肾功能不全课件

2.患者少尿、无尿是如何发生的？患者少尿、无尿的原因是什么？Questions3.少尿、无尿对机体有什么影响？AcuteRenalFailure(ARF)PeritubularcapillaryRenaltubuleH2OH2OH2OUrine

肾小球滤过

Glomerularfiltration

肾小管重吸收

Tubularreabsorption

肾小管分泌

TubularsecretionFlowoffiltrateRenalcorpuscleI.DefinitionofARF

各种原因导致肾脏泌尿功能在短期内急剧降低，引起水、电解质、酸碱平衡的紊乱以及代谢废物的蓄积，这种综合征被称为急性肾功能衰竭。Ⅱ.Causes&Classification肾前因素（PrerenalCauses)肾前性急性肾功能衰竭(PrerenalARF)肾性因素（IntrarenalCauses)肾性急性肾功能衰竭(IntrarenalARF)肾后因素（PostrenalCauses)肾后性急性肾功能衰竭(PostrenalARF)InferiorvenacavaAdrenal

glandKidneyAortaUreter

BladderUrethra

Ⅲ.MechanismofOliguria

肾血流量

肾小球有效滤过压

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

TubularObstruction原尿反流

RefluxofUrine(1)TubularObstruction肾毒物急性肾小管坏死

GFR↓肾小管阻塞Oliguria原尿排出受阻

NFP↓UrineflowDenudedtubularmembraneInjuredtubularcellsObstructionfromdebrisandnecroticcells(2)RefluxofUrine

间质水肿原尿反流至肾间质少尿压迫管周Cap.肾小管供血↓急性肾小管坏死基底膜断裂肾毒物压迫肾小管加重肾小管阻塞Cap.:capillaryRenalIntoxication

AcuteTubularNecrosisTubularObstructionRefluxofUrineCapsularPressure↑NFP↓GFR↓Oliguria肾活检病理：肾小球无明显病变，肾小管上皮细胞重度弥漫性变性、崩解，并有再生，管腔内可见细胞碎片和管型，肾间质弥漫性水肿。ClinicalExample(Cont΄d)NephrotoxicdrugsEdema,azotemiaAcutetubularnecrosisTubularobstructionRefluxofurineDisorderoftubularreabsorption

Oliguria,anuriaProteinuriaUrineNa+↑AnalysisOnline