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General Concept   of Renal  Diseases Department of Nephrology,the First Affiliated Hospital , Sun Yat-sun University  Qiongqiong Yang [email_address]
outline ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Anatomy ,[object Object],[object Object],[object Object],Right
Anatomy Renal Function Remove wastes Maintain homeostasis Secrete EPO Diagram of a bisected kidney
Afferent arteriole Efferent arteriole Capillary loops
Anatomy-nephron ,[object Object],[object Object],Renal corpuscle ( 肾小体 ) Renal tubule  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Formed by the Invagination of the tuft of capilleries into dilated blind end of a nephron Afferent arteriole Efferent arteriole Bowman’s Capsule Basement membrane Visceral Epithelium(Podocyte) Parietal Epithelium Capillary loops Bowman’s Space Endothelial cells Stucture of renal glomerulus Mesangial matrix and cell Basement membrane
View of glomerulus by scanning electron microscope Afferent arteriole Efferent arteriole The Invagination of the tuft of capilleries into  dilated blind end of a nephron
Ultramicroscopic Stucture of glomerullar Capillaries Filtration Mem
Glomerular Filtration Barrier
Glomerular Anatomy Capillary Lumen Endothelial cell Glomerular basement membrane Epithelial Cell of Bowman’s capsule Epithelial Foot process Electron micrograph  Capillary Lumen 毛细血管腔 Endothelial cell of the glomerular capillary Podocytes
1.  Each kidney contains 1.0  ×  10 6  nephrons 2.About 25% of the cardiac output perfuses  the kidneys (only 0.5% of body mass) 3. possess abundant microvascular networks 4.  countercurrent multiplication of renal tubule   Anatomic features of  Kidney
[object Object],[object Object],[object Object],Physiology functions of  Kidney
Clinical Manifestations of Renal Diseases ,[object Object],[object Object],[object Object],[object Object]
Edema ,[object Object],[object Object],[object Object],[object Object],[object Object]
Renal Hypertension ,[object Object],[object Object],[object Object],[object Object]
Flank pain & renal colic ,[object Object],[object Object],[object Object],[object Object]
urethral stimulate symptom ,[object Object],[object Object],[object Object],[object Object]
Urination disorders ,[object Object],[object Object],[object Object],[object Object],[object Object]
Abnormalities of urine volume ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Proteinuria ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Proteinuria Parameter Glomerular Tubulointerstitial Amount MW of Protein Massive>++ >1.5~2.0g/d Large/Medium/Small: Selective: mostly albumin;MCD Nonselective: FSGS,diabetes Small amount<2+ <1.0g/d Small: Tam-Horsfall,B2-microglobulin Abnormal proteinuria: Light chains (  ,  );Bence-Jones proteins Plasma cell dyscrasias
Proteinuria ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hematuria ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hematuria Isomorphic nonglomerular erythrocytes Dysmorphic glomerular erythrocytes Examination of the urine sediment by a  phase constrast microscope Dysmorphic glomerular erythrocytes>8000/ml, Acanthocytes 棘红细胞 >5% crenated erythrocytes 皱缩红细胞 , Acanthocytes  with their typical  ring-formed cell bodies  with one or more blebs 水泡 of different sizes and shapes
Dysmorphic glomerular erythrocytes Isomorphic nonglomerular erythrocytes
Hematuria ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hematuria ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cast urine ,[object Object],[object Object],[object Object],[object Object]
red cell cast
Pyuria, bacteriuria ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
Estimation of  renal function ,[object Object],[object Object],[object Object],[object Object],[object Object]
1 . MDRD ( the Modification of Diet in Renal Disease study ) equation eGFR (mL/min per 1.73 m 2 ) = 1.86 x (P Cr ) –1.154 x (age) –0.203    0.742 for female;    1.21 for African American 2 . Cockcroft-Gault equation (mL/min) =    0.85 for female Estimated GFR (eGFR)  equation
Stage of chronic kidney disease From K-DOQI guidelines Recommendation Stage Description GFR  ( ml/min ) Action 1  Kidney damage with normal or GFR     90 Diagnosis and treatment of CKD. Treatment of comormid condition. Slowing of progression. CVD risk reduction. 2  Kidney damage with mildly GRF ↓ 60-90 Estimating progression 3 Moderately GRF↓ 30-59  Evaluating and treating complications 4 Severely GRF↓ 15-29 Preparation for kidney replacement therapy 5 Kidney failure <15 Replacement (if uremia is present)
clinic syndromes of urinary diseases ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical syndromes and presentation of glomerular disease Latent GN (asymptomatic urinary abnormalities) Nephrotic  syndrome Acute GN RPGN Chronic GN microscopic or  Macroscopic hematuria Proteinuria Dysmorphic  Glomerular  erythrocytes Proteinuria>3.5g/d Hypoalbuminemia Hyperlipidemia Edema Hematuria Proteinuria (1-3g/d) ARF Edema Hypertension Red cell casts ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],nephritic syndrome
Diagnosis Clue for  urinary diseases   clinic syndromes of urinary diseases
Diagnosis Clue for  urinary diseases
General Principles of Diagnosis
Renal Biopsy Processing ,[object Object],[object Object],[object Object],renal biopsy material
Histology of GN PAS  MASSON  H&E  PASM
Pathological classification of GN
CASE  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Nephrotic syndromes
 
