kidney.

⭀䛴ḿᖏ⫏╉よ๕
⭀㝸ᐐ䛴⑋⌦
㛏ᔪὊ἖
䟺ฦᏄ⑋⌦Ꮥᩅᐄ䟻
[email protected]
• ⩹ᗣ∸ࡡᤴἝࠉమᾦࣁࣚࣤࢪࡡಕᣚ
• හฦἢჹᏻ࡚ࡵ࠵ࡾ㸯erythropoietin, renin, prostaglandins.
• 㔔㔖150 gm.
• ᑺ⟮ࡢureter ⭀㛓㒂hilum࠾ࡼ⭀࡞ථࡽ, ⭀⓺ pelvisࢅᙟᠺ
• ⭀⓺ࡢ2-3࡞ฦ࠾ࡿmajor
calycesࢅᙟᠺࠉࡈࡼ࡞3-4ࡡ
minor
calyces࡞ฦ࠾ࡿࡾ
• ๪㟻࡚ࡢ,⭀ࡢ⓮㈻cortex㸝ཉࡈ1.2 -1.5 cm㸞࡛㧂㈻medulla࠾ࡼ࡝
ࡾ.
• 㧂㈻ࡢ⭀㗱మrenal pyramids࠾ࡼ࡝ࡽ, ࡐࡡ㡤Ⅴࡢ஘㢄papillae
㸝⭀᮴calyx࡛㏻⤙㸞.
• ⓮㈻⤄⧂ࡢ⭀㗱మ㛣࡞ఘࡦrenal columns of Bertin࡛ࡻࡣࡿࡾ.
⭀䛴⾉Ὦ
⣊⌣మ
• ⭀㔔㔖ࡢධమ㔔ࡡ0.5%࡞㐛ࡁ࡝࠷࠿ࠉᚨᢷฝ
㔖ࡡ 25% ࡡ⾉ᾦࢅ౩⤝.
• ⓮㈻࡞90%ࡡ⾉ᾦࢅུᐖ
࣬㛜✾ᛮහ⓮ fenestrated endothelium࡞
しࢂࡿࡾẗ⣵⾉⟮ࡡྼྙ࠾ࡼ࡝ࡾ
• 2ᒒࡡ୕⓮⣵⬂㸯⮒ഁ୕⓮⣵⬂࡛ባഁ୕
⓮⣵⬂
• ⣊⌣మẗ⣵⾉⟮ࡢ℈㐛⭯:
ࠈࠈ㛜✾ᛮහ⓮⣵⬂
ࠈࠈ⣊⌣మᇱᗇ⭯
• ⭀ິ⬞୹ᖷࡢ⭀㛓㒂࡚๑ᚃ࡞ฦ࠾ࡿࡾ.Ѝⴝ㛣
ິ⬞interlobar
arteriesЍᘢ≟ິ⬞arcuate
arteriesЍᑚⴝ㛣ິ⬞interlobular arteriesЍ
㍲ථᑚິ⬞afferent
arteriolesЍ⣊⌣మ
glomerular tuftЍ⣊⌣మ౿㋗㸝ୌ⣊⌣మහ࡞
20-40㸞 Ѝ㍲ฝᑚິ⬞ efferent arterioles.
⣊⌣మ
࣒࣬ࢦ࣑ࣤ࢟ࢗ⣵⬂ 㸯glomerular tuftࡡẗ⣵⾉⟮ࡡ
㛣࡞௒ᅹ
• ࣒ࢦ࣑ࣤ࢟ࢗᇱ㈻㸯mesangial cells ࢅྱࡳᇱᗇ⭯
ᵕ∸㈻.
