《常用肾脏功能实验室检测课件》由会员分享，可在线阅读，更多相关《常用肾脏功能实验室检测课件（46页珍藏版）》请在金锄头文库上搜索。
1、诊诊诊诊断学断学肾功能检查 ASSESSMENT OF RENAL FUNCTION山东大学 刘运芳提要 Urine Tests: Cheap and convenient; For screening and following Renal Functions Immunological Test Imaging Examination Renal Biopsy3When or for What Kidney diseases or injuries Other diseases induced kidney function injuries Diabetes mellitus Hyper
2、tension Shock or extensive burn Auto-immunological diseases Drug toxicity 4Structure of Kidney5肾单位集合管肾小体肾小管肾小球肾小囊近曲小管远曲小管髓袢肾小球功能检查肾小球功能检查GLOMERULAR FUNCTION ASSESSMENT6Structure and FunctionGFR: the volume of fluid filtered from the glomerular capillaries into the Bowmans capsule per unit time 120-1
3、60ml/minContents Serum Creatinine (sCr) & Serum urea (SU) Creatinine Clearance Rate, Ccr Cystatin C Microalbumin (MA) 、 Transferrinuria (TRU)、uric acid、urine IgSerum Creatinine (sCr)Endogenousa waste product produced by muscle metabolism CreatinineExogenous Come from foods, such as meat, fish, coffe
4、e, tea, etc.9Serum Creatinine (sCr) A small molecule, filtrated by glomerular completely, and not reabsorbed by tubule sCr: rise if the filtering of the kidney is deficient, Normal Value: Serum Cr:male: 44-132mol/Lfemale: 70-106mol/L10Stage of renal failure (male)11445mol/L178mol/L707mol/L Stage 5 (
5、Uremia)ScrClinical Significance of sCr increase12 rise only with marked damage to nephrons filtrationSerum urea (SU)also named as BUN Influence factors Protein intake Protein degradation Liver function Glomerular filtration Normal value: Adults: 1.8-7.1mmol/L Children or infants: 1.8-6.5mmol/L13Urea
6、 or ornithine cycle in liverClinical Significance of SU Renal damage: Chronic renal failure Compensatory stage: SU9mmol/L Failure stage: SU20mmol/L Uremia: SU28.6mmol/L Acute renal disease14Clinical Significance Physical: ：high protein diet ：pregnancy Pre-renal: High fever, Shock, Upper gastrointest
7、inal hemorrhage, extensive burn，severe trauma Post-renal: Obstruction in urinary tract15SU/Cr ratio: BUN: 7-20 mg/dLUrea: 2.5-10.7 mmol/LsCr: 0.7-1.2 mg/dLsCr: 70-106 mol/LBUN:CrUrea:CrLocation20:1100:1Pre-renal10-20:140-100:1Normal or Post-renal50ml/min80ml/minStage 4 (Failure stage)Stage 3 (De-com
8、pensatory stage) Stage 2 (Compensatory stage)Stage 1 (Normal function)70728.6 Expressed in all nucleated cells, encoded by house keeping gene Low molecular weight, Filtrated freely through glomerulus Concentration in serum or plasma is determined by GFRCystatin CCystatin C better than creatinine in
9、predictingCystatin C better than creatinine in predicting优点vHigh sensitivity：better than Ccr High specificity：not influenced by acute phase reaction, activities, gender and age, et al. Used widely: for renal transplantation status for monitoring GFR in nephrotoxic drug therapy for acute and chronic
10、kidney diseases including a diabetic nephropathy Operated easily肾小管功能检查肾小管功能检查TESTS OF TUBULAR FUNCTION26Function of renal tubular重吸收：水、电介质、小分子蛋白葡萄糖、氨基酸肾单位集合管肾小体肾小管肾小球肾小囊近端小管远端小管髓袢尿液稀释、浓缩远端肾单位近端肾小管功能检查近端肾小管功能检查TESTS OF PROXIMAL TUBULAR FUNCTION28Tests of Proximal tubular Function 2-microglobulin 1-m
11、icroglobulin Retinol-binding protein, RBP N-acetyl-D-glucosaminidase, N-NAG Fraction of urine natrium excretion, FeNa2-microglobulin, 2-MG Present on all nucleated cells, especially on lymphocytes, and stable in blood Small protein, freely filtrated by glomeruli Almost reabsorbed by tubules complete
12、ly Threshold of reabsorption:5mg/LNormal value:Urine：lower，locationFraction of urine natrium excretionNatrium: freely filtrated through glomeruli and 99% was reabsorbed by proximal tubulesNormal values: FeNa: 1%Summary 2-microglobulin 1-microglobulin Retinol-binding protein, RBPreabsorption function
13、 N-acetyl-D-glucosaminidase, N-NAG kidney toxicity damage Fraction of urine natrium excretion, FeNa differential diagnosis of pre-renal and intra-renal azotemia远端肾小管功能检查远端肾小管功能检查TESTS OF DISTAL TUBULAR FUNCTION42Renal concentration functionMosenthals testAlso as :Circadian urine specific gravity (SG
14、) test Normal intake (water341 SG specific gravity： 1.015-1.025 highest 1.018 the gap of the highest and the lowest 0.009Clinical Significance Impairment in distal tubules： Early stage：overnight urine750ml, Day/overnight , SG is normal Severe impairment: polyuria，overnight urine SG Failure：polyuria, SG:1.0101.012 Diabetes insipidus : Total urine4L，SG1.006 Urine volume SG ：renal concentration function: normalblood volume or GFR 肾功能检测项目的选择和应用怀疑泌尿 系统疾病尿常规检查尿沉渣镜检Cystatin C、2-MG NAG、RBP早期监控 肾脏损害Cystatin C Ccr 血肌酐 尿素氮2-MG NAG、RBP昼夜尿比重 尿比重 尿渗量动态监测尿渗量 肾小球滤过功能肾小球滤过功能 肾小管吸收功能急性肾衰慢性肾衰累及肾小球累及远端肾小管累及近端肾小管
