1、文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。ContentComposition Anatomy Physiology Common diseaseExamination文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。CompositionKidney Ureter Urinary bladderUrethra 文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Part 1 kidneyBean-shape:a concave area on the edge toward the centre cal
2、led hilum,where renal artery enters the kidney and renal vein leaves it.The ureters also leave the kidneys at the hilum,leading to the bladder.The human kidneys represent about 0.5%of the total weight of the body,but receive 2025%of the total arterial blood pumped by the heart.文档仅供参考，不能作为科学依据，请勿模仿；如
3、有不当之处，请联系网站或本人删除。NephronsThe functional unit of the kidney Responsible for the actual purification and filtration of the blood About one million nephrons are in the cortex of each kidney Consists of a renal corpuscle and a renal tubule The renal tubule consists of the convoluted tubule and the loop
4、of Henle Urine formation proceeds through 3 major processes in the kidney:1.Glomerular filtration-by the glomeruli.2.2.Tubular reabsorption and secretion in the renal tubules.3.Tubular secretion文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。nephronrenal corpusclerenal tubuleglomerular capsule(Bowmans capsul
5、e)glomerulusafferentarterioleefferentarteriole肾单位肾单位肾小体肾小体肾小球肾小球Urine formation proceeds through 3 major processes in the kidney:1.Glomerular filtration-by the glomeruli.2.Tubular reabsorption and secretion in the renal tubules.3.Tubular secretion文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Working mechan
6、ism of the kidneys:Blood is brought to the kidney via the renal artery.The kidneys filter the blood and then reabsorb useful materials such as glucose.After it has been purified the blood returns to the circulation through the renal vein.文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。New words about kidneyG
7、eneral EnglishRootEg.kidneyRen/oRenographySuprarenalLienorenalNephr/oNephritisHydronephrosisRenal pelvisPyel/oPyelographyPyelonephritisPelvi/opelvilithotomy pelvioplastyGlomerularGlomerul/oGlomerulonephritis文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Part 2 Ureters Two muscular tubes which convey the uri
8、ne from the renal pelvis to the urinary bladder.Each measures 20-30cm in length,0.5-0.7cm in diameter.According to the course,each ureter can be divided into 3 parts:Abdominal part Pelvic part Intramural partThree constrictions:n1st:at pelviureteric junctionn2nd:where ureter crosses the pelvic inlet
9、 and iliac vesselsn3rd:at intramural part文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。New words about uretersGeneral General EnglishEnglishRootRootEg.Eg.UretersUreter/oUreteroceleUreterographyUreterostenosisUreterorrhaphy文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Part 3 Urinary bladder The urinary bladder is
10、a hollow muscular organ situated in the pelvic cavity posterior to the pubic symphysis.In the floor of the urinary bladder is a small,smooth triangular area,the trigone.The ureters enter the urinary bladder near two posterior points in the triangle;the urethra drains the urinary bladder from the ant
11、erior point of the triangle.文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。New words aboout urinary bladderGeneral EnglishGeneral EnglishRootRootEg.Eg.Urinary bladderVesic/oIntravesicalvesicoureteralCyst/oCystitisCystographyCystoptosiscystostomy文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Part 4 Urethra Female ur
12、ethra isrelatively shorter(about 3-5cm long),wider and straighter.nInternal orifice of urethra nExternal orifice of urethra：(opens into vaginal vestibule)文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。New words about urethra and urineGeneral EnglishGeneral EnglishRootRootEg.Eg.UrethraUrethr/oUrethritisUreth
13、rograpyMeat/oMeatorrhaphyMeatotomyUrineUrin/oUrinogenitialUrinationUr/oHematuriaUrobilin PolyuriaAnuria文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。THE URINARY SYSTEMIncluding the kidneys,ureters,urethra and urinary bladder.The kidneys are the primary excretory in the human body.They function by removing
14、toxins from the body while returning necessary compounds back to the body.The kidneys filter approximately 200 liters of fluid from the body everyday.The Primary Functions of the Urinary System include:1.Filtering waste products of metabolism from the blood and removing the wastes from the body via
15、the urine；2.Responsible for homeostasis:nRegulate the level of electrolytes such as sodium,potassium,chloride,bicarbonate.nMaintain the correct pH range within the body3.Endocrine function：Producing the enzyme Renin which regulates blood pressure and proper kidney functioning；Producing the hormone E
16、rythropoietin（EPO）which regulates and stimulates erythrocytes production;Metabolizing vitamin D to its active form.文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Mechanism Urinary Systemfilter and remove waste products from the bloodproduction and excretion of urinemain functionresult in 文档仅供参考，不能作为科学依据，请勿模
17、仿；如有不当之处，请联系网站或本人删除。Urinary system diseases文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。The most common disease list Acute renal failure(ARF)Chronic renal failure(CRF)Urinary tract infection Urinary calculus Primary glomerular disease Acute glomerulonephritis(AGN)Chronic glomerulonephritis(CGN)Nephrotic s