• ࣒ࢦ࣑ࣤ࢟ࢗ⣵⬂ࡢ㛣ⴝ⣌⏜ᮮ
ࠈࠈࠈ཭⦨ᛮࠉ㈆㣏⬗ࠉቌṢ⬗ࢅ᭯ࡌࡾ
ࠈࠈࠈᇱ㈻ࡷࢤ࣭ࣚࢣࣤࢅ௥ㅨ
ࠈࠈࠈኣࡂࡡ⏍⌦Ὡᛮ∸㈻ࢅ⏐⏍
ࠈࠈࠈ⾉⟮ᖲ⁝➵⣵⬂ࡷ࿔⣵⬂pericytes࡞㢦జ
ࠈࠈࠈ⣊⌣మ⭀ⅎ࡚㔔さ࡝ᙲ๪ࢅ᭯ࡌࡾ
⣊⌣మ
• ḿᖏ⣊⌣మ℈㐛ࡢỀฦࡷ᚜ᑚ⁈㈻࡞ᑊࡊࡀࢂ
ࡴ࡙㏩㐛ᛮ㧏࠷
• albumin (+3.6-nmᙼ; 70kDa)ࡻࡽኬ࡝ฦᏄࡢ
୘㏩㐛㸯glomerular barrier function
• ࣁࣛ࢓ᶭ⬗ࡢฦᏄࡡኬࡀࡈ࡛ᖈ㞹≟ឺ࡞౪Ꮛ
1
ᑺ⣵⟮
• ୕⓮ࡡᵋ㏸ࡢࢾࣆࣞࣤࡡ྘࡚ࣝ࣊ࣜ␏࡝ࡾ.
㎾నᑺ⣵⟮୕⓮proximal tubular cells㸯
• ㇇ᐣ࡚㛏࠷microvilli, ኣᩐࡡmitochondria,
apical canaliculi, ࡻࡂⓆ㐡ࡊࡒ intercellular
ࠈ interdigitationsЍNa,Ềฦࠉglucose, K,Pࠉ
ࠈ࢓࣐ࢿ㓗ࠉ⺦Ⓣࢅ්ྺ཭
എ⣊⌣మ⿞⨠
•⣊⌣మ࡞ afferent arteriole࠿Ὦථࡌࡾ௛㎾
࡞Ꮛᅹࡌࡾහฦἢჹᏻ
•reninࢅฦἢЍFngiotensinЍFldosterone
• ⹣⾉ᛮ㝸ᐐࢅུࡄࡷࡌ࠷
• Ẑᛮ∸㈻࠿්ྺ཭ࡈࡿഭᐐࢅུࡄࡷࡌ࠷.
᛬ᛮ⭀୘ධ䟺ᏽ⩇䟻
• ᛬㏷䛰⭀ᶭ⬗䛴఩ୖ䛑䜏మᾦ䛴ᜇᖏᛮ䛴
⥌ᣚ䛒ฝᮮ䛰䛕䛰䛩䛥≟ឺ
• 㧏✽⣪⾉⑍䟾䛣䛴௙䛴⭀ᶭ⬗௧୕䚮᳠ᰕ
ೋ␏ᖏ䜘♟䛟䚯
• ⾉ΰ䜳䝰䜦䝅䝏䝷ೋ䛒2.0-2.5mg/dl௧୕䚮
䜄䛥䛵䜳䝰䜦䝅䝏䝷ೋ䛒0.5mg/dl/᪝䜄䛥
䛵BUN䛒10mg/dl/᪝୕᪴
᛬ᛮ⭀୘ධ䛴ཋᅄ
