西安交通大学医学院血液系统疾病课件 Renal Diseases.pptVIP

Renal Diseases The General Introduction REVIEW (physiology) THE GENERAL MANIFESTATIONS OF RENAL DISEASES DIAGNOSIS OF RENAL DISEASES Gross Features The weight of each kidney： 100—140g （ adult man） （woman less than man） Length 10.5—11.5cm Width 5—7.2cm Thickness 2—3cm Clinical significance Essential Renal Functions Essential Renal Functions Filtering function by the glomerulus capillary glomerular basement membrane (GBM) (important structure) the glomerular capillary endothelium basement membrane the visceral epithelium of Bowman’s capsule Filtration is influenced by molecular size and charge. (size-barrier and charge barrier) 180 liters extracellular fluid /d Reabsorption and excretion by renal tubule urine volume 1.5 liter 99%reabsorption Essential Renal Functions Regulating water,acid-base and electrolyte balance consequence? Eliminating metabolic waste products Regulating blood pressure Endocrine functions homeostasis Waste excretion Filtrate by the glomerulus: urea, creatinine and urate Secretion by the tubule: organic acid, organic base and varieties of drugs Degradation of some peptide hormones: insulin Regulating blood pressure Sodium antidiuretic factors(ADH) Renin, ATII (RAAS) secreted by juxtaglomerular apparatus Endocrine functions Hormone Secreted by the kidneys Erythropoietin consequence? 1,25-(OH)2vitD3 Renin Kininase-kinin system Prostaglandin kindred Hormone receptors（target organ）: parathyroid hormone, aldosterone and antidiuretic hormone Some hormones degraded by the kidneys Brief review Important Approach to the patient with renal diseases Presentation discovered incidentally during a routine medical evaluation with evidence of renal dysfunction such as hypertension, edema, nausea, and hematuria Initial approach Ca