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1、蛋白尿的诊断和鉴别诊断Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd.尿液的形成尿液是血液经过 肾小球滤过、肾 小管和集合管重 吸收和排泌所产 生的终末代谢产 物。Evaluation o
2、nly.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd.肾小球滤过屏障Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Cl
3、ient Profile 5.2.0.0.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd.正常尿液中的蛋白成分l分子量低于70000，主要为带正电荷的蛋白可能滤入原尿中。l近端肾小管可重吸收原尿中95以上的蛋白。l每日终尿中仅30150mg的微量蛋白，并主要为白蛋白排出。Evaluation only.Evaluation only. Created with Aspose.S
4、lides for .NET 3.5 Client Profile 5.2.0.0.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd.蛋白尿的检测方法l定性检测：磺基水杨酸法、加热醋酸法、试纸条法。l定量检测：双缩脲法、染料结合法。Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Cl
5、ient Profile 5.2.0.0.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd.蛋白尿的定义l定性标准：尿蛋白定性试验呈阳性l定量标准：尿蛋白定量试验超过150mg/24 hrEvaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.C
6、reated with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd.蛋白尿的分类l生理性蛋白尿（功能性蛋白尿）l体位性蛋白尿（直立性蛋白尿）l病理性蛋白尿Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Created with Aspose.Slides f
7、or .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd.生理性蛋白尿l泌尿系统无器质性病变l一过性的蛋白尿l常见原因： 发热、寒冷、高温、剧烈运 动、紧张等应激状态l常为轻度蛋白尿l尿蛋白定量一般2g/24hrl常见于各种原发性或继发性肾小球疾病l可分为选择性蛋白尿和非选择性蛋白尿Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client P
8、rofile 5.2.0.0.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd.肾小管性蛋白尿l近端肾小管病变，尿蛋白重吸收功能受 损l尿蛋白以小分子蛋白为主l尿蛋白定量1g/24hrl常见于各种间质性肾炎、肾小管酸中毒 、重金属中毒、药物及肾移植术后Evaluation only.Evaluation only. Created with Aspose.Slides for .
9、NET 3.5 Client Profile 5.2.0.0.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd.混合性蛋白尿l肾小球和肾小管均发生病变l各种分子量的尿蛋白均可出现，以中小分子量尿蛋白为主Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.
10、2.0.0.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd.溢出性蛋白尿l肾小球和肾小管功能正常 l血浆中小分子量蛋白质（血红蛋白、肌 红蛋白、轻链）异常增多l多为小分子蛋白尿l尿蛋白定量一般不多 Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2
11、.0.0.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd.组织性蛋白尿l肾组织破坏或肾小管分泌的蛋白所致l多为轻度蛋白尿l较少见Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Created with Aspose.Slides for
12、 .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd.蛋白尿的特殊检测l尿圆盘电泳l尿微量白蛋白排泄率Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 20
13、04-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd.尿圆盘电泳l十二烷基磺酸钠聚丙烯酰胺凝胶电泳(SDS- PAGE)l在一定的PH溶液中，蛋白质成为带电荷的质点 ，在电场中受自身电荷大小、质量、溶液的离子 强度和粘度、支持物的理化性质等影响，具有不 同的迁移率，从而达到不同组分蛋白的分离。l蛋白与SDS结合，形成均带负电荷的复合物，加 之聚丙烯酰胺交联网的分子筛效应，使蛋白尿在 电场中达到按分子大小分离。Evaluation only.Evaluation only. Created with Aspose.Slides for
14、 .NET 3.5 Client Profile 5.2.0.0.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd.结果判断l小分子量蛋白尿：Mr 1000070000l中分子量蛋白尿:Mr 5000070000l大分子量蛋白尿:Mr 50000100000l混合性蛋白尿:Mr 10000100000Evaluation only.Evaluation only. Created
15、 with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd.尿微量白蛋白排泄率l24小时尿白蛋白排泄总量lUAER30mg/24 hr(20ug/min)l早期肾损害的敏感指标Evaluation only.Evaluation only. Created with Aspose
16、.Slides for .NET 3.5 Client Profile 5.2.0.0.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.Copyright 2004-2011 Aspose Pty Ltd.蛋白尿的临床诊断程序l鉴别是真性蛋白尿还是假性蛋白尿l区分是功能性蛋白尿、体位性蛋白尿、病理性 蛋白尿l对病理性蛋白尿进行定位分析，是肾小球性蛋 白尿还是肾小管性蛋白尿l通过蛋白尿分子量分析结合临床表现及肾穿刺 活检对病理性蛋白尿进行病因确定Evaluation only.Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0.Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty L
