-
(renal insufficiency)
-
Urine Glomerular filtration Tubular reabsorption Tubular
secretionFlow of filtrateRenal corpuscle
-
The fundamental unit for renal filtration and resorption
-
:: (renin)(EPO)PGs VitD
-
PGs EPO 125-(OH ) 2VD3
-
1234
-
Excretion filtration, resorption and secretion, to maintain the
balance in water, electrolytes, acid and alkali Endocrine renin,
prostaglandins, erythropoietin, 1,25 (OH)2VitD3 Inactivation PTH,
pepsinReview of normal renal function
-
Inferior vena cavaAdrenal glandKidneyAortaUreter Bladder
Urethra
-
Net Filtration Pressure60 out(25 mmHg)=-(-)60 mmHg10 mmHg25
mmHg
-
GFR
-
123
-
1--renin-angiotensia-aldosterone
systemRAAS)2erythropoietenEPO3125-D3125-dihydroxyvitamin
D,1,25-OH2VD34--kallikrein-kinin-prostaglandin-systemKKPGS5
-
hyperthrophy of remaining nephrons Normal glomeruli, LM
390xGlomerulus from patient with unilat. kidney agenesis, LM
390x
-
(acute renal failureARF)
GFR
-
1(ATN) 1 2 3 2 GFR
-
GFRADH
-
1(ATN) 1 2 3 2 GFR
-
HgCL2 200
-
HgCL2 200
-
1 1 2 3 42
-
RBFGFR
80~160mmHgRBFGFR50~70mmHgRBFGFR1/2~2/340mmHgRBFGFR80mmHg
-
RPFGFR80180405.3
-
1- 2RAS34GFR
-
()1234DIC
-
12 12GFR GFR
-
RAA - PGE2 ; Ca2+ GFR
-
:,:, GFR AngADHGFR ,,,
-
Normal Cell Apoptotic cell Cell undergoing apoptosis
-
(1) (2)mTAL(S3) (3)mTAL (4) () NO (HO)(CO) /HO ARF
-
1ATPNa+-K+-ATP 2OFR Na+-K+-ATPCa2+-ATPATP
-
3GSH4GSH GSH AAPGSLTS 56
-
Na+K+-ATP Ca2+ - ATP Ca2+ATP OFR GSH PGsLTs
-
(1) (2) (3) (4) ATP N450
200 CHSP70
-
400ml/d100ml/d 1.010~1.020 > 40mmol/L
-
KfGFRATN
- ARI ARI >1.020 500 401
-
water intoxication
-
GFR
-
BUN3.57 ~ 5.25mmol/L 10~15mgBUN azotemia
-
GER
-
chronic renal insufficiencyCRI
-
GFR
-
%
-
() 1 2trade-off PTH
-
GFR PTHD3GFR
-
() 1 2 (1)-(2) (3) (4) GFR
-
1 1nocturia
2polyuria242000ml 3 400ml
-
100210351020
10081012266~300mmolL360~1450mmol/L
-
1proteinuria
2
-
lBUN GFR2 = 3 GFR(NPN>40mg/dl GFR
-
GFR PTH D
-
GFR PTHD3GFR
-
1GFR2PTHCAH+HCO3-3NH3 H+
-
1 2
3 PGA2E2
-
PGA2PGE2GFR
-
l 2D3 3
-
ADP 1 2
-
12 345 RBCRBCATPRBCRBCRBCRBCMPS
-
1.PTH: 2.: 3.4. 5.500~50006.
-
PTH
-
+ + + -+
-
PTH
-
kussmaul
-
1 ARF2345678910ARF11 ARF12
-
,68++1.01564 mmol/L809 ummol/L16.2 mmol/LClinical Example
-
2. Questions3.
-
35201
6104-52000ml/BP19.3/13.3kPaHb40-70g/LRBC1.3-1.761012/L+RBCWBC0-2/HP33000ml/1.01010
T37R20P120BP20/13kPaRBC1.49 1012/LHb47g/LWBC9.6
109/L1.9mmol/L1.3mmol/L+RBC10-15/HpWBC0-2/Hp0-2/Hp2-3/LPX
-
1922 965 363
