tal tubule and cortical collecting duct besides glomerulus and renal capsule, and cortical interstitial is relatively low, taking up 13%. 2、肾髓质：主要由肾小管组成，在形态上由818个肾锥体组成，呈圆锥状，尖端朝向肾窦，形成肾乳头，底部朝向外侧，与皮质相连，根据其结构特点，髓质可分为内带和外带。皮质和髓质并非截然分开，皮质中有许多条髓质放射状插入皮质，称皮质髓放线；髓放线之间的肾皮质称皮质迷路。部分肾皮质伸入肾锥体之间称为肾柱。2. The renal m

5、edulla is mainly composed of renal tubules, and is divided into 8-18 conical renal pyramides, the apex of which extend towards the sinus of the kidney to form a papilla, while the base of each pyramid extend toward the outside and connect with the cortex. The medulla, in terms of its structural feat

6、ures, is divided into inner segment and out segment. Longitudinal elements extend into the cortex, which is termed the cortical medullary rays; and the renal cortex between the medullary rays is cortical labyrinth. The renal cortex extends downward between the individual pyramids to form the renal c

7、olumns of Bertin. 第三题：肾脏的形状和位置？III. Shape and location of the kidneys. 1、双肾为蚕豆状，左右各一。 2、位于脊柱两侧，居腹膜后方；右肾上方有肝脏，故位置略低于左肾。左肾上极平第11胸椎，下级平第二腰椎，右肾的上下级均低于左肾的一个胸椎和腰椎，（12胸椎至第三腰椎），两肾的长轴均向外倾斜，所以，背部12肋骨下方与骶棘肌外缘之间是肾脏的触诊区。肾脏内缘中部凹陷，称为肾门，是血管、神经和输尿管出入的门户，故称“肾门”。肾门以内是肾脏围成的腔隙，称为肾窦，肾窦包括肾盂、肾盏、肾动脉及肾静脉的主要分支及它们周围的疏松结缔组织和脂肪。

8、Kidneys are paired retroperitoneal organs situated in the posterior part of the abdomen on each side of the vertebral column. The right kidney is slightly lower than the left one because there is the liver above the right kidney. The upper pole of left kidney lies opposite the 11th thoracic vertebra

9、, and the lower pole lies opposite the second lumbar vertebra. The right kidney is usually slightly more caudal in position (12th thoracic vertebra and third lumbar vertebra for the upper pole and lower pole respectively). Long axis of each kidney inclines outward, so the space between the lower 12t

10、h rib and outer edge of erector spinae is the palpation area. Located on the medial or concave surface of each kidney is a slit, called the hilum, though which the renal blood vessels, a nerve plexus and ureter pass, so it is called hilum. Inside the hilum, there is a cavity, called the sinus of the

11、 kidney which includes renal pelvis, renal calyx, main branches of the renal artery and vein as well as the loose connective tissue and fat around them. 第四题：肾脏的功能有哪些？IV. What are the functions of the kidneys?肾脏功能主要有：The functions of the kidneys mainly include:1、排泄体内代谢产物，如尿素、肌酐、有机酸等；1. Excretion of m

12、etabolites inside out body, such as: urea, creatinine, organic acid, etc. 2、调节水和电解质平衡；2. Regulation of the balance of water and electrolyte. 3、维持内环境稳定；3. Maintenance of the stability of inner environment. 4、内分泌功能，如分泌肾素、前列腺素、促红素等。4. Endocrine function, such as: secreting renin, prostaglandin, erythro

13、poietin, etc. 肾脏功能主要包括：Renal functions mainly include: （1）、肾小球滤过功能；(1)Filtration Function of the Glomerulus;（2）、肾小管重吸收功能、调节功能、浓缩功能、稀释功能、分泌功能、排泄功能。(2) Reabsorption function, regulatory function, concentration function, dilution function, secretion function and excretion function of the renal tubule.

