1、General introduction of NephrologyContentsAnatomyPhysiological functionCommon etiological factorsSymptoms and diagnosisTherapeuticsAdvancementRenal anatomyRenal anatomyTwo kidneyNephron:acinus renalis&tubulesTubules:Proximal,Henles loop,distal Collecting ductInterstitiumVesselsPhysiological function
2、 General:Maintaining internal homeostasisExcreting metabolic wastes productRegulating water,electrolyte,acid-base balanceEndocrine:RAS,PGs,kinin system,EPO and Vit D Glomerular filtrationTubular reabsorptionTubular excretionSNGFR=Kf(P-)=Kf(PGc-Pt)-(Gc-t)Kf:capillary permeability,filtration areaDaily
3、 glomerular filtration:180LUrinary volume:1000-2000mlProximal tubuleReabsorption(isotonic)Glucose:100%Amino acid:100%HCO3-:80%H2O:70%NaCl:70%Excretion:Organic acid DrugsHenles loopHenles loopCountercurrent multiplicationDistal tubuleTo determine final composition of the urineUrea recirculationCommon
4、 causes of renal diseasesConnective tissue diseases,allergyInfection:bacterium,TB,virus,etcRenal vascular diseaseMetabolism:DM,uric acidHeritage:hereditary nephritis polycystic kidney diseaseDrug poisoningCirculatory failureOthersSymptoms of renal diseasesSymptoms of renal diseasesAcute nephritic sy
5、ndromeNephrotic syndromeSymptomless urine abnormalityAcute renal failure syndromeAcute urinary tract infection syndromeChronic urinary tract infection syndromeTubular interstitial diseases syndromeChronic renal failure syndromeExamination and diagnosis of renal diseasesUrineRenal functionRenal biops
6、yOthersUrineUrineUrine volumeProteinuriaHaematuriaCastleucocyturiaBacteruriaOthers:color,taste,crystalUrine volumeNormal urine volume:1000-2000ml/24h average：1500ml/24hHypourocrinia oliguria：400ml/24h anuria：2500ml/24hHypourocriniaPrerenal:Decreased effective circulation volumeRenal:Glomerular,tubul
7、ar and interstitial diseasesPostrenal:urinary obstructionpolyuriaDecreased ADH production:Central diabetes insipidusRenal insensitivity to ADH：Nephrogenic diabetes insipidusImpaired hypertonicity in the medulla：Primary urine is hypertonic：osmotic diuresisPsychogenic polydipsiaPathogenesis of protein
8、uriaPathogenesis of proteinuriaFilter membrane damageChange of electric chargeChange of haemodynamicsSignificance of proteinuriaPhysiological100/mg/d，postural，functionalReflect disease stateAccelerate progression of renal diseasesClassification of proteinuriaGlomerular proteinuria：Middle molecule&Ma
9、cromolecule proteinuriaTubuloproteinuria：Micromolecule proteinuriaOverflow proteinuria：Bence-Jones Protein,Haematoglobin,MyohemoglobinExcretory proteinuria：IgA，T-H proteinTissue proteinuriaHaematuriaNaked eyeMicroscope：3-5/HPnThree-glass testnGlomerular/NonglomerularCauses of haematuriaSystemic dise
10、aseOrgans close to urinary tractKidneyUrinary tractReasons unknownCylindruriaCoagulation and deposition of protein in tubulesType：Hyaline cast,granular castCellular cast:epithelial cell cast red cell cast white cell castFatty cast，renal failure castLeucocyturiaMicroscope：5/HPExcretory rate accountPa
11、thogenStaining microscopeBacterial cultureSpecific pathogen:tuberculosis,etcDetermination of GFRInulin extraction ratioCcrIsotopeE-GFR:MDRDOthersRenal blood flow determinationAminohippuric acid clearanceDoppler ultrasoundPETConcentration&dilution functionUrine specific gravityUrine osmotic pressureF
12、ree water clearance：V-UosmxV PosmUrine acidificationUrinary pHUrinary acid excretion：Titratable acid,NH4,HCO3-Urinary AGOthersRadiation:Plain film,KUB+IVP,angiographyIsotope：nephrogram,scanningCT,MRIMolecular biologyRenal biopsy Renal pathologyLight microscope:HE,PAS,PASM,MassonIF:Direct immunofluor
13、escence IgM,IgA,IgG,C3,C4,C1q,Fg lamda,kappa,HBsAgElectron microscopeCommon stainingsCommon stainingsHEMassonPASMPASuMinor glomerular abnormalities (including minimal change disease)uFocal segmental glomerulosclerosis(FSGS)uDiffuse glomerulonephritisuMembranous nephropathyuProliferative glomerulonep
14、hritisuMesangial proliferative glomerulonephritisuEndocapillary proliferative glomerulonephritisu Mesangiocapillary glomerulonephritis （Membranoproliferative glomerulonephritis)uCrescentic glomerulonephritis uSclerosing glomerulonephritis uUnclassified glomerulonephritis DiagnosisCauses FunctionComp
15、licationTherapeutics of renal diseasesEtilogical treatmentSlowing the progression of diseasesHandling complicationRenal replacementProspect of nephrology Prospect of nephrology PathogenesisCKD progression Mechanism Chronic complication MechanismImprovement of blood purificationRenal transplantationRenal development and regenerationMolecular pathogenesis of hereditary diseaseLarge-scale RCT Prospect:RelevanceImmunology,Biochemics,Physiology,Cell biology,Genetics,Molecular biology,Pharmacology,Materials,Electric,EngineeringEvidence based medicine
