肾功能英文.ppt

Laboratory Assessment of Renal Function clinical college 徐萍 Renal Function Glomerular function assessment肾小球功能实验* 主要功能：滤过功能 肾小球滤过率：单位时间内经肾小球滤过的血浆液体量。 正常120-160ml/min Contents Serum creatinine (sCr) Creatinine Clearance rate,Ccr Cystatin C blood urea nitrogen,BUN Endogenous(内源性 a waste product produced by muscle metabolism Creatinine Exogenous(外源性） come from foods,such as meat ,fish,coffee,tea,etc. Serum creatinine (sCr) 小分子，被肾小球完全滤过，不被肾小管重吸收。 sCr：rise if filtering of the kidney is deficient Normal value serum Cr: male:44-132μmol/L femal:70-106μmol/L 临床意义 1. 2.鉴别肾前性和肾实质性少尿 类型 Cr Pre renal 200μmol/L Organic nature 200μmol/L 3.Physiological changes：老年人，肌肉消瘦者Cr偏低 4.Drugs blood urea nitrogen BUN influence factors 1.protein intake 2.protein degradation 3.liver function 4.glomerular filtration normal value:adults:3.2-7.1mmol/L 临床意义 Renal damage Acute renal disease Chronic renal failure compensatory stage:BUN9mmol/L Decompensatory stage:BUN9mmol/L Renal failure stage:BUN20mmol/L Physical: ↑ :high protein diet ↓ :pregnancy Pre-renal: high fever,shock,upper alimentary canal massive hemorrhage（上消化道大出血）,etal. Post-renal: Obstuction in urinary tract 内生肌酐清除率Ccr 单位时间内把若干毫升血液中的内在肌酐全部清除，称为内生肌酐清除率。 normal value：80-120ml/min?1.73m2 Phsiological：related with sports ,diets,age,etal. Pathological decrease sensitive for kidney injury GFR50%时，Ccr约50ml/min。较早反应GRF的灵敏指标。 临床意义 患者处于代偿期时：针对于病因进行治疗。 慢性肾衰竭：Ccr30-40ml/min,应开始限制蛋白质摄入 Ccr30ml/mim氢氯噻嗪等利尿治疗常无效 Ccr10ml/min 肾脏替代治疗。 Cystatin C，cys C 1.人体内几乎各种有核细胞均可表达 2.low molecular weight,filtrated freely through glomerulus 3.concentration in serum or plasma is determined by GFR. 临床应用价值 high sensitivity：better than Ccr High specificity:not influenced by acute phase reaction,activities,gender and age,et al. Used widely: for renal transpantation for monitoring GFR