14、第五题：肾脏的组织结构？V. Structure of the Kidney 肾脏的组织结构分为肾实质和肾间质：The kidney is composed of renal parenchyma and renal interstitium: 1、肾实质由功能肾单位和集合管组成。Renal parenchyma is comprised of functional unit and collecting duct. 2、肾间质由间质细胞和疏松的细胞外基质构成Renal interstitium is comprised of interstitial cell and loose extra

15、cellular matrix. 第六题：肾实质的组织结构？VI. Structure of the renal parenchyma肾实质由功能肾单位和集合管组成：Renal parenchyma is composed of nephron and collecting duct:1、肾单位是肾脏的基本组织结构和功能单位，每个肾脏有100多万个肾单位。肾单位由肾小体及其各段肾小管组成。包括：近端肾小管、髓袢的降支和升支，远端肾小管，集合管不包括在肾单位之内。Nephron is the essential structure and functional unit of the kidne

16、y and each human kidney contains about more than one million nephrons. The essential components of the nephron include the renal or malpighian corpuscle (glomerulus and Bowman capsule) and all segments of the renal tubule, including: proximal tubule, the medullary ascending and descending limbs, the

17、 distal tubule, but the collecting duct is excluded. 1）、肾小体由肾小囊（鲍曼氏囊）和毛细血管球（肾小球）组成，一侧与近端肾小管相接称尿极，另一侧与入球小动脉和出球小动脉相连，称血管极。Malpighian corpuscle is composed of renal capsule (Bowman capsule) and glomerular tuft, with one side connecting with proximal tubule, which is called urinary pole and the other si

18、de connecting with afferent arteriole and efferent arteriole, which is called the vascular pole. a、 肾小球：入球小动脉自血管极进入肾小体，并分成5-8个分支，每个分支各自形成一团毛细血管网，构成一个肾小球的毛细血管小叶或称节段，各小叶的毛细血管再汇集成出球小动脉离开血管极。a. Glomerulus: The afferent arteriole enters the malpighian corpuscle from the vascular pole and is divided into

19、5-8 branches, each of which forms a capillary network to comprise a capillary lobule or segment of the glomerulus, and then the lobular capillaries gathers to form the efferent arteriole and exit the vascular pole. b. 该血管特点：入球小动脉较出球小动脉粗而直，出球小动脉细而长，使两者保持了相当的血管内压力差，从而使肾小球毛细血管的静水压（球内压）高于身体其他部位的毛细血管内压，以

20、利于肾小球毛细血管的滤过功能（肾小球滤过功能）。b. Features of the vessels: Compared with the efferent arteriole, the afferent arteriole is thick and straight, and the efferent arteriole is thin and long, which forms certain capillary lumen pressure difference between the two, thus that hydrostatic pressure of the glomerul

21、ar capillary is higher than that of other parts in our body, so it is good for the filtration function of the glomerular capillary (Filtration function of the glomerulus). 第七题：肾间质的组织结构？VII. Structure of the renal interstitium 肾间质由间质细胞和疏松的细胞外基质构成：The renal interstitium is composed of interstitial cel

22、ls and a loose extracellular matrix material: 1、 肾间质位于肾单位及集合管之间的间叶组织，由间质细胞、少量网状纤维和胶原纤维、细胞外基质（ECM）组成。肾皮质主要由肾小体与部分肾小管组成，含间质较少，约占13%，肾髓质含间质较多，约占20%，肾乳头部占30-40%。Renal interstitium is located at mesenchymal tissue between nephron and collecting duct, which is composed of interstitial cell, small amount o

23、f reticular fiber and collagen fiber, and extracellular matrix (ECM). Renal cortex is mainly composed of malpighian corpuscle and part of renal tubule, which contains little interstitium, that is approximately 13%, while interstitial volume in renal medulla is more, accounting for 20%, and for 30-40

24、% in papilla. 2、 皮质肾间质细胞：主要有成纤维细胞、巨噬细胞、间质树突状细胞。成纤维细胞位于相邻肾小管基底膜之间和管周毛细血管之间，可产生胶原纤维。Cortical interstitial cell mainly includes myofibroblast, macrophage, and interstitial dendritic cell. Fibroblasts is located between the adjacent basement membrane of a tubule and between peritubular capillary, which

25、can produce collagenous fibre. 3、 髓质间质细胞：除有纤维母细胞、成纤维细胞、巨噬细胞、树突状细胞外还有一种特殊表型具有分泌前列腺素的细胞。3. Medullary interstitial cell: there is a kind of special cell, the phenotype of which can secrete prostaglandin, besides fibroblast, myofibroblast, macrophage and dendritic cell. 4、肾间质细胞具有合成和分泌细胞外基质（ECM）、前列腺素、促红素

26、等功能。4. Interstitial cell has the functions like synthetization and secretion of extracellular matrix, prostaglandin, erythropoietin, etc. 第八题：肾小球的组织结构？VIII. The structure of glomerulus? 肾小球毛细血管壁共分三层：The capillary wall of glomerulus is divided into three layers: 1、 第一层是内皮细胞层，由单层的内皮细胞（EC）组成。内皮细胞体本身有许多

