【持续性肾脏替代治疗crrt英文精品课件】management of patients with alterations in the renal system

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1、ManagementofPatientswithalterationsintheRenalsystemC.CummingsRN,EdDRenalAnatomyAnatomySystemincludesthekidneysandentireurinarytract2kidneyslocatedbehindtheperitoneum,oneithersideofthespineWeighsabout8ozandtheleftiflongerandnarrowerthantherightKidneyRenalcapsule-fibroustissueRenalcorte

2、x-outertissueMedulla-innertissuewith“fans”Pyramids-12-18/kidneyPapilla-endofthepyramidCalyx-collectstheurineattheendofthepapillaRenalpelvis-calicesformitandleadstoureterRenalbloodflowKidneysreceive20-25%ofthetotalcardiacoutputBloodflowis600-1300ml/minRenalarterycomesoffoftheabdominala

3、ortaExitsofftherenalveinandintotheIVCNephronsFunctioningunitofthekidneyUrineisformedfromblood1millionnephronsBloodcomesfromtheafferentarterioles,enterstheglomerulusLeavesbyefferentarteriolesNephronpartsBowman’scapsulesurroundstheglomerulusProximalconvolutedtubuleLoopofHenleDistalconvo

4、lutedtubuleCollectingductsRenin-angiotensinsystemReninisproducedbythemaculadensacellsnotechangesinthedistalconvolutedtubulesBasedondecreasedBP,bldvolumeandbldNAlevelsReninchangesangiotensinogenintoangiotensinI,ACEchangesittoangiotensinIIAngiotensinIILeadsto4mainoutcomes:IncreasedNacon

5、centration(aldosteronefromadrenalcortex)IncreasedserumNalevelbytubularreabsorptionofNainascendingloopofHenle(constrictsafferentarterioletodecreaseGFR,ifbldvolumeislow)AllowsfluidtoberemovedandincreasesNaconcentrationinthebld,ifbloodvolumeifnormal(constrictsefferentarterioletoincreaseG

6、FR)EnhancesreabsorptionofNafromDCTRenalregulatoryfunctionsGlomerularfiltration-water,electrolytes,Cr,ureaNandglucosearefilteredBlood,albuministoolargeForms180Loffiltrate/dayorGFR=125ml/minRegulatedbyconstrictinganddilatingtheafferentarterioleWhenSBPgoesbelow70mmHg,GFRstops(MAPof60)Tub

7、ularreabsorptionandSecretionReabsorptionMostofthewaterandelectrolytesarereabsorbed,65%offiltratetokeepurineoutputat1-3LMostofwaterreabsorptionisinthePCT,someisinDCTDCTisaffectedbyADHandaldosteroneADHenhanceswaterreabsorptionbyincreasingmembranepermeabilityAldosteronereabsorbsNaSoluteR

8、eabso