肾病知识（初级）

肾病知识（初级） 第一题：肾脏在人体中的作用有哪些？ I. What are the functions of the kidneys? 肾脏是维持机体内环境稳定的重要器官： Kidney is the important organ, which is maintaining the stability of internal environment: 1、 排泄代谢终产物 1. Excretion of the end product of metabolism of the body. 2、 调节血容量 2. Regulation of blood volume. 3、 维持电解质和酸碱平衡 3. Maintenance of balance of electrolyte and pH. 4、 分泌多种活性物质，以保证机体的正常生理功能。 4. Secretion of various active substance to guarantee normal physiological functions of the body. 第二题：肾脏的解剖结构？ II. Anatomy of the Kidney? 肾脏解剖结构分为肾皮质和肾髓质： 1. Anatomical structure of the kidney may divided into the cortex and the medulla: 1、肾皮质：位于表层，占肾脏的外1/3，肾皮质的厚度为1.0cm，皮质内富含血管和皮质肾单位，其中除有肾小球、肾小囊外，还有部分远端肾小管和皮质集合管，皮质间质含量较少，约占13%。 2. The renal cortex refers to the outer region, which accounts for 1/3 of the kidney, and is 1.0 in thickness. This part is rich in blood vessels and cortical nephron, in which there are section of distal tubule and cortical collecting duct besides glomerulus and renal capsule, and cortical interstitial is relatively low, taking up 13%. 2、肾髓质：主要由肾小管组成，在形态上由8—18个肾锥体组成，呈圆锥状，尖端朝向肾窦，形成肾乳头，底部朝向外侧，与皮质相连，根据其结构特点，髓质可分为内带和外带。皮质和髓质并非截然分开，皮质中有许多条髓质放射状插入皮质，称皮质髓放线；髓放线之间的肾皮质称皮质迷路。部分肾皮质伸入肾锥体之间称为肾柱。 2. The renal medulla is mainly composed of renal tubules, and is divided into 8-18 conical renal pyramides, the apex of which extend towards the sinus of the kidney to form a papilla, while the base of each pyramid extend toward the outside and connect with the cortex. The medulla, in terms of its structural features, is divided into inner segment and out segment. Longitudinal elements extend into the cortex, which is termed the cortical medullary rays; and the renal cortex between the medullary rays is cortical labyrinth. The renal cortex extends downward between the individual pyramids to form the renal columns of Bertin. 第三题：肾脏的形状和位置？ III. Shape and location of the kidneys. 1、双肾为蚕豆状，左右各一。 2、位于脊柱两侧，居腹膜后方；右肾上方有肝脏，故位置略低于左肾。左肾上极平第11胸椎，下级平第二腰椎，右肾的上下级均低于左肾的一个胸椎和腰椎，（12胸椎至第三腰椎），两肾的长轴均向外倾斜，所以，背部12肋骨下方与骶棘肌外缘之间是肾脏的触诊区。肾脏内缘中部凹陷，称为肾门，是血管、神经和输尿管出入的门户，故称“肾门”。肾门以内是肾脏围成的腔隙，称为肾窦，肾窦包括肾盂、肾盏、肾动脉及肾静脉的主要分支及它们周围的疏松结缔组织和脂肪。 Kidneys are paired retroperitoneal organs situated in the posterior part of the abdomen on each side of the vertebral column. The right kidney is slightly lower than the left one because there is the liver above the right kidney. The upper pole of left kidney lies opposite the 11th thoracic vertebra, and the lower pole lies opposite the second lumbar vertebra. The right kidney is usually slightly more caudal in position (12th thoracic vertebra and third lumbar vertebra for the upper pole and lower pole respectively). Long axis of each kidney inclines outward, so the space between the lower 12th rib and outer edge of erector spinae is the palpation area. Located on the medial or concave surface of each kidney is a slit, called the hilum, though which the renal blood vessels, a nerve plexus and ureter pass, so it is called hilum. Inside the hilum, there is a cavity, called the sinus of the kidney which includes renal pelvis, renal calyx, main branches of the renal artery and vein as well as the loose connective tissue and fat around them. 第四题：肾脏的功能有哪些？ IV. What are the functions of the kidneys? 