• ⭀๑ᛮ䠌మᾦ㔖䚮᭯ຝ⾉ₚ㔖䛴΅ᑛ䚮ᚨᢷฝ㔖΅ᑛ䚮⭀
හ⾉⾔ິឺ䛴ን໩
• ⭀ᛮ䠌㍲ථ⣵ິ⬞䝿⣊⌣మ⑋ን䚮᛬ᛮ㛣㈻ᛮ⭀ⅎ䟺䝞䝏
䜻䝮䝷䚮㟸䜽䝊䝱䜨䝍⣌ᾐⅎ๠䚮᛬ᛮ⭀⓺⭀ⅎ䟻䚮᛬ᛮ⭀
ᑺ⣵⟮ቪṒ䟺⹣⾉ᛮ䚮ⷾ∸ᛮ䚮䝣䜮䜴䝱䝗䝷ᑺ⑍䟻
• ⭀ᚃᛮ䠌୦ഁᑺ⟮䛴㛚ራ䟺ᝇᛮ⭐⑾㦭┑හᾈ₮䟻䚮⭜⬌
ᑺ㐠䛴㛚ራ䟺๑❟⭚⤎⟿ᛮ㐛ᙟᠺ䟻
᛬ᛮ⭀୘ධ䛴ฦ㢦
• ⭀๑ᛮ䠌⭀⾉Ὦ㔖䜊⣊⌣మ⾉ᅸ఩ୖ
• ⭀ᛮ䠌⭀ᐁ㈻䛴㝸ᐐ
• ⭀ᚃᛮ䠌⭀⓺䚮ᑺ⟮௧ୖ䛴ᑺὮ䛴㝸ᐐ
᛬ᛮ⭀୘ධ䛴⑋ឺ⏍⌦
• ⭀ᶭ⬗䛴᛬⃥䛰఩ୖ䛱䜎䜑⩹ᗣ∸䛴⵫✒䚮
Ề䝿㞹よ㈻ㄢ⟿␏ᖏ䚮㓗䝿ሲᇱㄢ⟿㝸ᐐ
• 㧏✽⣪⾉⑍䠌⾉⟮ᅄᏄ䛮ᑺ⣵⟮ᅄᏄ
• ㏳ᖏ䛵௙⮒ჹ୘ධ䛮ྙె䠌ኣ⮒ჹ୘ධ
(multiple organ failure, MOF):ධ㌗ᛮ㧏䜹
䜨䝌䜯䜨䝷⾉⑍
2
᛬ᛮ⭀୘ධ䛴⑍≟
᛬ᛮ⭀୘ධ䛴⑋⌦
• ᑺ㔖䛴ን໩䠌இᑺ᭿䊲ฺᑺ᭿䊲ᅂᚗ
• 㧏✽⣪⾉⑍䛱䜎䜑ᑺẐ⑍⑍≟䠌
䚭䚭䚭ᾐ໩⟮⑍≟䟺㣏ᛦ୘ᣲ䚮ᝇᚨ䚮჊ྡ䚮⭙⑚䟻䚮
䚭䚭䚭♼⤊䝿➵⑍≟䟺ධ㌗್ᛨវ䚮㞗୯ງ఩ୖ䚮Ί㏖䚮
䚭䚭䚭䚭䚭᪻╟䚮➵⑙᨝䟻䚮
䚭䚭䚭㈃⾉䟺䜬䝮䜽䝱䝡䜬䝅䝷఩ୖ䚮⁈⾉䚮ฝ⾉䟻䚮
䚭䚭䚭᪾វ᯹ᛮ
• ⭀๑ᛮ䠌⭀䛱䛵┘䛦䛩䛥ን໩䛵䛰䛊
• ⭀ᛮ䠍ཋ⑄ᝀ䜘ཬ᫆䛟䜑ᡜぜ
䚭䚭䚭䚭᛬ᛮ⭀ᑺ⣵⟮ቪṒ
䚭䚭䚭䚭䚭䚭⭀䛴⭐ኬ䚮⓮㈻㈃⾉䚮㧂㈻䛌䛩⾉
䚭䚭䚭䚭䚭䚭ᑺ⣵⟮୕⓮䛴ቪṒ䚮⬲ⴘ
䚭䚭䚭䚭䚭䚭ᑺ⣵⟮䛴ᣉᘿ䚮ළᰍᙟᠺ
• ⭀ᚃᛮ䠌Ề⭀⑍
• Ề䚮Na䛴⵫✒䠌⣵⬂አᾦቌຊ䟺ᾃ⭐䚮㧏⾉ᅸ䚮⫭䛌䛩⾉䟻
• K⵫✒䟺୘ᩒ⬞䚮᫤䛱⮬Ṓᛮ䟻
DIC
ះᛮ⭀୘ධ䟺ᏽ⩇䟻