27、直径为50-100nm的窗孔，从而能阻止血液中的有形成分不能进入内皮下与基底膜接触，内皮细胞本身覆盖一层带阴电荷的唾液酸蛋白，阻止血液中带阴电荷的离子与物质滤过，从而构成了肾小球滤过膜的静电屏障。该屏障能阻止带阴电荷的蛋白漏出。1. The first layer is endothelial cells, which is composed of a single layer of endothelial cell. The endothelium is perforated by pores or fenestrae which range from 50-100nm in diamete

28、r. This layer can prevent the formed elements of the blood from entering into the endothelium to contact with the basement membrane. The endothelial cells are covered with silaoprotein that is negatively charged, which prevent the filtration of ions and substances with negative charge in blood. The

29、endothelial cells form the static barrier of the glomerular filtration membrane, which can prevent the protein with negative charge from leaking out. 2、第二层基底膜层（GBM）：基底膜分三层，由内疏松层、致密层、外疏松层组成。GBM主要由糖蛋白，带阴电荷的硫酸类肝素和胶原、层粘连蛋白、纤粘连蛋白（FN、LN）等构成。成人GBM厚度为310-370nm。2. The second layer is glomerular basement memb

30、rane, which is composed of lamina rara interna, lamina densa and lamina rara externa. GBM is formed by glycoproteins, heparan sulfate proteoglycan, and type IV collagen, laminin, fibronectin (FN, LN), etc. The thickness of GB Min the adult is 310-370nm. 3、第三层为上皮细胞（足细胞）层，粘附于GBM外侧，上皮细胞有很多突起与基底膜接触，突起分三

31、级，形成如指状，交叉相嵌，突起间的空隙称为裂孔（裂隙），其直径为410nm，表面覆盖一层裂孔膜，起着选择性滤过作用。其表面也覆盖一层带阴电荷的唾液酸蛋白，对大分子物质具有选择性滤过。3. The third layer is visceral epithelial cell (podocytes), adhering to outside of GBM, which has long processes or trabeculae which contact with GBM. The finger-like processes can be divided into three classe

32、s which intersect with each other. The gap between the foot processes is referred to as filtration slit or slit pore, the diameter of which range from 4-10nm. It is covered with a filtration slit membrane, which contributes to the selective filtration function. The surface of this filtration slit me

33、mbrane is also covered with a layer of negatively charged silaoprotein, which also can filtrate the macromolecules selectively. 系膜细胞（MC），位于毛细血管小叶的中轴，邻近毛细血管内皮和基底膜，主要由系膜细胞与系膜基质组成。系膜细胞支撑着毛细血管不被塌陷，是一种多功能细胞，具有对血管收缩舒张与滤过面积大小的调节功能以及吞噬、分泌功能。Mesangial cells (MC), situated at central region of capillary lobul

34、e, is adjacent to endothelium and basement membrane of the capillaries. The mesangial cells and their surrounding matrix material constitute the mesangium. It can provide structural support for the capillaries to prevent them from collapse, which is a kind of multifunctional cell and has many functi

35、ons, such as: regulation of constriction and distention of blood vessels as well as filtration area, phagocytic properties and secretory function. 第九题：肾小球的滤过屏障？肾小球的滤过屏障分为机械屏障和电荷屏障。 1、机械屏障：有五层结构组成（1） 内皮细胞表面膜结构（2） 内皮细胞与内皮细胞之间的滤过孔（3） 基底膜致密层（4） 足细胞下间隙（5） 足细胞9. The filtration barrier of the glomerulusThe

36、 filtration barrier of the glomerulus can be divided into mechanical barrier and charge barrier.There are five layers of mechanical barrier. endothelial cells pores (fenestra) lamina densa of Glomerular basement membrane podocyte inferior space podocyte 2、电荷屏障：在内皮细胞和上皮细胞表面均覆盖一层带阴电荷的唾液酸蛋白，基底膜内存有丰富的带阴

37、电荷的硫酸类肝素，这两种糖蛋白，、氨基多糖，有力地阻止了血浆中带阴电荷的蛋白漏出，从而被称为电荷屏障。Charge barrier:There is a layer of silaoprotein with negative charge on the surface of endothelial cell and epithelial cell. On the basement membrane, there are rich heparan sulfate with negative charge. The two kinds of glycoprotein and glycosamino

