慢性肾功能衰竭 Chronic Renal Failure,概 述,概 述,概 述,概 述,慢性肾脏疾病定义,标准 1、肾脏损伤（肾脏结构或功能异常）/= 3个月, 可以有或无GFR下降,可表现为下面任何一条: 肾脏病理学检查异常 肾脏损伤的指标：包括血、尿成分异常或影像 学检查异常 2、 GFR/= 3个月, 有或无肾脏损伤证据,概 述,概 述,CKD,ESRD,1 million,20 million,慢性肾脏疾病的发病率占普通人群的10%左右,概 述,慢性肾脏疾病分期,K/DOQI推荐计算GFR公式: Cockcroft-Gault公式: Ccr(ml/min)=(140 年龄)(0.85女性)/(72 Scr),概 述,Phase of Chronic Kidney Failure,慢性肾衰竭的分期,概 述,Etiological Factors,Primary Chronic Glomerunephritis （60%） Diabetic nephropathy Hypertension nephropathy Obstructive nephropathy Lupus nephritis Polycystic Kidney,Nephron damage Glomerulosclerosis,Uremia,病 因,各种病因所占CKD的比重,病 因,病 因,病 因,病 因,增生硬化性肾小球肾炎，代偿肥大(H)与萎缩(A)区域相间存在 ( HE, 40 ),病 因,Pathogenesis,Mechanism of CRF deteriorating Health survive nephron - trade-off hypothesis Glomerulus Hyperfiltration Hypothesis,发病机制,Pathogenesis,Mechanism of CRF deteriorating Renal tubule Hypermetabolism hypothesis Reneal tubule lesion 、Interstitial inflammation and fibrosis。 Other Angiotensin II、Transforming growth factor, ECM Lipid metabolism disorder, LDL, Protein filter,发病机制,Pathogenesis,Occurrence Mechanism of Various kinds in Uremia Kidney Principal Function Maintenance wate ,electrolure,acid-base equilibration； Eliminating metabolism refuse； Endocrine function： Erythropoietin, 1-hydroxylase; Degradation pheromone：Insulin and so on;,发病机制,Pathogenesis,Occurrence Mechanism of Various kinds in Uremia,Water-Electrolyte and Acid-base dysequilidrium; Metabolism refuse retention，Endocrine hormones savings, causing uremia symptom.,发病机制,Clinical situation,Sodium dysequilibrium Desiccation Edema Low sodium（Dilution） High sodium K dysequilibrium,Water-Electrolyte and Acid-base dysequilibrium,临床表现,Acidosis：Common death cause Calcium and Phosphorus dysequilibrium Low Calcium High Phosphorus Hypermagnesemia,Clinical situation,Water-Electrolyte and Acid-base dysequilibrium,临床表现,Cardia-blood vessel systemic symptoms Hypertension Cardia-insufficiency Pericarditis Atherosclerosis Respiratory systemic symptoms Respiratory profound Uremic pneumonia Pleurisy,Clinical situation,Each systemic symptoms,临床表现,Blood systemic manifestation Anemia ：EPO ，RBC destruction and so on Hemorrhagic tendency Leucocyte abnormilly Nervus-Muscular systemic manifestation Muscle spasm Coma Peripheral nervous lesion,Clinical situation,Each systemic symptoms,临床表现,Gastrointestinal manifestation Appetite descent Nausea and Vomiting Gastrointestinal hemorrhage Skin manifestation Uremia Facial Features Skin to tickle,Clinical situation,Each systemic symptoms,临床表现,Renal Osteodystrophy Clinical Manifestation 10% X-ray 40% Bone biopsy 90% Osteitis fibrosa (纤维性骨炎) Renal Osteomalacia (肾性骨软化症) Osteoporosis (骨质疏松) Renal Osteosclerosis (肾性骨硬化症),Clinical situation,Each systemic symptoms,临床表现,Endocrine disturbance Plasm1,25(OH)2D3 , Renin , PTH, Estrin (雌激素) Testosterone (睾丸素) Easy combine infection Common infection in Lung and Urinary tract Metabolism disturbance Hypothermia (体温过低), Carbohydrate Metabolism disturbance， Sugar Tolerance decrease, Hyperuricemia, Lipo-Metabolism Disorder,Clinical situation,Each systemic symptoms,临床表现,Diagnosis,Diagnosis of Background Disease based Earlier Period：Imagelogy，Renal Biopsy Late Period：Difficult for diagnosis backgound disease Finding Facts of deteriorating in CFR Deteriorate Facts: Hypovolemia；Infection ； Urinary tract obstruction； Congestive heart failure ; Severity arrhythmia； Blood pressure fluctuation,诊 断,Treatment,I Therapeutics of background disease and deteriorate agent.,治 疗,II Slowing Development in CRF Diet Treatment Essential Amino Acid Angiotensin-Converting Enzyme Inhibitor Angiotensin II receptor 1 antagonist Blood creatinine 350mol/L， Blood creatinine elevating over than 30% stop using。 Other Anti lipideomia,Treatment,治 疗,III Complication Treatment Water-Electrolyte imbalance Metabolic Acidosis Calcium-Phosphorum metabolism imbalance Cardia-blood vessel and lung complication Blood System Complication Renal Osteodystrophy; Infection ;Mind, Nerves and Muscle System Complication,Treatment,治 疗,IV Dialysis Therapy Hemodialysis Peritoneal Dialysis V Renal Transplantation,Treatment,治 疗,治 疗,治 疗,治 疗,平板透析器 空心纤维透析器,治 疗,治 疗,治 疗,治 疗,