肾脏功能主要有： The functions of the kidneys mainly include: 1、排泄体内代谢产物，如尿素、肌酐、有机酸等； 1. Excretion of metabolites inside out body, such as: urea, creatinine, organic acid, etc. 2、调节水和电解质平衡； 2. Regulation of the balance of water and electrolyte. 3、维持内环境稳定； 3. Maintenance of the stability of inner environment. 4、内分泌功能，如分泌肾素、前列腺素、促红素等。 4. Endocrine function, such as: secreting renin, prostaglandin, erythropoietin, etc. 肾脏功能主要包括： Renal functions mainly include: （1）、肾小球滤过功能； (1)Filtration Function of the Glomerulus; （2）、肾小管重吸收功能、调节功能、浓缩功能、稀释功能、分泌功能、排泄功能。 (2) Reabsorption function, regulatory function, concentration function, dilution function, secretion function and excretion function of the renal tubule. 第五题：肾脏的组织结构？ V. Structure of the Kidney 肾脏的组织结构分为肾实质和肾间质： The kidney is composed of renal parenchyma and renal interstitium: 1、肾实质由功能肾单位和集合管组成。 Renal parenchyma is comprised of functional unit and collecting duct. 2、肾间质由间质细胞和疏松的细胞外基质构成 Renal interstitium is comprised of interstitial cell and loose extracellular matrix. 第六题：肾实质的组织结构？ VI. Structure of the renal parenchyma 肾实质由功能肾单位和集合管组成： Renal parenchyma is composed of nephron and collecting duct: 1、肾单位是肾脏的基本组织结构和功能单位，每个肾脏有100多万个肾单位。肾单位由肾小体及其各段肾小管组成。包括：近端肾小管、髓袢的降支和升支，远端肾小管，集合管不包括在肾单位之内。 Nephron is the essential structure and functional unit of the kidney and each human kidney contains about more than one million nephrons. The essential components of the nephron include the renal or malpighian corpuscle (glomerulus and Bowman capsule) and all segments of the renal tubule, including: proximal tubule, the medullary ascending and descending limbs, the distal tubule, but the collecting duct is excluded. 1）、肾小体由肾小囊（鲍曼氏囊）和毛细血管球（肾小球）组成，一侧与近端肾小管相接称尿极，另一侧与入球小动脉和出球小动脉相连，称血管极。 Malpighian corpuscle is composed of renal capsule (Bowman capsule) and glomerular tuft, with one side connecting with proximal tubule, which is called urinary pole and the other side connecting with afferent arteriole and efferent arteriole, which is called the vascular pole. 肾小球：入球小动脉自血管极进入肾小体，并分成5-8个分支，每个分支各自形成一团毛细血管网，构成一个肾小球的毛细血管小叶或称节段，各小叶的毛细血管再汇集成出球小动脉离开血管极。 Glomerulus: The afferent arteriole enters the malpighian corpuscle from the vascular pole and is divided into 5-8 branches, each of which forms a capillary network to comprise a capillary lobule or segment of the glomerulus, and then the lobular capillaries gathers to form the efferent arteriole and exit the vascular pole. 该血管特点：入球小动脉较出球小动脉粗而直，出球小动脉细而长，使两者保持了相当的血管内压力差，从而使肾小球毛细血管的静水压（球内压）高于身体其他部位的毛细血管内压，以利于肾小球毛细血管的滤过功能（肾小球滤过功能）。 b. Features of the vessels: Compared with the efferent arteriole, the afferent arteriole is thick and straight, and the efferent arteriole is thin and long, which forms certain capillary lumen pressure difference between the two, thus that hydrostatic pressure of the glomerular capillary is higher than that of other parts in our body, so it is good for the filtration function of the glomerular capillary (Filtration function of the glomerulus). 第七题：肾间质的组织结构？ VII. Structure of the renal interstitium 肾间质由间质细胞和疏松的细胞外基质构成： The renal interstitium is composed of interstitial cells and a loose extracellular matrix material: 肾间质位于肾单位及集合管之间的间叶组织，由间质细胞、少量网状纤维和胶原纤维、细胞外基质（ECM）组成。肾皮质主要由肾小体与部分肾小管组成，含间质较少，约占13%，肾髓质含间质较多，约占20%，肾乳头部占30-40%。 