18、yndrome(NS)A kidney infection Acute pyelonephritis Chronic pyelonephritis Cystitis Perinephric abscess Renal damage in metabolic disease Diabetic nephropathy Hyperuricemia nephrosis文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。auxiliary examinationHow to use the auxiliaryexamination(辅助检查)in diagnosisof uri
19、nary system diseases?文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。nIconographynUrinalysisnRenal biopsynKidney function test文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。IconographynX-ray examination：（1）Plain abdominal radiograph （radio-放射，-graph 描绘、记录，radiograph X光照片）（2）Urography：Excretory urography Retrograde u
20、rography （retro-向后、倒退，Retrograde 逆行性）Selective renal arteriography nCT detection Plain scan CT Enhanced CT nMagnetic Resonance Imaging nUltrasonography （ultrasono-超声）文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Comparation and Preference 1.Urography examination use for hydronephrosis,ureterectasis and con
21、genital anomaly detection and diagnosis,as well as preoperative assessment of the value of the contralateral kidney function.2.CT examination can be used in the founding of vast majority of tumors,stones,cysts and other diseases and congenital anomalies.3.MRI is often used as secondary screening met
22、hod of atypical lesions for further diagnosis and differential diagnosis.文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Urinalysis1.A urinalysis(UA),is an array of tests performed on urine,and one of the most common methods of medical diagnosis.2.The target parameters that can be measured or quantified in u
23、rinalysis include many substances and cells,as well as other properties,such as specific gravity.3.It is the main basis for diagnosis of kidney injury.文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Urinalysis Methods1.Urine test strip nLeukocytes with presence in urine known as leukocyturianNitrite with pre
24、sence in urine known as nitriturianProtein with presence in urine known as proteinuria,albuminuria,or microalbuminurianBlood with presence in urine known as hematurianspecific gravity比重文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。The numbers and types of cells and/or material such as urinary casts can yie
25、ld a great detail of information and may suggest a specific diagnosis.Hematuria associated with kidney stones,infections,tumors and other conditionsPyuria associated with urinary infectionsEosinophiluria associated with allergic interstitial nephritis,atheroembolic diseaseRed blood cell casts associ
26、ated with glomerulonephritis,vasculitis,or malignant hypertensionWhite blood cell casts associated with acute interstitial nephritis,exudative glomerulonephritis,or severe pyelonephritis(Heme)granular casts associated with acute tubular necrosisCrystalluria associated with acute urate nephropathy(or
27、 acute uric acid nephropathy,AUAN)Calcium oxalatin associated with ethylene glycol2.Microscopic examination文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。3.Other methods of urinalysisnUrine culture a microbiological culture of urine samples,detecting bacteriuria,is indicated when a urinary tract infection i
28、s suspected.nIctotest this test is used to detect the destruction of old red blood cells in the urine.nHemoglobin test this tests for hemolysis in the blood vessels,a rupture in the capillaries of the glomerulus,or hemorrhage in the urinary system,which cause hemoglobin to appear in the urine.文档仅供参考
29、，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Renal biopsy Renal biopsy,often used in the diagnosis of kidney diseases,is regarded as the gold standard of the glomerular disease.It can not only guide our treatment options,but also timely reflect the prognosis and determine the therapeutic effect.Sometimes we nee
30、d to repeat it.文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。kidney function testClearance rate:Glomerular filtration rate GFR Endogenous creatinine clearance rate，Ccr Renal blood flow RBFConcentration-dilution test（浓缩稀释试验）文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。（ARF）DifinitionClassificationPathogenesisDiag
31、nosisDifferential TreatmentPrognosis文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。DefinitionDefinitionnAcute renal failure（ARF）is a syndrome characterized by a relatively rapid decline in renal function that leads to the accumulation of water,crystalloid solutes,and nitrogenous metabolites in the body.文档仅供
32、参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Classificationn Prerenal Acute Renal Failuren Postrenal Acute Renal Failuren Intrarenal Acute Renal Failure 文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。EtiologyDiabetic nephropathy Hypertensive nephrosclerosis Primary or secondary glomerulonephritis Tubulointerstitial d
33、isease （tubulo-管，tubulointerstitial 小管间质性）Renal vascular disease（vas-血管、输精管）Hereditary kidney diseases 文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Main Mechanismn renal hemodynamic changes n renal ischemia （reperfusion cell damage)n acute tubular damage文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。P Pathogenesi
