肾小管因素.ppt

第16章 肾功能不全 Renal Insufficiency 肾功能不全 (renal insufficiency) 各种原因引起的肾脏功能障碍，使代谢产物、药物和毒物不能排出体外而在体内蓄积，以致产生水、电解质和酸碱平衡紊乱，并伴有肾脏内分泌功能障碍的病理过程。 Causes Primary renal diseases Primary glomerular diseases, Primary tubular diseases, Interstitial nephritis, et al. Secondary renal lesion Circulatory system diseases, immunity diseases, metabolic diseases, hematopathy, et al. 肾功能障碍的分类Classification of Renal Failure Acute Renal Failure The kidneys abruptly stop working Chronic Renal Failure The kidneys lose their functions gradually §1 肾功能不全的基本发病环节Basic pathological taches for renal failure （一）肾小球滤过功能障碍  Dysfunction of glomerular filtration （一）肾小球滤过功能障碍  Dysfunction of glomerular filtration （二）肾小管功能障碍Renal tubular dysfunction Dysfunction of proximal convoluted tubules renal diabetic urine, amino acid urine, sodium and water retention, etc. Dysfunction of Henle’s loop polyuria, hypotonic or isotonic urine. Dysfunction of the distal convoluted tubules and collecting ducts acid-base imbalance. （三）肾脏内分泌功能障碍 Renal endocrine dysfunction RAAS激活 激肽释放酶－激肽－前列腺素系统(KKPGS)活性下降 EPO生成减少 1,25-(OH)2VitD3 对甲状旁腺激素灭活减弱 对胃泌素灭活减弱 §2 急性肾功能衰竭Acute Renal Failure(ARF) Concept Etiology and classification Pathogenesis Clinical process, alterations of metabolism and function Prevention and treatment Concept ARF is a pathological process, which is characterized by a sudden deterioration of renal function over a period of hours to days, resulting in failure of kidney to excrete nitrogenous waste products and to maintain fluid, electrolyte homeostasis and acid-base balance. 一、病因与分类— Etiology and classification of ARF 肾前性急性肾衰（Prerenal ARF） 功能性急性肾衰 (Functional ARF) 肾性急性肾衰（Intrarenal ARF） 器质性急性肾衰 (parenchymal ARF) 肾后性急性肾衰（Postrenal ARF） 梗阻性急性肾衰 (Obstructional ARF) 急性肾小管坏死（ATN） 是指因肾缺血（包括缺血-再灌注损伤）、肾毒物和严重体液因素异常等引起的以肾小管细胞坏死性损伤为主的病理过程，属于器质性急性肾衰。 ARF的分类Classification of ARF 少尿型Oliguric type of ARF(400ml/d) 非少尿型Non-oliguric type of ARF 二、ARF（少尿型）的发病机制 ARF的发生机制是多种因素、多种机制综合作