M2                    2011.5.24

M2 2011.5.24 PowerPoint PPT Presentation


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2. ??? ?Nephrology"???. 1.??=????vital organ???? ???????????" ? "?????????????2.????????????????(??????????) ? ??????(??)3.??????????????????(????????) ???????, ????, ????, ??, ???? ? ?????????? ???????(??????, ?, ???

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M2 2011.5.24

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2. 2 ??? “Nephrology”??? 1.??=????vital organ???? “??????????” ? ”?????????“??? 2.?????·??????????(??????????) ? ??????(??) 3.??????????????????(????????) ??·????, ????, ????, ??, ???? ? ?????·???? ?·?????(??????, ?, ????) 4.???????CKD?????????AKI?????? ? ????·???? 5.“????? CKD”???(???8??1?) ??????????????? ? ????????? ????????? 6.??????? ? ??????????(???400??1?) ? ?????(????1.5??)

3. “Nephrology”???????? ????·???????????? ??????????????(IgA??, ????, ?????????) ???·????(???????) ???·?????????(???????ANCA??????) ????(?????????????????????????) ?????????????????(?????????Fabry???) ?????(??????????/?????????????) ?????? ???(?????/AKI ??????/CKD) ???????(?????????????)?????? ?????????????? ????(??)?????? ??? ???:??????

4. ?????????? ????? ?????? - ?????? ? ??????(???) - ??????(????????)??? ??? ? ??????(?????) ???? ? ????(?·???·???)??? ??? * ?????????????????????? ? ??????·?? ???????? - ????????(??????) ? ???? - ???????D(?????????)? ?Ca???2?HPT ??????? - ???(?????) ? ??? ?????????·?? ? ???????

5. ?????

6. ????????????????????

8. ?????? ???? “??????????”(????????) ????????? ???,?????????????????????? ??????????????,????????????????

9. ????? Renal Hemodynamics ???? Cardiac Output (CO) = 5 L/? ???? Renal Blood Flow (RBF) = 1 L/?(20%) = ???????????????? ????? Renal Plasma Flow (RPF) = 0.6 L/? (600 mL/?) ??? Filtration Fraction (FF) = 20% ?????? Glomerular Filtration Rate (GFR) = 120 mL/? ~150 L/? = ???????10???????????????

10. ???? ????

12. ???????? ????? ???????? ?????????? ?????????? ??? ???????? ????? ?????????? ?·????? ??(???????) ?·????? ?? ?????? ????? ???????? ???????????? ????? ??? ?????? ????????? ???????? ????? ????

13. ?·?????·?????

14. = ?????????????

15. ??????????????????????

16. ?????·?????

17. ????????

19. ???? Volume Expansion???·??

20. ? ? edema

21. Pitting edema ? Nonpitting edema Pitting edema ????? = ????(?????) - ???????? - (?)??? - ??? - ??? - ????? Nonpitting edema ??????? - ????(????????) myxedema - ????? lymphedema - ????? - ???? angioedema

22. ??(Na??)???????? Underfilling Theory ?????????????? ? RAA????????????Na?? ???????*?(?????) Overflow Theory ?????????·Na???? (??????????) ???/???(?????) * Peripheral arterial vasodilation Theory(???) ????????????????????underfilling??????

23. ??????????

24. ????????? ???(??)????????? ????? ? (???????????)?????? pH ??? ?? ?? ???(???????????????) ???? - Fractional excretion (FE) - ??????????????????????

25. ? ? Oliguria     ?????? · ??????????400~500ml??(???????20ml/???)??????????????????????????????????????????500ml???????????????????????????????? ????????(?????:AKI)??????????????????????????????3???????? 

26. ? ? anuria ????????? ?????? ????????? ?????????? ??????(?????) ?????????(???) ?????(???)

27. ?????? Polyuria and Nocturia ?????? ??????????????????????????????????1???3???????????????? ?????????1??????????????? · ?????????????? · ??·???????????????(????) · ???????????(?????)

28. ????????? ???(Isotonic urine, isosthrenuria)????????????????????????300mOsm/kg?????????????1.010???????????????????(hypertonic urine)???????? (hypotonic urine)????

29. ????? ???(Uosm<150mOsm/kg) 1) ?????(???????) 2) ??????? · ?????? · ????? ?????(Uosm>300 mOsm/kg) 1) ???? osmotic diuresis Uosm > 2 x (UNa+K) ????? (???) ???(???????????????) 2) ?????????? salt and water diuresis Uosm~2 x (UNa+K) ??????? Natriuresis (????????????)

30. ?????? ?????=???(??????)??? (-)??(3+) ? ???????(????) · ???????(???? 20~30 mg/dl ) · ??????????? * ?????????????????(light chain??) ????????????(??????????) ???? :SAS (Sulfosalyclic acid;?????????)? ????????????? ????(mg/dl) · ????(??????????????) · ?????(???? 5~15 mg/dl ) ? ??????·?????????

31. ??? / gCr ?

