慢性肾功能衰竭(八年制)

慢性肾功能衰竭

ChronicRenalFailure

1

概述2

概述3

概述4

概述5慢性肾脏疾病定义标准1、肾脏损伤（肾脏结构或功能异常）>/=3个月,可以有或无GFR下降,可表现为下面任何一条:

肾脏病理学检查异常肾脏损伤的指标：包括血、尿成分异常或影像学检查异常2、GFR<60ml/min/1.73m2>/=3个月,有或无肾脏损伤证据

概述6

概述7CKDESRD1million20million慢性肾脏疾病的发病率占普通人群的10%左右

概述8慢性肾脏疾病分期阶段描述GFRml/min/1.73m2

处理方案CKD危险增加>/=90，有危险因素筛查，减少危险因素1肾脏损伤GFR正常或增加>/=90诊断治疗，减少CVD危险，延缓进展2轻度下降60-89评估进展3中度30-59治疗并发症4重15-29替代治疗准备5肾衰竭<15（透析）替代治疗K/DOQI推荐计算GFR公式:Cockcroft-Gault公式:Ccr(ml/min)=[(140–

年龄)х(0.85女性)]/(72хScr)

概述9PhaseofChronicKidneyFailureGRF

(Ccrml/min)Cr(μmol/L)EarlyPhase50~20Normal20~35%186~442FailurePhase20~10Normal10~20%450~770EndPhase<10>770慢性肾衰竭的分期

概述10EtiologicalFactors■PrimaryChronicGlomerunephritis（60%）■

Diabeticnephropathy■Hypertensionnephropathy■Obstructivenephropathy■Lupusnephritis■PolycysticKidneyNephrondamageGlomerulosclerosisUremia病因11各种病因所占CKD的比重病因12病因13病因14病因15增生硬化性肾小球肾炎，代偿肥大(H)与萎缩(A)区域相间存在(HE,×40)病因16PathogenesisMechanismofCRFdeterioratingHealthsurvivenephron--trade-offhypothesisGlomerulusHyperfiltrationHypothesis发病机制17PathogenesisMechanismofCRFdeterioratingRenaltubuleHypermetabolismhypothesisRenealtubulelesion、Interstitialinflammationandfibrosis。

Other

AngiotensinII、Transforminggrowthfactor,ECMLipidmetabolismdisorder,LDL,Proteinfilter发病机制18Pathogenesis

OccurrenceMechanismofVariouskindsinUremiaKidneyPrincipalFunction①Maintenancewate,electrolure,acid-baseequilibration；②Eliminatingmetabolismrefuse；③Endocrinefunction：Erythropoietin,1-hydroxylase;④Degradationpheromone：Insulinandsoon;发病机制19PathogenesisOccurrenceMechanismofVariouskindsinUremiaWater-ElectrolyteandAcid-basedysequilidrium;Metabolismrefuseretention，Endocrinehormonessavings,causinguremiasymptom.

发病机制20Clinicalsituation

SodiumdysequilibriumDesiccationEdemaLowsodium（Dilution）Highsodium

KdysequilibriumWater-ElectrolyteandAcid-basedysequilibrium临床表现21Acidosis：CommondeathcauseCalciumandPhosphorusdysequilibriumLowCalciumHighPhosphorusHypermagnesemiaClinicalsituationWater-ElectrolyteandAcid-basedysequilibrium临床表现22

Cardia-bloodvesselsystemicsymptoms

HypertensionCardia-insufficiencyPericarditisAtherosclerosis

Respiratorysystemicsymptoms

RespiratoryprofoundUremicpneumoniaPleurisyClinicalsituationEachsystemicsymptoms临床表现23

Bloodsystemicmanifestation

Anemia：EPO，RBCdestructionandsoonHemorrhagictendencyLeucocyteabnormillyNervus-Muscularsystemicmanifestation

MusclespasmComaPeripheralnervouslesionClinicalsituationEachsystemicsymptoms临床表现24

GastrointestinalmanifestationAppetitedescentNauseaandVomitingGastrointestinalhemorrhage

SkinmanifestationUremiaFacialFeaturesSkintotickleClinicalsituationEachsystemicsymptoms临床表现25

RenalOsteodystrophy

ClinicalManifestation10%X-ray40%Bonebiopsy90%Osteitisfibrosa(纤维性骨炎)RenalOsteomalacia(肾性骨软化症)Osteoporosis(骨质疏松)RenalOsteosclerosis(肾性骨硬化症)ClinicalsituationEachsystemicsymptoms临床表现26

Endocrinedisturbance

Plasm1,25(OH)2D3,Renin,PTH,Estrin(雌激素)Testosterone(睾丸素)

Easycombineinfection

CommoninfectioninLungandUrinarytract

Metabolismdisturbance

Hypothermia(体温过低),CarbohydrateMetabolismdisturbance，SugarTolerancedecrease,Hyperuricemia,Lipo-MetabolismDisorderClinicalsituationEachsystemicsymptoms临床表现27Diagnosis

DiagnosisofBackgroundDiseasebased

EarlierPeriod：Imagelogy，RenalBiopsyLatePeriod：Difficultfordiagnosisbackgounddisease

FindingFactsofdeterioratinginCFR

DeteriorateFacts:Hypovolemia；Infection；Urinarytractobstruction；

Congestiveheartfailure;Severityarrhythmia；

Bloodpressurefluctuation诊断28TreatmentITherapeuticsofbackgrounddiseaseanddeteriorateagent.治疗29II

SlowingDevelopmentinCRF

DietTreatment

EssentialAminoAcid

Angiotensin-ConvertingEnzymeInhibitorAngiotensinIIreceptor1antagonist

Bloodcreatinine<350μmol/L，

Bloodcreatinineelevatingoverthan30%stopusing。

OtherAntilipideomiaTreatment治疗30III

ComplicationTreatmentWater-ElectrolyteimbalanceMetabolicAcidosisCalcium-PhosphorummetabolismimbalanceCardia-bloodvesselandlungcomplicationBloodSystemComplicationRenalOsteodystro