34、sathogenesisDecreased Renal blood flowRenal ischemiaIschemia-reperfusion injury GFRAcute renal tubular damageHypovolemiaThe resistance of afferent arteriole increasedRenal poisoningARF文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Pathology of acute renal failure文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。nIn ge
35、neral：nephromegaly,kidney is pale,Renal cortex is pale and Renal medulla is dark red.n（-megaly 异常扩大，eg.Splenomegaly cardiomegaly）nMicroscope:renal tubular epithelial cells are degenerative,necrotic and deciduous.nToxicant cause:Pathological changes is uniform in the proximal tubule,glomerular baseme
36、nt membrane(GBM)is relatively complete.nIschemia cause:Pathological changes is not uniform in medullary thick ascending limb and distal convoluted tubule,glomerular basement membrane(GBM)is fractured.文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。The epithelial cells o
37、f renal proximal convoluted tubule are hydropic（eg：The most striking change in the tubules is hydropic degeneration of the epithelium.文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Manifestations of acute renal failurenOliguric acute renal failure oliguric stage diuretic stage recovery stagenNonoliguric acu
38、te renal failure 文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Manifestations of Oliguric acute renal failure 1.The initial phase The primary disease performance:Hypotension，Manifestations caused by bleeding 、infection、poison and so on.文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。(1)General symptoms of each syst
39、emThe digestive system dyspnea，thoracalgia The respiratory system hypertension，myocardiosis The circulatory system nausea，vomiting The nervous system hemorrhage，anemia The blood system uremic encephalopathy coma2.Maintenance phase(oliguric stage)文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。(2)Water,electr
40、olyte and acid-base balance disordersMetabolic acidosis：weak、cephalalgia、coma、arrhythmiahyperpotassaemia(K+5.5mmol/L)：early stage：no characteristic manifestations.later stage：weak、tendon reflex disappearing、drowsiness、arrhythmia.Hyperpotassaemia is one of the most common causes of death！文档仅供参考，不能作为科
41、学依据，请勿模仿；如有不当之处，请联系网站或本人删除。hyponatremia hapntrem (Na+135mmol/L)hypochloraemia hapkl:ri:mj (Cl-95mmol/L)hypocalcemia hapklsi:m (Ca2+1.61mmol/L)(2)Water,electrolyte and acid-base balance disorders文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。3.recovery phase(diuretic stage)Hydrouria:more than 3000ml-5000ml/d
42、.nEarly stage:the markely elevated Creatinine(Cr)and blood urine nitrogen(BUN)levelsnLater stage:hyponatremia,dehydration nAll kinds of complications can still exist nA few patients have severe and permanent renal function damages.文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Manifestations of Nonoliguric
43、acute renal failure Characteristics:nunobvious oligurianlow specific gravity of urinenlow urinary sodium levels nazotemianmost patient have not hyperpotassaemia文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Diagnostic criteriaThe serum creatinine of absolute value of average daily increase of 44.2 mol/L,or
44、88.4 mol/L;or in the 24 72 hours blood creatinine values increased from 25%to 100%.文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Differential diagnosis1.Firstly,we should exclude the ARF based on the CKD(chronic kindny diseases),which can be evidenced from the following signs:double kidney shrinks,anemia,u
45、remia face and renal neuropathy.2.Secondly we should exclude prerenal and postrenal causes.3.After the determination of renal ARF,there should be differentiated whether it is causaed by glomerular,renal vascular or tubulointerstitial lesions.文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。(1)ATN vs.Pre-renal
46、 oligurianFluid infusion test Prior to the onset,there are medical history such as capacity lack and body fluid loss etc.If the physical examination found skin and mucous membranes dry,and hypotension,we should consider firstly the prerenal oliguria.At this time you can try to infuse and inject loop
47、 diuretics for observing the load of circulatory system after infusion.文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。If the blood pressure returned to normal and urine volume increased after the supplement of blood volume ,it supports the diagnosis of prerenal oliguric.The hypotension lasts for at long tim
48、e,especially for the elder with heart dysfunction and without increased urine output after fluid infusion,it should be suspected that prerenal azotemia have transformed into ATN.文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。(2)ATN vs.urinary tract obstruction Post-renal obstruction of the urinary tract:1.C
49、ause：stone/tumor/prostatauxe2.Symptom：anuria or intermittent anuresis suddenly;Renal colic,rib abdomen or abdominal pain;Renal percussive pain;3.Auxiliary examination：Ultrasonography and X-ray examination can help diagnosis文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Treatment and prognosis of acute renal
50、 failure文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。The principle of treatmentnTreatment of primary disease nTreatment based on symptoms 1.Strictly control the liquid intake 2.Treatment of hyperkalemiahyperkalemia 高钾血症高钾血症 3.Correction of metabolic acidosis 代谢性酸中毒代谢性酸中毒 4.Therapy of azotemia 氮质血症氮质血症 5.D
