重庆医科大学第二临床学院教案 2008年3月10日 授课题目：慢性肾衰竭 授课教师：钟玲 授课对象：2005级留学生 学时：3 ■目的要求：掌握慢性肾衰的定义、病因、发病过程及发病机制、临床表 现、诊断及治疗 ■重点：慢性肾衰的常见病因、发病机制、临床表现诊断及治疗 难点：慢性肾衰的常见病因、发病机制、临床表现诊断及治疗 采用教具及电化器材：多媒体、黑板及粉笔 教学内容、方法及时间分配： 一、定义(Definitions):(2分钟)uremia,ESRD 二、发病过程及机制(25分钟) 1、病因：(Causes)(5分钟) primary glomerular diseases secondary glomerular diseases ·Tubulointerstitial ·hereditary diseases ·Vascular diseases Obstructive nephropathy
重庆医科大学第二临床学院教案 2008 年 3 月 10 日 授课题目：慢性肾衰竭 授课教师：钟玲 授课对象：2005 级留学生 学时： 3 ◼ 目的要求：掌握慢性肾衰的定义、病因、发病过程及发病机制、临床表 现、诊断及治疗 ◼ 重 点：慢性肾衰的常见病因、发病机制、临床表现诊断及治疗 难 点：慢性肾衰的常见病因、发病机制、临床表现诊断及治疗 采用教具及电化器材：多媒体、黑板及粉笔 教学内容、方法及时间分配： 一、 定义（Definitions）:（2 分钟）uremia,ESRD 二、发病过程及机制（25 分钟） 1、 病因：(Causes)（5 分钟） • primary glomerular diseases • secondary glomerular diseases • Tubulointerstitial • hereditary diseases • Vascular diseases • Obstructive nephropathy
2、慢性肾衰病情进行性加重的机制(20分钟) (l)、慢性肾衰进行恶化的机制Mechanism associated with exacerbation of renal function) Hyperfiltration theory Trade-off hypothesis in acidosis ·Effect of proteinuria Disturbance of lipid metabolism Tubulointerstitial injury ·Renal hypoxia (2)尿毒症症状机制(Mechanism associated with uremic symptom)) ·Toxins Underproduction of Renal Hormones 三、临床表现(clinical findings)(20分钟) l、水电解质酸碱平衡紊乱：(Disturbances in water or electrolyte and acid-base balance) ·water intoxication ·Hypo-or hyper-natremia钠失衡 ·Hypo-or hyper-kalemia钾失衡 ·Hypo-or hyper-calcemia钙失衡 ·hyper-phosphatemia磷失衡 。metabolic acidosis酸中毒 2.各系统表现Manifestation of the Uremic Syndrome (l)胃肠道：Gastrointestinal (2)精神神经系统：Neurologic
2、 慢性肾衰病情进行性加重的机制（20 分钟） （1）、慢性肾衰进行恶化的机制(Mechanism associated with exacerbation of renal function) • Hyperfiltration theory • Trade-off hypothesis in acidosis • Effect of proteinuria • Disturbance of lipid metabolism • Tubulointerstitial injury • Renal hypoxia (2)尿毒症症状机制(Mechanism associated with uremic symptom) ·Toxins ·Underproduction of Renal Hormones 三、 临床表现 (clinical findings)（20 分钟） 1、水电解质酸碱平衡紊乱：(Disturbances in water or electrolyte and acid-base balance) • water intoxication • Hypo- or hyper-natremia 钠失衡 • Hypo- or hyper-kalemia 钾失衡 • Hypo- or hyper-calcemia 钙失衡 • hyper-phosphatemia 磷失衡 • metabolic acidosis 酸中毒 2.各系统表现 Manifestation of the Uremic Syndrome （1）胃肠道: Gastrointestinal （2）精神神经系统: Neurologic
(3)心血管系统Cardiovascular (4)造血系统Hematologic (5)呼吸系统：Pulmonary (6)皮肤：Dermatologic (7)肾性骨病：Bone,Calcium,Phosphorus Disorders (8)内分泌失调：Endocrinologic 四、诊断(l0分钟)Diagonosis and differential diagnosis 1.基础疾病的诊断 Stage diagnosis of chronic kidney disease ·Etiologic diagnosis 2寻找促使肾衰竭恶化的原因 Progressive factor of chronic renal failure 3.与急性肾衰竭With acute renal failure 五、治疗及预后Principles of treatment for CRF(20分钟) l.治疗基础疾病和促使肾衰竭恶化的因素：Conservative management (1)、饮食治疗Diet: Protein restriction Phosphate restriction starting early in CKD Potassiun restriction Sodium and water restriction as needed to avoid volume overload treatment of the underlying condition if possible (2)、ACEI和ARB的应用：Use of ACE inhibitors as tolerated,.with close monitoring for renal deterioration and for hyperkalemia (3)、中药：Traditional Chinese medicine
