內(nèi)科學(xué)教學(xué)課件：慢性腎功能衰竭

慢性腎功能衰竭

ChronicRenalFailure

概述

概述

概述

概述慢性腎臟疾病定義標(biāo)準(zhǔn)1、腎臟損傷（腎臟結(jié)構(gòu)或功能異常）>/=3個(gè)月,可以有或無(wú)GFR下降,可表現(xiàn)為下面任何一條:

腎臟病理學(xué)檢查異常腎臟損傷的指標(biāo)：包括血、尿成分異?；蛴跋駥W(xué)檢查異常2、GFR<60ml/min/1.73m2>/=3個(gè)月,有或無(wú)腎臟損傷證據(jù)

概述

概述CKDESRD1million20million慢性腎臟疾病的發(fā)病率占普通人群的10%左右

概述慢性腎臟疾病分期階段描述GFRml/min/1.73m2

處理方案CKD危險(xiǎn)增加>/=90，有危險(xiǎn)因素篩查，減少危險(xiǎn)因素1腎臟損傷GFR正?；蛟黾?gt;/=90診斷治療，減少CVD危險(xiǎn)，延緩進(jìn)展2輕度下降60-89評(píng)估進(jìn)展3中度30-59治療并發(fā)癥4重15-29替代治療準(zhǔn)備5腎衰竭<15（透析）替代治療K/DOQI推薦計(jì)算GFR公式:Cockcroft-Gault公式:Ccr(ml/min)=[(140–

年齡)х(0.85女性)]/(72хScr)

概述PhaseofChronicKidneyFailureGRF

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

概述EtiologicalFactors■PrimaryChronicGlomerunephritis（60%）■

Diabeticnephropathy■Hypertensionnephropathy■Obstructivenephropathy■Lupusnephritis■PolycysticKidneyNephrondamageGlomerulosclerosisUremia病因各種病因所占CKD的比重病因病因病因病因增生硬化性腎小球腎炎，代償肥大(H)與萎縮(A)區(qū)域相間存在(HE,×40)病因PathogenesisMechanismofCRFdeterioratingHealthsurvivenephron--trade-offhypothesisGlomerulusHyperfiltrationHypothesis發(fā)病機(jī)制PathogenesisMechanismofCRFdeterioratingRenaltubuleHypermetabolismhypothesisRenealtubulelesion、Interstitialinflammationandfibrosis。

Other

AngiotensinII、Transforminggrowthfactor,ECMLipidmetabolismdisorder,LDL,Proteinfilter發(fā)病機(jī)制Pathogenesis

OccurrenceMechanismofVariouskindsinUremiaKidneyPrincipalFunction①M(fèi)aintenancewate,electrolure,acid-baseequilibration；②Eliminatingmetabolismrefuse；③Endocrinefunction：Erythropoietin,1-hydroxylase;④Degradationpheromone：Insulinandsoon;發(fā)病機(jī)制PathogenesisOccurrenceMechanismofVariouskindsinUremiaWater-ElectrolyteandAcid-basedysequilidrium;Metabolismrefuseretention，Endocrinehormonessavings,causinguremiasymptom.

發(fā)病機(jī)制Clinicalsituation

SodiumdysequilibriumDesiccationEdemaLowsodium（Dilution）Highsodium

KdysequilibriumWater-ElectrolyteandAcid-basedysequilibrium臨床表現(xiàn)Acidosis：CommondeathcauseCalciumandPhosphorusdysequilibriumLowCalciumHighPhosphorusHypermagnesemiaClinicalsituationWater-ElectrolyteandAcid-basedysequilibrium臨床表現(xiàn)

Cardia-bloodvesselsystemicsymptoms

HypertensionCardia-insufficiencyPericarditisAtherosclerosis

Respiratorysystemicsymptoms

RespiratoryprofoundUremicpneumoniaPleurisyClinicalsituationEachsystemicsymptoms臨床表現(xiàn)

Bloodsystemicmanifestation

Anemia：EPO，RBCdestructionandsoonHemorrhagictendencyLeucocyteabnormillyNervus-Muscularsystemicmanifestation

MusclespasmComaPeripheralnervouslesionClinicalsituationEachsystemicsymptoms臨床表現(xiàn)

GastrointestinalmanifestationAppetitedescentNauseaandVomitingGastrointestinalhemorrhage

SkinmanifestationUremiaFacialFeaturesSkintotickleClinicalsituationEachsystemicsymptoms臨床表現(xiàn)

RenalOsteodystrophy

ClinicalManifestation10%X-ray40%Bonebiopsy90%Osteitisfibrosa(纖維性骨炎)RenalOsteomalacia(腎性骨軟化癥)Osteoporosis(骨質(zhì)疏松)RenalOsteosclerosis(腎性骨硬化癥)ClinicalsituationEachsystemicsymptoms臨床表現(xiàn)

Endocrinedisturbance

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

Easycombineinfection

CommoninfectioninLungandUrinarytract

Metabolismdisturbance

Hypothermia(體溫過(guò)低),CarbohydrateMetabolismdisturbance，SugarTolerancedecrease,Hyperuricemia,Lipo-MetabolismDisorderClinicalsituationEachsystemicsymptoms臨床表現(xiàn)Diagnosis

DiagnosisofBackgroundDiseasebased

EarlierPeriod：Imagelogy，RenalBiopsyLatePeriod：Difficultfordiagnosisbackgounddisease

FindingFactsofdeterioratinginCFR

DeteriorateFacts:Hypovolemia；Infection；Urinarytractobstruction；

Congestiveheartfailure;Severityarrhythmia；

Bloodpressurefluctuation診斷TreatmentITherapeuticsofbackgrounddiseaseanddeteriorateagent.治療II

SlowingDevelopmentinCRF

DietTreatment

EssentialAminoAcid

Angiotensin-ConvertingEnzymeInhibitorAngiotensinIIreceptor1antagonist

Bloodcreatinine<350μmol/L，

Bloodcreatinineelevatingoverthan30%stopusing。

OtherAntilipideomiaTreatment治療III

ComplicationTreatmentWater-ElectrolyteimbalanceMetabolicAcidosisCalcium-PhosphorummetabolismimbalanceCardia-bloodvesselandlungcomplicationBloodSystemComplication