余先生怎么了泌尿系统PBL第二组肾小球正常结构杨佳妮、肾单位（Nephron）血管球毛细血管（有孔毛细管）：有孔（70nm左右，最大100nm）无隔膜内皮细胞游离面细胞衣负电荷肾脏基膜（RenalBasementMembrane）•连续结构•由毛细血管内皮细胞与足细胞共同产生足细胞（podocyte)：突起（process）裂孔（slitpore)裂孔膜(slitmembrane)GlomerulusFunction张家旭GlomerularfiltrationGlomerularfiltrationbarrierNeutralsolutes:Solutessmallerthan2nanometersinradiusarefreelyfilteredSolutesgreaterthan4.2nanometersdonotfilterSolutesbetween2and4.2nmarefilteredtovariousdegreesGlomerularfiltrationrate(GFR)isthevolumeoffluidfilteredfromtherenal(kidney)glomerularcapillariesintotheBowman'scapsuleperunittime.Kfisthefiltrationcoefficient–aproportionalityconstantPgcistheglomerularcapillaryhydrostaticpressurePbcistheBowman'scapsulehydrostaticpressureπgcistheglomerularcapillaryoncoticpressureπbcistheBowman‘scapsuleoncoticpressure=0EFR≈125ml/min1.Changesinrenalbloodflow2.ChangesinglomerularcapillaryhydrostaticP-changesinsystemicBP-afferentorefferentarteriolarconstriction3.ChangesinhydrostaticPinBowman’scapsule-ureteralobstruction,renaledema4.Changesinglomerularcapillaryoncoticpressure5.ChangesinKf-Reductionineffectivefiltrationsurfacearea-Changesinglomerularcapillarypermeability•TwomechanismscontroltheGFR–Renalautoregulation–NervousandhumoralregulationRegulationofGlomerularFiltrationUndernormalconditions(MAP=80-180mmHg)renalautoregulationmaintainsanearlyconstantglomerularfiltrationrateTwomechanismsareinoperationforautoregulation:MyogenicmechanismTubuloglomerularfeedback尿常规刘逸馨项目•理学检验（physicalexam）：尿量、尿气味、尿外观、比重（SG）•化学检验（chemicalexam）pH、蛋白质、葡萄糖、酮体、胆红素、尿胆原、血红蛋白/隐血、亚硝酸盐、白细胞酯酶、维生素C、微量白蛋白•显微镜检验（microscopicexam）细胞（RBC、WBC）、管型、结晶、微生物尿量（Vol）•正常：成人600～2000ml/24h•少尿（oliguria）：尿量<400ml/d，常伴脱水，如呕吐、腹泻、流汗、烧伤。•无尿（anuria）：尿量<100ml/d，肾严重损伤或肾血流量减少，使尿流停止。•...