Renal interstitium is located at mesenchymal tissue between nephron and collecting duct, which is composed of interstitial cell, small amount of reticular fiber and collagen fiber, and extracellular matrix (ECM). Renal cortex is mainly composed of malpighian corpuscle and part of renal tubule, which contains little interstitium, that is approximately 13%, while interstitial volume in renal medulla is more, accounting for 20%, and for 30-40% in papilla. 皮质肾间质细胞：主要有成纤维细胞、巨噬细胞、间质树突状细胞。成纤维细胞位于相邻肾小管基底膜之间和管周毛细血管之间，可产生胶原纤维。 Cortical interstitial cell mainly includes myofibroblast, macrophage, and interstitial dendritic cell. Fibroblasts is located between the adjacent basement membrane of a tubule and between peritubular capillary, which can produce collagenous fibre. 髓质间质细胞：除有纤维母细胞、成纤维细胞、巨噬细胞、树突状细胞外还有一种特殊表型具有分泌前列腺素的细胞。 3. Medullary interstitial cell: there is a kind of special cell, the phenotype of which can secrete prostaglandin, besides fibroblast, myofibroblast, macrophage and dendritic cell. 4、肾间质细胞具有合成和分泌细胞外基质（ECM）、前列腺素、促红素等功能。 4. Interstitial cell has the functions like synthetization and secretion of extracellular matrix, prostaglandin, erythropoietin, etc. 第八题：肾小球的组织结构？ VIII. The structure of glomerulus? 肾小球毛细血管壁共分三层： The capillary wall of glomerulus is divided into three layers: 第一层是内皮细胞层，由单层的内皮细胞（EC）组成。内皮细胞体本身有许多直径为50-100nm的窗孔，从而能阻止血液中的有形成分不能进入内皮下与基底膜接触，内皮细胞本身覆盖一层带阴电荷的唾液酸蛋白，阻止血液中带阴电荷的离子与物质滤过，从而构成了肾小球滤过膜的静电屏障。该屏障能阻止带阴电荷的蛋白漏出。 1. The first layer is endothelial cells, which is composed of a single layer of endothelial cell. The endothelium is perforated by pores or fenestrae which range from 50-100nm in diameter. This layer can prevent the formed elements of the blood from entering into the endothelium to contact with the basement membrane. The endothelial cells are covered with silaoprotein that is negatively charged, which prevent the filtration of ions and substances with negative charge in blood. The endothelial cells form the static barrier of the glomerular filtration membrane, which can prevent the protein with negative charge from leaking out. 2、第二层基底膜层（GBM）：基底膜分三层，由内疏松层、致密层、外疏松层组成。GBM主要由糖蛋白，带阴电荷的硫酸类肝素和胶原Ⅳ、层粘连蛋白、纤粘连蛋白（FN、LN）等构成。成人GBM厚度为310-370nm。 2. The second layer is glomerular basement membrane, which is composed of lamina rara interna, lamina densa and lamina rara externa. GBM is formed by glycoproteins, heparan sulfate proteoglycan, and type IV collagen, laminin, fibronectin (FN, LN), etc. The thickness of GB Min the adult is 310-370nm. 3、第三层为上皮细胞（足细胞）层，粘附于GBM外侧，上皮细胞有很多突起与基底膜接触，突起分三级，形成如指状，交叉相嵌，突起间的空隙称为裂孔（裂隙），其直径为4—10nm，表面覆盖一层裂孔膜，起着选择性滤过作用。其表面也覆盖一层带阴电荷的唾液酸蛋白，对大分子物质具有选择性滤过。 3. The third layer is visceral epithelial cell (podocytes), adhering to outside of GBM, which has long processes or trabeculae which contact with GBM. The finger-like processes can be divided into three classes which intersect with each other. The gap between the foot processes is referred to as filtration slit or slit pore, the diameter of which range from 4-10nm. It is covered with a filtration slit membrane, which contributes to the selective filtration function. The surface of this filtration slit membrane is also covered with a layer of negatively charged silaoprotein, which also can filtrate the macromolecules selectively. 系膜细胞（MC），位于毛细血管小叶的中轴，邻近毛细血管内皮和基底膜，主要由系膜细胞与系膜基质组成。系膜细胞支撑着毛细血管不被塌陷，是一种多功能细胞，具有对血管收缩舒张与滤过面积大小的调节功能以及吞噬、分泌功能。 