CASE Lung  Carcinoma
Silver PAS
CASE LM-PASM:”spikes” along the GBM
CASE IF: IgG deposition along GBM
CASE EM: subepithelial electron dense material
Diagnosed: carcinoma related Membranous nephropathy
General Principle of Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
新鲜 腹透液 透出液 管路
Integrated ESRD Care Residual renal function HD CCr (ml/min) 20 15 10 5 0 Time on dialysis Start time peritoneal dialysis TX PD
Tranæus, December 2002 Early  referral  of patient with CRF to renal center Pre-ESRD  medical management Patient Education Program CAPD/APD as first option if medically suitable, allowing for patient choice CAPD/APD HD Transplant Adapted from Coles,G, et al. Kidney Int, 54:2234-2240, 1998 Late referral increases mortalityDe Veechi et al, PDI 1999 1 1
THANKS  !

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23 renal disease

  • 1. General Concept of Renal Diseases Department of Nephrology,the First Affiliated Hospital , Sun Yat-sun University Qiongqiong Yang [email_address]
  • 2.
  • 3.
  • 4. Anatomy Renal Function Remove wastes Maintain homeostasis Secrete EPO Diagram of a bisected kidney
  • 5. Afferent arteriole Efferent arteriole Capillary loops
  • 6.
  • 7. Formed by the Invagination of the tuft of capilleries into dilated blind end of a nephron Afferent arteriole Efferent arteriole Bowman’s Capsule Basement membrane Visceral Epithelium(Podocyte) Parietal Epithelium Capillary loops Bowman’s Space Endothelial cells Stucture of renal glomerulus Mesangial matrix and cell Basement membrane
  • 8. View of glomerulus by scanning electron microscope Afferent arteriole Efferent arteriole The Invagination of the tuft of capilleries into dilated blind end of a nephron
  • 9. Ultramicroscopic Stucture of glomerullar Capillaries Filtration Mem
  • 11. Glomerular Anatomy Capillary Lumen Endothelial cell Glomerular basement membrane Epithelial Cell of Bowman’s capsule Epithelial Foot process Electron micrograph Capillary Lumen 毛细血管腔 Endothelial cell of the glomerular capillary Podocytes
  • 12. 1. Each kidney contains 1.0 × 10 6 nephrons 2.About 25% of the cardiac output perfuses the kidneys (only 0.5% of body mass) 3. possess abundant microvascular networks 4. countercurrent multiplication of renal tubule Anatomic features of Kidney
  • 13.
  • 14.
  • 15.
  • 16.
  • 17.
  • 18.
  • 19.
  • 20.
  • 21.
  • 22. Proteinuria Parameter Glomerular Tubulointerstitial Amount MW of Protein Massive>++ >1.5~2.0g/d Large/Medium/Small: Selective: mostly albumin;MCD Nonselective: FSGS,diabetes Small amount<2+ <1.0g/d Small: Tam-Horsfall,B2-microglobulin Abnormal proteinuria: Light chains (  ,  );Bence-Jones proteins Plasma cell dyscrasias
  • 23.
  • 24.
