1、1Generation urineDrain water,metabolites,waste and keep useful materialRegulating water and osmotic pressureRegulating electrolyte and acid-base balanceMake some important physiological active substances,such as renin,EPO.2345Glomerular filtration rate(GFR)is reflected glomerular filtration function
2、 objective index,with unit time two renal generated ultrafiltrate quantity namely former urine generation to saidRenal clearance is refers to the double kidney in unit time(min)inside,can how much ml plasma contains a substance to clear all,results to ml/min or L/24 h6principlePlasma creatinine cate
3、gories:endogenous and exogenousPlasma creatinine metabolism:mostly from the glomerular filtration,not by renal tubule heavy absorption,and renal tubule of shedding capacity is very few7 Condition:in the strict control diet and muscle activity under the condition of relatively stable,plasma creatinin
4、e of generation and in the urine discharge is constant,the content change is mainly affected by the influence of the endogenous creatinine8 Endogenous creatinine clearance rate(Ccr):refers to the renal unit time,clear how many ml plasma of endogenous creatinine9The preparation for the patient The pa
5、tient continuous eating low protein food 3 days,every protein intake 40 g,fast meat,forbidden to drink strong tea,coffee,avoid strenuous exerciseMethods10Specimen collection(标本收集标本收集)The fourth day morning 8 start collecting 24 hour urine(join toluene anticorrosive),the blood in any time 2 ml and ur
6、ine(measurement of urine volume)at the same time clearedCalculation formula（计算公式计算公式）Every minute creatinine clearance=urine creatinine concentration every minute urine volume/plasma creatinine concentration(unit:ml/min)MethodsIt takes a long time11Normal Range Adult:80-120 ml/min Neonatal:40 65 ml/
7、minIncreased in and decreased decreased inin.Page278Acute or chronicrenal failure,decreased renal blood flow(shock,hemorrhage,dehydration,CHF).drugs:nephrotoxic drugs.12Clinical significance 1.Are early reflect glomerular filtration function of the sensitive index.(the majority of acute glomerulonep
8、hritis Ccr low to normal below 80%,but serum BUN,Cr is still in the normal range)132.Preliminary appraisal renal damage70 51 ml/min mild damage 50 31 ml/min moderate damage 30 ml/min severe damageChronic renal failure patients Ccr if:20 11 ml/min early renal failure10 6 ml/min advanced renal failure
9、 5 ml/min end-stage renal failure143.Guide therapy(指导治疗指导治疗)30 40 ml/min should limit protein intake 30 10 ml/min thiazide diuretics treatment often invalid 10 ml/min should dialysis In addition,renal failure by renal metabolism or all the renal discharge drug can reduce degree according to the Ccr
10、to adjust the use quantity and decided to use time.15Principle（原理）（原理）Blood urea nitrogen(BUN)and serum creatinine(Scr)mainly by glomerular filtration and urine,in the renal parenchyma damaged,glomerular filtration rate is reduced,cause BUN and Scr increasing concentration in blood16BUN:1.78 7.14 mm
11、ol/LScr:Male 44 132 mol/L,Female 70 106 mol/L17Clinical significance All kinds of serious kidney disease Reduces kidney function.Upper gastrointestinal bleeding,severe infections and dietary protein is overmuch,can also lead to a temporary increase in BUN;18 Because of serum creatinine by other effe
12、cts are smaller,more can reflect renal patients,Cr increased significantly(明显地明显地),indicating that the prognosis（预后）（预后）is poor.19principle UA is an end product of,most of the glomerular filtration,in proximal renal tubule in 98-100%is absorped,the normal circumstances of UA lower clearance 20 Males
13、:150416 mol/L Females:89357 mol/L Normal person the uric acid in the formation and excretion rate is constant.For smaller solubility,the body content when too much can form urinary stones or gout.21Clinical significance Increase in:gout,acute or chronic leukemia,multiple myeloma(MM),pernicious anemia(恶性贫血恶性贫血),kidney failure,liver failure,erythrocytosis,gravid reaction,acuteness activity and high fat after dinner.22Gout harm1.Can cause high blood fat high blood glucose2.Cause atherosclerosis3.Cause gout attacks4.The influence of renal function2324
