高血压英文ppt精品课件renal disorder in systemic

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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