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ID:19495462
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页数:24页
时间:2018-10-02
《高血压英文ppt精品课件renal disorder in systemic 》由会员上传分享,免费在线阅读,更多相关内容在教育资源-天天文库。
1、RenaldisorderinsystemicdiseaseAhugevarietyofsystemicconditionscanaffectthefunctionofthekidneys,fromacuteillnessestodrugsandmoreinsidiousillnesses.DiabeticnephropathyHypertensivenephropathy/nephrosclerosisVasculitidesSicklecelldiseaseDiabeticnephropathyDefinition:Amicrovascularcomplica
2、tionofdiabetesmarkedbyalbuminuriaandadeterioratingcoursefromnormalrenalfunctiontoESRD.Diabeticnephropathyisthecommonestcauseofendstagerenalfailure(ESRF)inthedevelopedworld(about30–40%ofcasesofESRF).Incidencerisinginlinewithdiabetes.Itismorecommonasacomplicationoftype1diabetesmellitusb
3、utalsoaffectsasignificantproportionoftype2patientsItusuallyaffectspatientswhohavehaddiabetesfor>10years,withpeakincidenceof~3%peryearinthosewhohavehaddiabetesfor10–20yearsThediabetickidneyThekidneymaybedamagedbydiabetesinthreemainways:glomerulardamageischaemiaresultingfromhypertrophyo
4、fafferentandefferentarteriolesascendinginfection.PathologyExpansionofmesangialmatrixwithdiffuseandnodularglomerulosclerosis(Kimmelstiel-Wilsonnodules)ThickeningofglomerularandtubularBMArteriosclerosisandhyalinosisofafferentandefferentarteriolesTubulointerstitialfibrosisSignsandSymptom
5、sApproximately25%to40%ofpatientswithDM1ultimatelydevelopdiabeticnephropathy(DN),whichprogressesthroughfivepredictablestages.Stage1(veryearlydiabetes)Increaseddemanduponthekidneysisindicatedbyanabove-normalglomerularfiltrationrate(GFR).Hyperglycemialeadstoincreasedkidneyfiltration(seel
6、ater)ThisisduetoosmoticloadandtotoxiceffectsofhighsugarlevelsonkidneycellsIncreasedGlomerularFiltrationRate(GFR)withenlargedkidneysStage2(developingdiabetes)ClinicallysilentphasewithcontinuedhyperfiltrationandhypertrophyTheGFRremainselevatedorhasreturnedtonormal,butglomerulardamagehas
7、progressedtosignificantmicroalbuminuria(smallbutabove-normalleveloftheproteinalbuminintheurine).Significantmicroalbuminuriawillprogresstoend-stagerenaldisease(ESRD).Therefore,alldiabetespatientsshouldbescreenedformicroalbuminuriaonaroutinebasis.Stage3(overt,ordipstick-positivediabetes
8、)Glom
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