1. General Concept of Renal Diseases Department of Nephrology,the First Affiliated Hospital , Sun Yat-sun University Qiongqiong Yang [email_address]

4. Anatomy Renal Function Remove wastes Maintain homeostasis Secrete EPO Diagram of a bisected kidney

5. Afferent arteriole Efferent arteriole Capillary loops

7. Formed by the Invagination of the tuft of capilleries into dilated blind end of a nephron Afferent arteriole Efferent arteriole Bowman’s Capsule Basement membrane Visceral Epithelium(Podocyte) Parietal Epithelium Capillary loops Bowman’s Space Endothelial cells Stucture of renal glomerulus Mesangial matrix and cell Basement membrane

8. View of glomerulus by scanning electron microscope Afferent arteriole Efferent arteriole The Invagination of the tuft of capilleries into dilated blind end of a nephron

9. Ultramicroscopic Stucture of glomerullar Capillaries Filtration Mem

10. Glomerular Filtration Barrier

11. Glomerular Anatomy Capillary Lumen Endothelial cell Glomerular basement membrane Epithelial Cell of Bowman’s capsule Epithelial Foot process Electron micrograph Capillary Lumen 毛细血管腔 Endothelial cell of the glomerular capillary Podocytes

12. 1. Each kidney contains 1.0 × 10 6 nephrons 2.About 25% of the cardiac output perfuses the kidneys (only 0.5% of body mass) 3. possess abundant microvascular networks 4. countercurrent multiplication of renal tubule Anatomic features of Kidney

22. Proteinuria Parameter Glomerular Tubulointerstitial Amount MW of Protein Massive>++ >1.5~2.0g/d Large/Medium/Small: Selective: mostly albumin;MCD Nonselective: FSGS,diabetes Small amount<2+ <1.0g/d Small: Tam-Horsfall,B2-microglobulin Abnormal proteinuria: Light chains (  ,  );Bence-Jones proteins Plasma cell dyscrasias

25. Hematuria Isomorphic nonglomerular erythrocytes Dysmorphic glomerular erythrocytes Examination of the urine sediment by a phase constrast microscope Dysmorphic glomerular erythrocytes>8000/ml, Acanthocytes 棘红细胞 >5% crenated erythrocytes 皱缩红细胞 , Acanthocytes with their typical ring-formed cell bodies with one or more blebs 水泡 of different sizes and shapes

26. Dysmorphic glomerular erythrocytes Isomorphic nonglomerular erythrocytes

30. red cell cast

35. 1 ． MDRD （ the Modification of Diet in Renal Disease study ） equation eGFR (mL/min per 1.73 m 2 ) = 1.86 x (P Cr ) –1.154 x (age) –0.203  0.742 for female;  1.21 for African American 2 ． Cockcroft-Gault equation (mL/min) =  0.85 for female Estimated GFR (eGFR) equation

36. Stage of chronic kidney disease From K-DOQI guidelines Recommendation Stage Description GFR （ ml/min ） Action 1 Kidney damage with normal or GFR   90 Diagnosis and treatment of CKD. Treatment of comormid condition. Slowing of progression. CVD risk reduction. 2 Kidney damage with mildly GRF ↓ 60-90 Estimating progression 3 Moderately GRF↓ 30-59 Evaluating and treating complications 4 Severely GRF↓ 15-29 Preparation for kidney replacement therapy 5 Kidney failure <15 Replacement (if uremia is present)

39. Diagnosis Clue for urinary diseases clinic syndromes of urinary diseases

40. Diagnosis Clue for urinary diseases

41. General Principles of Diagnosis

43. Histology of GN PAS MASSON H&E PASM

44. Pathological classification of GN

46. Nephrotic syndromes

48. CASE Lung Carcinoma

49. Silver PAS

50. CASE LM-PASM:”spikes” along the GBM

51. CASE IF: IgG deposition along GBM

52. CASE EM: subepithelial electron dense material

53. Diagnosed: carcinoma related Membranous nephropathy

55. 新鲜 腹透液 透出液 管路

56. Integrated ESRD Care Residual renal function HD CCr (ml/min) 20 15 10 5 0 Time on dialysis Start time peritoneal dialysis TX PD

57. Tranæus, December 2002 Early referral of patient with CRF to renal center Pre-ESRD medical management Patient Education Program CAPD/APD as first option if medically suitable, allowing for patient choice CAPD/APD HD Transplant Adapted from Coles,G, et al. Kidney Int, 54:2234-2240, 1998 Late referral increases mortalityDe Veechi et al, PDI 1999 1 1

58. THANKS ！