Mesangial cells (MC), situated at central region of capillary lobule, is adjacent to endothelium and basement membrane of the capillaries. The mesangial cells and their surrounding matrix material constitute the mesangium. It can provide structural support for the capillaries to prevent them from collapse, which is a kind of multifunctional cell and has many functions, such as: regulation of constriction and distention of blood vessels as well as filtration area, phagocytic properties and secretory function. 第十八题：肾动脉血液灌注？ 1、肾动脉发自腹主动脉，在肾门处分为前后二支，再在肾窦内分成3～4条段动脉，继而分成叶间动脉，穿行于肾柱之间。叶间动脉分支横向走行于皮髓质交界处，形成弓形动脉。 2、弓形动脉均匀发生多个放射状分支伸入皮质迷路，形成小叶间动脉。 Question 18: Renal Arterial Blood Perfusion 1. Renal arteries originate from abdominal aorta and are divided into two branches at the renal hilus. The two branches before and behind will be divided into 3～4 segmental arteries and then interlobar arteries which go through the renal column. The branches of interlobar arteries go crosswise the junction of cortex and medulla forming arcuate arteries. 2. Arcuate arteries produce equably multiple radial branches that stretch into cortical labyrinth, thus forming interlobular arteries. 3、小叶间动脉发出侧支进入肾小球形成入球小动脉。 4、入球小动脉进入肾小球形成5～8个分支的毛细血管球（毛细血管袢），数个袢支再汇集成出球小动脉。 5、然后再分支形成肾小管周围毛细血管网。 3. Interlobular arteries spread out collaterals than enter the glomerulis, thus forming afferent arterioles. 4. After entering the glomerulis the afferent arterioles will form 5～8 capillary balls (capillary loops). Several loops will converge to efferent arterioles. 5. Then the efferent arterioles will form renal tubular capillary net. 6、多个毛细血管网再汇集形成小叶间静脉再进入弓形静脉、叶间静脉，最后形成肾静脉。 7、髓旁单位的出球小动脉，以及由弓形动脉与小叶间动脉分支共同组成直小动脉伸入到髓袢和集合管周围，达到不同深度后转折而上形成直小静脉，汇入小叶间静脉、弓形静脉、再入叶间静脉和肾静脉。 6. Several capillary net will converge to interlobular veins and then enter arcuate veins, interlobar veins forming renal veins at last. 7. Efferent arterioles of juxtamedullary nephrons and the arteriolae rectae consist of arcuate arteries and interlobular arteries will stretch into medullary loops and concentrated tubules. When they arrive at certain depth, they will turn and rise thus forming venae rectae which will converge to interlobular veins, arcuate veins and then interlobar veins and renal veins. 第十九题：影响肾小球滤过率的因素？ 肾小球滤液的形成与： 肾小球滤过膜的通透性 滤过面积 有效滤过压 4、 肾血流量等因素有关。（两岁婴儿的滤过率就达到成人水平。） Question 19: Factors That Influence the Glomerular Filtration Rate 1. The permeability of glomerular filtration membrane. 2. The filtration area. 3. Effective filtration pressure. 4. Renal plasma flow. (The filtration rate of a two-year-old baby is at the same level of that of adults) 第二十题：肾脏血流灌注量的特点？ 肾脏血流灌注量占心排出量20～25％较其他脏器的血流量多70倍，全身约1∕5的血容量由肾脏滤过，肾血流灌注量中80%灌注于肾皮质，20％灌注于肾髓质。 Question 20: Features of Renal Blood Perfusion Renal blood perfusion is of 20～25％ of cardiac output, which is 70 times more than that of other organs. Nearly 1/5 of the blood volume is filtrated by the kidneys. 80% of the renal blood volume perfuse into cortex, while 20% perfuse into medulla. 第二十一题：肾脏有效滤过压的特点？ 1、肾小球的滤过压由两部分组成: 一是：促进肾小球超滤的动力；二是：对抗超滤的阻力； 具有超滤动力的有：肾小球毛细血管静水压（血流灌注压）和肾小囊内超滤液胶体渗透压组成。 促使超滤阻力的有：肾小球毛细血管内的血浆胶体渗透压，和肾小囊的囊内压。 