3.肾脏病学总论

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1、NEPHROLOGY(肾脏病学总论）ZhouFuhua（周富华）ThesecondaffiliatedhospitalofNanjingMedicalUniversityNEPHROLOGYStructureofthekidney(结构)FunctionofthekidneyClinicalmanifestationLaboratoryEvaluationofRenalDiseaseMajorRenalSyndromesTheNephron(肾单位)Consistsoftheglomerulus(肾小球)anditsattachedtubules(肾小管).Thefunctionaluni

2、tofthekidney(是肾脏的功能单位)Glomerulus(肾小球)Endothelialcells(内皮细胞)Glomerularbasementmembrane(肾小球基底膜GBM)Podocytes(足突细胞)-VisceralEpithelialCellMesangialcellsandmatrix(系膜细胞和基质)ParietalepitheliumBowman’sCapsuleNormalGlomerulus(PAS)NormalGlomerulusEMGBMMesangiumGlomerularBasementMembraneCapillarySpaceEndotheli

3、umUrinarySpaceGBMPodocyteGlomerularBasementMembranePodocytesJuxtaglomerularApparatus(近球旁器)VascularcomponentAfferentarterioleEfferentarterioleExtraglomerularmensangialregionTubulecomponentthickascendinglimbMechanismofreninreleaseThemaculadensatheorychangesintheNa+,Cl-concentrationThestretch-recepto

4、rtheoryalterationsinthevolumestretchoftheafferentarteriolTUBULAREPITHELIALCELLSNEPHROLOGYStructureofthekidneyFunctionofthekidney(功能)ClinicalmanifestationLaboratoryEvaluationofRenalDiseaseMajorRenalSyndromesNephronFunctionGlomerularfiltration(肾小球滤过功能）Tubulesecretionandreabsorption（肾小管重吸收和分泌功能）肾小球滤过功

5、能（glomerularfiltrationfunction）含氮废物如尿素、肌酐等主要由肾小球滤过排出。马尿酸、苯甲酸、各类胺类及尿酸也有部分经滤过排出肾小球滤过示意图排泄功能（excretoryfunction）肾小管重吸收和分泌功能（tubularreabsorptionandexcretionfunction）近端小管重吸收髓袢维持髓质高张及尿液的浓缩和稀释远端小管AVP作用下,尿素再循环马尿酸、苯甲酸、各类胺类及尿酸主要由肾小管分泌NephronFunctionWaterbalance(水平衡)Eletrolytemetabolism(电解质代谢)Acid-basebalance(

6、酸碱平衡)Ureasecretion(代谢产物排泄)Others:内分泌功能（endocrinefunction）球旁器分泌肾素血管紧张素原→血管紧张素Ⅰ→血管紧张素Ⅱ、血管紧张素ⅢRAS系统Renin-angiotensinsystem(肾素血管紧张素系统RAS)angiotensinogenangiotensinⅠangiotensinⅡAldosteroneAT1,AT2ReninACEAngiotensinⅡIncreasepreglomerularandefferentarterioarresistancesEnhancethereabsorptionofsodiumEffect

7、sonvasavectaDecreaseKf—adecreaseinhydraulicconductivityEnhanceproductionofPG,TGFβEndocrinefunctionProstaglandin:PGE2,I2,A2,F2,TXA2(前列腺素族)Bradykinin(缓激肽)Erythropietin,(促红细胞生成素EPO)1,25-dihydroxycholecalcifero