• Disseminated intravascular coagulation
• ᩐ䝺᭮䛑䜏ᩐᖳ䛱䜕䛥䛩䛬⭀஢ങ⣙䛒఩
ୖ
• మᾦ䛴㔖䚮㈻Ⓩᜇᖏᛮ䛒⥌ᣚ䛭䛓䛰䛕䛰䛩
䛥≟ឺ
• ኣᙤ䛰⑍≟䜘♟䛟
• ⭀⣊⌣మ౿㋗䜊⫭ẗ⣵⾉⟮䛰䛯䛱䝙䜧䝚䝮
䝷᚜ᑚ⾉ᰞ
• ฆᅖᅄᏄ䛴ᾐ㈕䛱䜎䜑ධ㌗ᛮฝ⾉ലྡྷ
• ἖⒢ᚃ䟺ᢘฆᅖ⒢Ἢ䟻䛭䛈䜑⑍ౚ䛒ኣ䛕䚮
ᵾᮇ䛴䜎䛌䛰᪺䜏䛑䛰⾉ᰞ䛒ぜ䜏䜒䜑䛴
䛵⌃䛝䛊䚯
ះᛮ⭀୘ධ䟺⑋᭿䟻
⑋᭿
➠1᭿
➠2᭿
➠3᭿
ះᛮ⭀୘ධ䛴ཋᅄ䟺㏩ᯊᝀ⩽⣑25୒ெ䟻
➠4᭿
Seldin䜏䛴ฦ㢦
Dimished
renal reserve
Renal
insufficiency
Renal failure
Uremia
⣊⌣మ℈㐛ೋ
(GFR)
50ml/ฦ௧୕
30-50ml/ฦ
10-30ml/ฦ
10ml/ฦ௧ୖ
⾉ΰ䜳䝰䜦䝅䝏䝷
ḿᖏ⠂ᅑ
2.0mg/dl௧ୖ
2.0-8.0mg/dl
8.0mg/dl௧୕
⮣ᗃ⑍≟
↋⑍≟
㈃⾉䚮እ㛣
ᑺ䚮㧏✽⣪⾉
⑍
್ᛨវ䚮⬲ງវ䚮 ᑺẐ⑍⑍≟䚮
㈃⾉䚮㧏✽⣪⾉
㧏⾉ᅸ䚮⫭Ề
⑍䟾ኣᑺ䚮㧏P⾉
⭐
⑍䚮఩Ca⾉⑍䚮㧏
⾉ᅸ
• 䟺2000ᖳ㏩ᯊᑙථᝀ⩽䟻
• 䟺2000ᖳᮆ㏩ᯊᝀ⩽䟻
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
1.⢶ᑺ⑋
2.ះᛮ⣊⌣మ⭀ⅎ
3.⭀◫໩⑍
4.ᄙ⬂⭀
5.᛬㏷㐅⾔ᛮ⭀ⅎ
6.ះᛮ⭀⓺⭀ⅎ
7.SLE
8.ᝇᛮ㧏⾉ᅸ
9.䜦䝣䝱䜨䝍⭀
10.㦭㧂⭐
1.ះᛮ⣊⌣మ⭀ⅎ
2.⢶ᑺ⑋
3.⭀◫໩⑍
4.ᄙ⬂⭀
5.ះᛮ⭀⓺⭀ⅎ
6. SLE
7.ዲፈ୯Ẑ⑍