（3）心血管系统 Cardiovascular （4）造血系统 Hematologic （5）呼吸系统: Pulmonary （6）皮肤: Dermatologic （7）肾性骨病: Bone, Calcium, Phosphorus Disorders （8）内分泌失调: Endocrinologic 四、 诊断（10 分钟）Diagonosis and differential diagnosis 1.基础疾病的诊断 ·Stage diagnosis of chronic kidney disease ·Etiologic diagnosis 2 寻找促使肾衰竭恶化的原因 ·Progressive factor of chronic renal failure 3.与急性肾衰竭 With acute renal failure 五、 治疗及预后 Principles of treatment for CRF（20 分钟） 1.治疗基础疾病和促使肾衰竭恶化的因素: Conservative management （1）、饮食治疗 Diet: Protein restriction Phosphate restriction starting early in CKD Potassiun restriction Sodium and water restriction as needed to avoid volume overload treatment of the underlying condition if possible （2）、ACEI 和 ARB 的应用:Use of ACE inhibitors as tolerated, with close monitoring for renal deterioration and for hyperkalemia （3）、中药:Traditional Chinese medicine
（5.)、并发症治疗 ·贫血：Anemia with Recombinant erythropoietin ·低钙高磷： Hyperphosphatemia with dietary phosphate binders and dietary phosphate restriction Hypocalcemia with calcium supplements+/-calcitriol Hyperparathyroidism with calcitriol or vitamin D analogs ·水钠失衡的治疗： Volume overload with loop diuretics or ultrafiltration ·高钾血症的治疗： stop to intake potassium-rich foods,potassium-containing drugs stop transfusion of aged blood Management is typically divided into three phases: A.Membrane stabilization (especially cardiac tissue) B.Shifting potassium from extracellular to intracellular fluid C.Removal of potassium from the body ·高血压的治疗：combination2 more agents Calcium channel blockers ACE inhibitors and ARB ·Alpha-blockers ·Beta-blockers ·diuretics ·Dialysis 2.透析治疗：Dialysis
（⒌）、并发症治疗 ·贫血:Anemia with Recombinant erythropoietin ·低钙高磷: Hyperphosphatemia with dietary phosphate binders and dietary phosphate restriction Hypocalcemia with calcium supplements +/- calcitriol Hyperparathyroidism with calcitriol or vitamin D analogs ·水钠失衡的治疗: Volume overload with loop diuretics or ultrafiltration ·高钾血症的治疗: stop to intake potassium-rich foods, potassium-containing drugs, stop transfusion of aged blood Management is typically divided into three phases: A.Membrane stabilization (especially cardiac tissue) B.Shifting potassium from extracellular to intracellular fluid C.Removal of potassium from the body ·高血压的治疗: combination 2 more agents • Calcium channel blockers • ACE inhibitors and ARB • Alpha-blockers • Beta-blockers • diuretics • Dialysis 2.透析治疗：Dialysis
血液透析Haemodialysis 腹膜透析Peritoneal dialysis 3.肾移植Renal transplantation 六：总结(3分钟)
血液透析 Haemodialysis 腹膜透析 Peritoneal dialysis 3.肾移植 Renal transplantation 六：总结（3 分钟）