肾功能检验PPT精品课件

LaboratorytestsofrenalfunctionJunfuHuangSouthwesternHospitalTMMUAnatomyofKidneyFunctionsofthekidneyExcretionofMetaboliteWaste:urea,uricacid,creatinineUrineProduction,regulationofhomeostasis,water,acidbasebalanceEndocrineFunction:renin,erythropoietin,1,25-dihydroxycholecalciferolRenalfunctiontestsDetectrenaldamageMonitorfunctionaldamageDistinguishbetweenimpairmentandfailureKidneyFunctionAplumbersviewHowdoyouknowit’sbroken?NOUrine!ClinicalsymptomsTestsWherecanitbreak?Pre-renalRenalPost-renalLaboratorytestsofrenalfunctionGlomerularFunctionTestsRenalTubularFunctionTestsSection1InvestigationofGlomerularFunctionRenalBloodFlow:1200-1400ml/minRenalPlasma:600-800ml/min20%ofplasma:glomerularfiltrationGFR:GlomerularFiltrtionRateConceptRenalCleranceConceptVirtualvolumeofplasmafromwhichthesubstanceinquestionhasbeencompletelyremovedduringagiventimeinterval.C=UV/PU:urineconcentrtionP:plasmacon.V:urineflowrateUsefulnessofRenalCleranceFreelyfiltrated,neithersecreted,norreabsorbed:Inulin:GFRDeterminationFreelyFiltrated,smallamountssecreted,withoutreabsorption:Cretinine:GFRFreefiltrated,completelyreabsorption:GlucoseTubularMaximaReabsorptionRateInulinClerancePolymeroffructoseMW:5500Freefiltration,withoutsecretionandreabsorptionGFRMethodReferenceInterval:2.0-2.3ml/minEndogenousCreatinineClearance100g,98%storedinmusle,MW:113Cretinephosphate---cretine—cretinineFreelyfiltration,smallmounts:secretionExogenousandEndogenousCreatinineGrosslyInvestigatetheGFRMethod24hurinecollectionmethodmodified4hurinecollectionmethodCleranceCorrection：CcrxSBSA/IBSAPlasmaureaSecretedandreabsorbedbytubules,freelyfiltratedquick,simplemeasurementwidereferencerange3-8mmol/Lsensitivebutnon-specificindexofillnessUreaexcretionfilteredatglomerulusabout40%filteredureaisreabsorbedbyrenaltubulesinhealthmoreureaisreabsorbedifrateoftubularflowisslowtubularflowrateisslowwhenthereisrenalhypoperfusionIncreasedplasmaureaGIbleedtraumarenalhypoperfusiondecreasedRBFdecreasedECFVacuterenalimpairmentchronicrenaldiseasepost-renalobstructioncalculustumourUreaUsefultestbutmustbeinterpretedwithgreatcareAlwaysconsiderinput,outputandpatient’sfluidvolumePlasmacreatinine50-140umol/LincreasesinconcentrationasGFRdecreasesanalyticalinterferences(acetoacetate-DKA)NOTproportionaltorenaldamagePlasmaCreatinineGFR[pCreat]140mL/min0mL/minChangewithinanindividualpatientisusuallymoreimportantthantheabsolutevaluePlasmacreatinineinchronicrenaldiseaseMayincreaseto1000umol/LPlotofrecipricolofplasmacreatinineconcentrationpredictswheninterventionisrequiredinendstagerenalfailureTime1/[pCreat]PlasmaUricAcid20%:foods;80%:purinemetabolismSmallamounts:conjugatedwithalbuminFreeFiltrated,98%-100%:reabsorbedPlasmaUAconcentration:dependonglomerularfiltrationandtubularreabsorptionProgressionofchronicrenaldiseasePlasmaCystatinCCysteineproteinaseinhibitorProducedbynucleatedcellsMW:13000,freefiltration,reabsorbedandmetabolizedbytubulesPlasmaCysCconcentrtion:dependonglomerularfiltrationCarbamylatedhemoglobinUrea—blood—cyanate—Hbcarbamylated—CarHbARF：nochanges(1weeks)CRF:increaseLaboratorytestsofrenalfunctionglomerularfiltrationrateimpracticalcreatinineclearanceunreliableplasmacreatininespecificbutinsensitiveplasmaureasubjecttoproblemsurinevolumeoftenforgotten!Section2InvestigationofTubularFunctionDistalnephronFunctiontests1.MosenthaltestConcentrationdilutiontest8AM:VoidingandDiscarded10,12,14,16,18,20:00and8:00nextday:collectingurinesamplesDetermingtheurinevolumeandgravity2.UrineOsmolarity3.AcuteOliguriaPrenal?Renal?ProximaltubularFunctiontests1.LowMWproteinsinurine2.Tubularmaximalglucosereabsorption3.TubularmaximalPAHsecretion4.AminoacideinurineFanconiSyndromeSection3EffectiveRenalBloodFlowIsotopeMethod:131I-OIHPAHClearance:20%:filtrated,80%:secretedbytubulesSection4InvestigationofrenaltubularacidosisTubularAcidosis:I,II,III.IVI:distalformII:proximalformNH4ClLoadingTestOraladministrationofNH4ClArtificialMetabolicAcidosisUrineSampleCollectionpHdeterminationFractionofHCO3-excretionHCO3-:85-90%:reabsorbedbyproximaltubules;10-15%:reabsorbedbydistaltubulesOralAdministrationofNaHCO3UrineCollectionDeterminationofPCr,UCr,PHCO3,UHCO3Caculation:FEHCO3=UHCO3.PCr/UCr.PHCO3小朋友们:上节课我们了解到小明的一天是如何过的,现在我们一起去看看小明的同学----小芳的上午是如何过的6时刚过快到8时9时快到10时你能读出这两个钟面的时间吗?12时刚过快到12时请你们讨论一下它们有什么不同?我出了几道 题 快递公司问题件快递公司问题件货款处理关于圆的周长面积重点题型关于解方程组的题及答案关于南海问题 考小动物们,你们认为他们过关了吗?4时1时半12时6时4时半11时快12时了6时刚过小朋友们:在你们的帮助下,小动物们都……过关了小朋友们:现在看看你们能否也过关…请读出下列钟面的时间.3时半快到12时快到12时4时12时刚过恭喜:你们也过关了!