Question 21: Features of Effective Filtration Pressure 1. Glomerular filtration pressures consists of two parts: One is the motive power promoting glomerular ultrafiltration; the other is resistance that confronts ultrafiltration. The motive power: Glomerular capillary hydrostatic pressure(blood perfusion pressure) and colloid osmotic pressure of ultrafiltrate in renal capsules. The resistant power: Plasma oncotic pressure inside glomerular capillaries and renal intracapsular pressure. 2、肾小球有效滤过压=（肾小球毛细血管静水压+囊内胶体参透压）－（血浆胶体渗透压+肾小球囊内压）。 请注意：在正常情况下，囊内压一般比较稳定。当上尿路有梗阻时，小管液与终末尿不能排出，可引起逆行性压力升高，最终导致囊内压升高，从而会降低有效滤过压和GFR。 2. Glomerular effective filtration pressure=( Glomerular capillary hydrostatic pressure+ renal capsular colloid osmotic pressure)-( plasma oncotic pressure+ renal intracapsular pressure). Attention: Ordinarily, the intracapsular pressure is stable. When there is obstruction in upper urinary tract, the tubular fluid and terminal urine cannot be discharged out, thus causing retrograde high pressure. It will finally cause rise of intracapsular pressure and decrease of effective filtration pressure and GFR. 同理：在正常情况下，血浆胶体渗透压不会发生大变动（血浆白蛋白相对恒定），当出现低蛋白血症时，血浆胶体渗透压降低，会使有效滤过压和肾小球滤过率增加（高滤过状态）。 It is similar that plasma oncotic pressure will not change too much in ordinary cases(plasma albumin is stable). When there is hypoproteinemia, the plasma oncotic pressure will become low, which will lead to the increase of effective filtration pressure and glomerular filtration rate(high filtration state). 第二十二题：什么是肾小球滤过率？ 1、当血浆流经肾小球毛细血管时，除蛋白质分子外的血浆成分，被滤过进入肾小囊腔形成超滤液——“原尿”。 2、滤过率：为单位时间内（每分钟）双肾生成的超滤液（ml）为肾小球的滤过率。 3、正常人的肾小球滤过率平均值为125ml/min，双肾每天滤出原尿为180L。 4、180L原尿中流经肾小管，其中99%的原尿被重吸收，终末尿仅占原尿的1%。 Question 22: What Is Glomerular Filtration Rate? 1. When plasma flows through glomerular capillaries, the compositions of the plasma except protein will be filtrated into the renal capsules and form ultrafiltrated liquid—“initial urine”. 2. Filtration rate: the ultrafiltrated liquid(ml) produced by bilateral kidneys every minute is glomerular filtration rate. 3. The average glomerular filtration rate of healthy people is 125ml/min and the initial urine filtrated by bilateral kidneys is 180L. 4. The 180L initial urine will flow through the tubules. 99% of the initial urine will be reabsorbed and the terminal urine is only 1% of the initial urine. 第二十三题：肾小管功能有哪些？ 肾小管的功能是重吸收原尿中的水分、电解质及营养物质如葡萄糖、氨基酸；分泌H+、K+及有机酸；排泄废物如尿素及有机酸等；以及参与尿的浓缩与稀释，调节液体容量。 第二十四题：肾小管重吸收功能有哪些特点？ 1、对钠离子的重吸收 2、对氯离子的重吸收 3、对水的重吸收 4、对钾离子重吸收 5、对钙的重吸收 Question 23: What Are the Functions of the Tubules? The functions of the tubules are reabsorbing the water, electrolytes and nutrition such as glucose and amino acid; secreting H+, K+ and organic acid; excreting wastes such as urea and organic acid; taking part in the concentration and dilution of urine and regulating liquid volume. Question 24: What Are the Features of the Reabsorption of the Tubules? 1. Reabsorption of Na+ 2. Reabsorption of Cl- 3. Reabsorption of water 4. Reabsorption of K+ 5. Reabsorption of Ca+ 第二十五题：肾脏的分泌功能有哪些？ 肾脏通过自分泌、旁分泌、胞分泌形式，产生系列内分泌生物活性物质，以调节体内血压、水电解质平衡，钙、磷代谢等多方面起重要作用。 第一、分泌肾素、血管紧张素（RAAS） 第二、分泌前列腺素 第三、分泌激肽释放酶——激肽系统 第四、分泌内皮素及一氧化氮 第五、分泌促红细胞生成素 第六、分泌维生素D3 第七、血管内皮功能在肾脏血流灌注的作用 Question 25: The Secretion Function of the Kidneys By autocrine, paracrine and intracrine, the kidneys will secrete a series of endocrine bioactivator to regulate the blood pressure, electrolytes balance and calcium and phosphorus metabolism etc. 1. Secrete rennin and angiotensin (RAAS) 2. Secrete prostaglandin 3. Secrete kallikrein—kininsystem 4. Secrete endothelin and nitric oxide 5. Secrete hemopoietin 6. Secrete vitamin D3. 