32. ?????? ??????? Glomerular proteinuria ??????? 1?10g????? ??????? Tubular proteinuria ??????? b2???????? (MW=11,800) 1?1g?? a1???????? (MW=30,000) * NAG (N-acetyly-b-glucosaminidase) ···??????? ?????? (???)Overflow proteinuria Bence Jones???? ??????(???) Tissue proteinuria

33. ??? Proteinuria ????????????????? - ???????(??????5~25 mg > IgG,IgA??) - ?????Tamm-Horsfall?? ? ????200mg??(150~300mg)????? ??????? ( =?????;?????????20 mg/dl ??)

34. ???????

36. ?? hematuria ?????? microscopic hematuria - ????????????(?)??? - ???????????????/1???? ?????? ? ?1??????1~3 ml ?????? ????? macroscopic (gross) hematuria ? ?1???????1~3 ml?????

37. ?????(???)

38. ???????: ???(???) vs. ??(?????) ????????????????(??????????)???????(?????????)??????????????????????????????????????????? ??? ????? ??? ????? ?????? ???? ?~??? ? ???0.5g/? ???? ? ????? ?? ???? ?~??? ??? ????? ? ?

39. ?????????

40. ???? ???????(???????)????? ????????? ?? ??????????????? ????(????????????????) ????(????????????) ??(????????????????) ????? ????????????????

41. ??????

42. ?????

43. ?????

44. ???????

45. ? ? cast ?????????????????????????Tamm-Horsfall??(UMOD: uromodulin)??????????????????(??)????????????????????????????????????? ???? hyaline cast ???????(???????????) ???? granular cast???????????????????????? ????? waxy cast ??????????????????????????? ·····?????????????? ????? ? ???????? ????? ? ?????????????????? ???? ? ????????????????? ???? ? ??????(?????)???

46. ???? hyaline cast

47. ???? granular cast

48. ????? waxy cast

49. ?????

50. ?????

51. ????

52. ??????

53. ????

54. ??? Colored Urine ???? ·???? (?????????????) ·????? ·???????(???????????????) ·???????(?????) ???? ·??(????????????????????) ·???????????????

55. Fractional Excretion (FE) ??? ????x?????? ?????????? Ux·V Ux·V S ·GFR Sx·CCr Ux·V Sx x Ucr·V/Scr Ux·Scr Sx·Ucr

56. Fractional Excretion (FE) ??????? (??????????????????) Na 1~2 % K 10~20 % Ca 1~2 % P 10~20 % Mg 3~6 % UA 7~14 %

57. ????????

58. ??????????????????CKD???????????. NKF(??????)???2002???????CKD??????????KDIGO(Kidney Disease Improving Global Outcomes)????????2005??????????? ?????????(CKD)??????????????????????????????????????????????????????? ??????????????????????/????(??????????????)???????????????3???????????CKD???????. ?????(????)????????????GFR(??????)???????????15?30?????????????????????????????. ????????????????????????????????????????????????? ??????????52?????27????????????????????????????????????????????????????? ????????????????GFR??????????????????????? ??????????????????CKD???????????. NKF(??????)???2002???????CKD??????????KDIGO(Kidney Disease Improving Global Outcomes)????????2005??????????? ?????????(CKD)??????????????????????????????????????????????????????? ??????????????????????/????(??????????????)???????????????3???????????CKD???????. ?????(????)????????????GFR(??????)???????????15?30?????????????????????????????. ????????????????????????????????????????????????? ??????????52?????27????????????????????????????????????????????????????? ????????????????GFR???????????????????????

59. ???????GFR??? ??GFR (ml/min/1.73m2) eGFR = 194 x Cr-1.094 x Age-0.287 (??? x 0.739)

60. ?????????????????. ??????????????????????????????????? ?????????????????????????????????????????????????????????????? ??????????????????????????????????????????????????????????????????? ????????????????????????????????????????????????????? ??????????????????????????????????? ???????????????????????????????????????????Cockcroft-Gault????????????? ?????????????GFR??????????????????????????????????????????????GFR???????? ???GFR??????????? GFR??????????????????????????GFR??????????????????????????????? ????????????????????????GFR??????(MDRD???)???????????????????? ??????????????????????????????????????????? ?????????????????C?????????????????????????????????? ???????????????????????????????????????????????????????? ????????????????????? ?????????????????. ??????????????????????????????????? ?????????????????????????????????????????????????????????????? ??????????????????????????????????????????????????????????????????? ????????????????????????????????????????????????????? ??????????????????????????????????? ???????????????????????????????????????????Cockcroft-Gault????????????? ?????????????GFR??????????????????????????????????????????????GFR???????? ???GFR??????????? GFR??????????????????????????GFR??????????????????????????????? ????????????????????????GFR??????(MDRD???)???????????????????? ??????????????????????????????????????????? ?????????????????C?????????????????????????????????? ???????????????????????????????????????????????????????? ?????????????????????

61. ???(CCr)?????????????????

62. 62

63. ????? uremia ?????????????? ????(????) ????? : ??????????? ???? ???? : ??????????????? ???? : ?? ? ?????????·?? ???????????????????? ???? ????? ????(??????????????) ???? ????: ???uremic lung?????????

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