  • 25. Hematuria Isomorphic nonglomerular erythrocytes Dysmorphic glomerular erythrocytes Examination of the urine sediment by a phase constrast microscope Dysmorphic glomerular erythrocytes>8000/ml, Acanthocytes 棘红细胞 >5% crenated erythrocytes 皱缩红细胞 , Acanthocytes with their typical ring-formed cell bodies with one or more blebs 水泡 of different sizes and shapes
  • 26. Dysmorphic glomerular erythrocytes Isomorphic nonglomerular erythrocytes
  • 27.
  • 28.
  • 29.
  • 31.
  • 32.  
  • 33.  
  • 34.
  • 35. 1 . MDRD ( the Modification of Diet in Renal Disease study ) equation eGFR (mL/min per 1.73 m 2 ) = 1.86 x (P Cr ) –1.154 x (age) –0.203    0.742 for female;   1.21 for African American 2 . Cockcroft-Gault equation (mL/min) =    0.85 for female Estimated GFR (eGFR) equation
  • 36. Stage of chronic kidney disease From K-DOQI guidelines Recommendation Stage Description GFR ( ml/min ) Action 1 Kidney damage with normal or GFR   90 Diagnosis and treatment of CKD. Treatment of comormid condition. Slowing of progression. CVD risk reduction. 2 Kidney damage with mildly GRF ↓ 60-90 Estimating progression 3 Moderately GRF↓ 30-59 Evaluating and treating complications 4 Severely GRF↓ 15-29 Preparation for kidney replacement therapy 5 Kidney failure <15 Replacement (if uremia is present)
  • 37.
  • 38.
  • 39. Diagnosis Clue for urinary diseases clinic syndromes of urinary diseases
  • 40. Diagnosis Clue for urinary diseases
  • 42.
  • 43. Histology of GN PAS MASSON H&E PASM
  • 45.
  • 47.  
  • 48. CASE Lung Carcinoma
  • 51. CASE IF: IgG deposition along GBM
  • 52. CASE EM: subepithelial electron dense material
  • 53. Diagnosed: carcinoma related Membranous nephropathy
  • 54.
  • 56. Integrated ESRD Care Residual renal function HD CCr (ml/min) 20 15 10 5 0 Time on dialysis Start time peritoneal dialysis TX PD
  • 57. Tranæus, December 2002 Early referral of patient with CRF to renal center Pre-ESRD medical management Patient Education Program CAPD/APD as first option if medically suitable, allowing for patient choice CAPD/APD HD Transplant Adapted from Coles,G, et al. Kidney Int, 54:2234-2240, 1998 Late referral increases mortalityDe Veechi et al, PDI 1999 1 1

Editor's Notes

  1. 世纪之交,糖尿病的治疗观念发生了巨大变化,以往糖尿病的诊断标准、随访指标和疗效评估主要依据空腹血糖,但随着 UKPDS 等大规模临床研究结果公布于世,人们逐渐认识到餐后高血糖的重要性。从只重视空腹血糖到更注重餐后血糖是内分泌学术界认识上的飞跃,是治疗观念的更新。 下面我们复习近年来有关餐后血糖的文献,从多个层面讨论餐后血糖的重要性。
  2. The glomerulus is formed by the Invagination of the tuft of capilleries into dilated blind end of a nephron
  3. The glomerulus is formed by the Invagination of the tuft of capilleries into dilated blind end of a nephron
  4. The glomerulus is formed by the Invagination of the tuft of capilleries into dilated blind end of a nephron. They are supplied by the afferent arterioles and drained by the efferent artioles.
  5. dilated blind end of a nephron
  6. Be made up of three layers
  7. Amylosis, multiple myeloma
  8. More than 3 red blood cells per high-power field
  9. mass