慢性肾功能衰竭chronic renal failure（crf）课件

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1、ChronicRenalFailure(CRF)ShanghaiRuijinHospitalaffiliatedtoShanghaiSecondMedicalUniversity,Dept.ofNephrologyQianYingCRFDefinition:finalstageofnumorousrenaldiseasesresultingfromprogressivelossofglomerular,tubularandendocrinefunctioninbothkidneys.Thisle

2、adstodisturbedexcretionofendproductsofmetabolismdisturbedeliminationofelectrolytesandwaterdisturbedsecretionofhormones(eg.Erythropoietin,renin,prostaglandins,activeformofvitaminD)CRFRegionalandracialincidenceofCRFBritain70-80/permillionChina100/permi

3、llionUSA60-70/permillionCRFEtiologydiabeticnephropathy,hypertensiveglomerularsclerosis,chronicGNchronicGN,obstructivenephropathy,diabeticnephropathyoverseaschinaCRFPathogenesis(unknown)uremictoxinssmallmolecularweight:urea,creatinine,uricacid,guanidi

4、ne,phenol,amines,indolesmiddlemolecularweight:PTHlargemolecularweight:2-MGCRFMajorhypothesisintactnephronhypothesisfinalcommonpathway(hemodynamicallymediatedglomerularinjury)CRFglomerularinjuryadaptivesinglenephronhyperfiltrationglomerularcapillary

5、plasmaflow,hydraulicpressureIntactnephronhypertrophyandsclerosisCRFTrade-offhypothesisCRFCalciumphostatePTHSHPTbone,heart,blood,nervesinjuryHypertensionandcompensatoryhypertrophyofglomeruliHypermetabolismofrenaltubulicytokinesandlipiddisturba

6、ncesCRFStage1:thenormalstageofrenalfunctionGFR>70ml/min,BUN<6.5mmol/L,Scr<110umol/LStage2:imcompensationstageofrenalGFR50-70ml/min,6.5

7、n,BUN>9mmol/LScr>178umol/Ltheremaybeslightfatigue,anorexiaandanemiaStage4:uremicstageGFR<25ml/min,BUN>20mmol/LScr>445umol/LaconstellationofuremicsyndromemayappearinthisstageCRFSignsandsymptomsofuremiaGeneralGastrointestinaltractNeuropathyBoneBloodEle

8、ctrolytedisordersHeartSkinMusclesInfectionLungEndocrineandmetabolicCRFCRFCardiovasculardisordersHypertension80%WaterandsodiumretentionAlterationsofRAASGlomerularcapillarypressure>systemicarterialpressureCRFAtherosclerosishypertriglycerid,hypercholest