38、glycan can effectively prevent the leaking of negatively charged protein in plasma. Thereby, this barrier is called charge barrier. 第十题：机械屏障有哪五层结构组成？1、内皮细胞表面膜结构2、内皮细胞与内皮细胞之间的滤过孔3、基底膜致密层4、足细胞下间隙5、足细胞血浆通过滤过膜形成原尿，在形成原尿中，要通过内皮细胞滤过孔，其孔径大小为50100nm,基底膜致密层滤过孔径为50-70nm,最后通过直径为40nm的上皮细胞滤过孔。以上三层共同组成机械屏障,该屏障对滤过

39、物质有严格的选择性，只允许低于分子量为70000d以下物质通过，所以滤过膜的完整性，是尿液正常的主要保证。There are five layers of mechanical barrier. endothelial cells pores (fenestra) lamina densa of Glomerular basement membrane podocyte inferior space podocyte The plasma will go through the filtration membrane, and in the process of forming initial

40、 urine, they will first pass the endothelial cell pores which vary from 50-100nm. then filtrate pores in lamina densa of Glomerular basement membrane, varying from 50-70nm, and finally pass the epithelial cell pores, with diameter of 40nm. The above three layers constitute the mechanical barrier, wh

41、ich is strictly selective in the filtrating substances, only allowing materials with molecular weight less than 70000d to pass through. Therefore, the integrity of the filtration membrane will assure the normality of the urine. 第十一题：肾小囊 ？肾小囊（鲍曼氏囊）是包绕在肾小球毛细血管球外层的囊腔，其脏层（内层）为肾小球上皮细胞层，壁层为壁层上皮细胞，以及肾小囊基底膜

42、共同组成，接收来自肾小球滤出的原尿，然后排入肾小管内。肾小囊壁层上皮细胞一侧与近端肾小管上皮细胞相延续，另一侧在肾小球血管级处转换为脏层上皮细胞（足细胞），肾小囊基底膜，在血管级处融合为肾小球毛细血管基底膜。Bowman's Capsule Bowman's Capsule is the outer bursal lumen surrounding the glomerular capillaries. It is made up of visceral layer-the glomerular Epithelial layer, parietal layer-epitheli

43、um, and basement membrane. It receives the initial urine which has been filtrated out by the glomerulus, and then discharge it into kidney tubules. One side of parietal layer epithelium is related with the epithelial cells of proximal tubules, and the other side turns into visceral layer epithelial

44、cells at the point of glomerular blood vessels(podocyte), renal capsule basement membrane, 第十二题：肾小管的组织结构？ 肾小管是肾单位的另一个重要组成部分，与肾小球一起构成完整的功能肾单位。1、肾小管分为近端肾小管，髓袢（细段），远端肾小管组成，对终末尿的生成有着重要作用。肾小管的管壁由单层上皮细胞和基底膜组成。2、近端肾小管由单层立方上皮细胞组成，其细胞表面有一层密集的微绒毛（刷状缘）以提高重吸收面积，细胞内含有大量的酶，有利于重吸收与代谢功能发挥。3、肾小管髓袢段由降支和升支薄段、厚段组成，细胞扁平

45、，结构相对简单。4、远端肾小管的上皮细胞为矮立方形细胞，细胞管腔面无刷状缘，细胞内腺粒体丰富。Organization and structure of the kidney tubules kidney tubule is one of the important part of nephron, together with glomerulus, forming the complete renal function unit. 1. The components of the renal tubule are: Proximal convoluted tubule, Loop of He

46、nle, Distal convoluted tubule, which are important for the form of the urine. The tubule wall is made up of simple epithelial cell and basement membrane.2. Proximal convoluted tubule is composed by simple cuboidal epithelium cells. On the surface of the cells, there is a layer of dense microvilli wh

47、ich can increase the reabsorption area. There are also a large amount of enzyme which is favorable for reabsorption and metabolism. 3. Loop of Henle consists of a descending limb and ascending limb, the structure of which are comparatively simple. 4. The epithelial cell of Distal convoluted tubule a

48、re short cuboidal cells which contain numerous mitochondria.第十三题：肾单位？肾单位分两类：1、 一类为皮质肾单位，肾小体位于皮质浅层，髓袢短，血液供应充足。2、 另一类为髓旁肾单位，肾小体主要分布于皮质深层，髓袢长，可达肾乳头，血液循环较慢，皮质肾单位多于髓旁肾单位（7:1）。NephronTwo general classes of nephrons are cortical nephrons and juxtamedullary nephrons.第十四题：集合管的组织结构？集合管是连接远端肾小管之间的管道，按其所处肾实质部位分