7. The vascular endothelial function in renal blood perfusion 第二十六题：尿毒症血液系统并发症？ 肾性贫血是慢性肾衰竭常见的临床表现，也是促使慢性肾衰病情进展，心脑血管并发症的发生率与死亡率增加的重要危险因素。 Question 26: The Blood System Complications of Uremia Renal anemia is a common manifestation of chronic renal failure. It is also an important dangerous factor that promotes the progressing of chronic renal failure and increases the incidence and death of heart cerebrovascular complications. 第二十七题：常见的肾性贫血原因有哪些？ 1、肾性贫血是由各种因素造成促红细胞生成素（EPO）产生不足，而EPO产生不足是肾性贫血的主要原因：大约有90％以上的EPO由肾组织产生。 2、营养不良铁缺乏。 3、红细胞生长抑制因子。 4、活动性失血。 5、红细胞寿命缩短 6、继发性甲旁亢致肾性贫血 ７、铝负荷过重 Question 27: Common Reasons of Renal Anemia 1. Renal anemia leads to less production of hemopoietin (EPO)due to many factors, while less production of EPO becomes the main reason of renal anemia: over 90% of EPO is produced by renal tissues. 2. Malnutrition and iron deficiency. 3. Inhibiting factor of red blood cells. 4. Active blood loss. 5. Life-shortening of red blood cells. 6. Renal anemia due to secondary hyperparathyroidisme. 7. Over burden of aluminum. 第二十八题：滤过率下降与病情演变规律？ 1、肾脏有强大的代偿能力，当GFR在50ml／min以上时，血肌肌酐正常；患者可以没有任何症状。 2、当GFR进一步下降到50ml／min以下时，在一般情况下可仅有乏力，夜尿增多等表现，易被患者忽略； Question 28: The Relationship between the Decline of Filtration Rate and the Progression of Patient’s Condition 1. The Kidneys have strong ability of functional compensation. When the GFR is higher than 50ml/min, the serum creatinine is normal and the patient has no symptom. 2. When the GFR has decreased and is lower than 50ml/min, generally there will be fatigue and increase of night urine, which are often ignored by the patients. 3、当GFR降至25ml／min以下时，患者可有明显的贫血，恶心，呕吐，食欲减退等消化适症状； 4、当GFR降至10ml／min以下时，患者才表现出典型的尿毒症症状； 5、肾小球疾病表现出明显的高血压、蛋白尿、血尿、少尿等； 6、肾小管间质疾病表现出贫血、代谢性酸中毒，夜尿增多，而高血压相对轻少； 3. When GFR is lower than 25ml/min, the patients will have obvious anemia and some symptoms of digestive tract such as nausea, vomiting, poor appetite etc. 4. When GFR is lower than 10ml/min, the patient will have typical symptoms of Uremia. 5. Glomerular damage will cause obvious high blood pressure, proteinuria, hematuria and oliguria etc. 6. Tubular damage will cause manifestations such as anemia, metabolic acidosis, increase of night urine while high blood pressure is not that common or serious. 第二十九题：肾功能损害的临床表现？ 1、轻度肾功能损害 1）、GFR≥30ml／min时，大多数患者无主现症状或仅有的夜尿增多，乏力和腰酸等。辅助检查时可能合并存在继发性甲状旁腺功能亢进， 2）、肾小球疾病导致的慢性肾炎肾功能衰竭（CRF）患者，可伴有贫血和血尿、蛋白尿、高血压比较常见，以及少尿等。 3）、肾小管间质疾病导致的CRF者，更多表现为贫血，代谢性酸中毒和夜尿增多，而高血压发生率较低，除非合并尿路梗阻或反流肾等。 2、中、重度肾功能损害 随着CRF进展，体内各种毒素的积聚及水、电解质酸碱平衡紊乱，患者可以出现多种临床表现，可以累及全身各脏器和系统。 Clinical symptoms of damage on renal function mild damage on renal function 1)when GFR is no less than 30ml／min, most patients have no main symptoms or only have symptoms like increasing nocturnal enuresis, fatigue, sore waist and so on. During assistant test, some patients may accompany with secondary hyperparathyroidism. 2)Patients with Chronic Renal Failure which is caused by the glomerulus disease may accompany with some common symptoms, such as anemia, hematuria, proteinurine, high blood pressure, oliguria, etc. 3) T