8.ᝇᛮ㧏⾉ᅸ
9.᛬㏷㐅⾔ᛮ⭀ⅎ
10.⑚㢴⭀
3
⭀ᄙ⬂ᛮ⑄ᝀ
⑋⌦ᡜぜ
• ᠺெᆵኣᄙ⬂ᛮ⭀⑍䠌ᖏ᯹Ⰵమඁᛮ㐿ఎ䚯
⭀䚮⫚䚮⬹䚮⭽䛰䛯䛱ኣⓆᛮᄙ⬂䚯⬳ິ⬞⒏
ྙె䚯
• ⣊⌣మ◫໩⑍䠌
䚭䚭䚭⤎⟿ᛮ⑋ን
䚭䚭䚭ᾈฝᛮ⑋ን䠌fibrin cap, capsular drop
• ஘ඡᆵኣᄙ⬂ᛮ⭀⑍䠌ᖏ᯹Ⰵమ຋ᛮ㐿ఎ䚯
⭀䛱㧂ᨲ⥲䛱Ἒ䛩䛥ᑺ⣵⟮䛴ᣉᘿ䚯⫚⥲⥌
໩䜘ྙె䚯⏍ᚃ䚮㛣䜈䛰䛕Ṓஷ䚯
䚭䚭䚭℣₌ᛮ⑋ን
• ⣵ິ⬞◫໩⑍
• ⭀⓺⭀ⅎ䊲㔔⠔໩䛝஘㢄ቪṒ
⢓≟◫໩⑍
• ᙆᛮິ⬞䟺ኬິ⬞䚮㢍ິ⬞䚮⭘㦭ິ⬞䟻䜊
ኬ୯ᆵ➵ᛮິ⬞䟺෗≟ິ⬞䚮⭰❈ິ⬞䟻䜘
㝸ᐐ䚯
• ᚨ➵ᱶራ䚮⬳⾉⟮㝸ᐐ䚮ິ⬞⒏䜘⤾Ⓠ䚯
• හ⭯⫟ཉ䚮⬙㈻⵫✒䊲⢓≟ᩤatheroma
ᙟᠺ䟺ኬິ⬞䛭䛵ୖ㒂䛱ኣ䛊䚯ฦᯖ䜘⏍䛞
䜑㒂ฦ䛱ኣ䛊䚯
㛏᭿㏩ᯊ䛴ྙె⑍
• ⭀ᛮ㦭⑍䟺⭀ᛮ㦭␏ᰜ㣬⑍䟻䠌஦ḗᛮ๧⏝≟⭚
ᶭ⬗ஸ㐅⑍䛱䜎䜑
• ␏ᡜᛮ▴⅂໩
• ⭀ᛮ㈃⾉䠌erythropoietin఩ୖ䚮
• ㏩ᯊ䜦䝣䝱䜨䝍䞀䜻䜽䠌β2-microglobulin䛒୹మ
• ᚨ୘ධ䚮㏩ᯊᚨ
• ᚃኮᛮኣᄙ⬂⭀ACDK(acquired cystic
disease of the kidney)䛮㏩ᯊ⭀⒬
• ⓮⭭ᥑ⑓⑍
• ඞ␷⬗఩ୖ
㏩ᯊ⭀⒬
䇻
䇻
䇻
䇻
䇻
㏩ᯊᝀ⩽䠌㻃ᮇ㑝㻃㻕㻘୒ெ
⭀⒬Ⓠ⏍䠌ୌ⯙ౚ䛴㻃㻔㻓䡐㻕㻓㼛䛴䝮䜽䜳
⏠䠌ዥ䠏㻗䡐㻚䠌㻔䟺⏠䛱ኣ䛊䟻
ᖲᆍᖳ㱃䠌㻃㻘㻗䇩㻘㻘ṋ㻃䟺ୌ⯙ౚ䜎䜐⣑㻘ṋⱕ䛊䟻
㏩ᯊ⭀⒬䛴㻛㻓䟸䛒㻤㻦㻧㻮䛱ྙె㻃䊲㻃ᄙ⬂䚮୕⓮
㐛ᙟᠺ䚮⭚⭐䛴ྙె䛒ኣ
䇻 ㏩ᯊ᭿㛣㻔㻓ᖳ௧୕䛵䚮ᮅ‫‮‬䛴㻗ಶ䛴䝮䜽䜳
4