49、为皮质集合管、外髓部集合管和内髓部集合管三部分，由数个肾单位的远端肾小管汇集而成，不属肾单位组成部分，其结构由主细胞（亮细胞）和闰细胞（暗细胞）两种立方上皮细胞组成。总之，在解剖结构对肾小管的分布看，肾皮质中主要有近曲小管和远端肾小管；而髓质中主要有髓袢和集合管。Collecting duct systemCollecting duct system is the passage connecting Distal convoluted tubules. According to the location on the renal parenchyma, it can be divided i

50、nto cortical collecting duct, outer medulla collecting duct, inner medulla collecting duct. It is formed by several distal convoluted tubules, but not belonging to nephrons components. Structurally it is comprised by chief cells and intercalated cells. In Anatomy of the kidney tubules, there are pro

51、ximal convoluted tubule and distal convoluted tubules in the renal cortex, while in the medulla, there are mainly Loop of Henle and collecting duct. 第十五题：肾小球球旁器的组织结构？肾小球球旁器，位于肾小体近旁的球旁细胞、致密斑和球外系膜细胞组成。球旁器位于入球小动脉和出球小动脉壁之间，为变异的平滑肌细胞。是肾素合成分泌的主要细胞。致密斑是化学感受器，可感受尿液中钠离子浓度，从而可调节球旁细胞的肾素的释放。15. Juxtaglomerular

52、apparatus Juxtaglomerular apparatus contains three components: the macula densa, juxtaglomerular cells, and extraglomerular mesangial cells. The apparatus occurs near the site of contact between the afferent arteriole and efferent arteriole, which are variant smooth muscle cells. It is the main cell

53、s for synthetizing and secreting secrete. Macula densa is the chemoreceptor, which can sense the sodium chloride concentration and then regulate the release of the renin of Juxtaglomerular cells. 第十六题：肾脏的血液循环？肾脏的血液供应非常丰富，肾脏接受来自心搏出量的20%，远远高于其他主要脏器，主要是与尿液形成有关。来自心脏20%的血液供应，其中80%供应肾皮质，20%供应肾间质。第十七题：肾脏血流

54、灌注特点？1、满足肾小球滤过功能的肾小球微循环网。2、满足肾小管重吸收功能的管围毛细血管微循环网。16. The renal blood circulationThe blood supply in the kidneys are very efficient. Kidneys receive approximately 20% of the cardiac output, which exceeds more than other organs. It relates with the formation of the urine. Among the 20% blood supply fr

55、om the cardiac output, 80% supply for renal cortex, and 20% for renal interstitium.17. Characteristics of Kidney blood perfusionFirst, satisfy the microcirculation of the glomerular filtrating functionSecond, satisfy the blood capillary microcirculation of the tubular reabsorption function第十八题：肾动脉血液

56、灌注？1、肾动脉发自腹主动脉，在肾门处分为前后二支，再在肾窦内分成34条段动脉，继而分成叶间动脉，穿行于肾柱之间。叶间动脉分支横向走行于皮髓质交界处，形成弓形动脉。2、弓形动脉均匀发生多个放射状分支伸入皮质迷路，形成小叶间动脉。Question 18: Renal Arterial Blood Perfusion1. Renal arteries originate from abdominal aorta and are divided into two branches at the renal hilus. The two branches before and behind will

57、be divided into 34 segmental arteries and then interlobar arteries which go through the renal column. The branches of interlobar arteries go crosswise the junction of cortex and medulla forming arcuate arteries. 2. Arcuate arteries produce equably multiple radial branches that stretch into cortical

58、labyrinth, thus forming interlobular arteries. 3、小叶间动脉发出侧支进入肾小球形成入球小动脉。4、入球小动脉进入肾小球形成58个分支的毛细血管球（毛细血管袢），数个袢支再汇集成出球小动脉。5、然后再分支形成肾小管周围毛细血管网。3. Interlobular arteries spread out collaterals than enter the glomerulis, thus forming afferent arterioles. 4. After entering the glomerulis the afferent arterioles will form 58 capillary balls (capillary loops). Several loops will converge to efferent arterioles. 5. Then the efferent arterioles will form ren