【正文】 ure， neonate potassium excretion↓in 10 ays→hyperkalemia tendency。 urinary system 上海交通大學醫(yī)學院附屬新華醫(yī)院 兒內科教研室 衛(wèi)敏江 urinary system Urinary system includes the kidney、 ureter、bladder and urethra . The kidney is an important excretory an , also , it is an essential adjuster and endocrine an to maintain a precise balance of internal environment . anatomical character neonate larger， inmature， small glomerulus ， short tubule infant Ureter is much longer and incurvater, tube muscles and elastic fibers are dysontogenesis . Ureter close to the bladder is straighter and shorter, it is poor to prevent urine reverse flow. female infant has a shorter urethra ,but male infant often has capistration physiologic character ◆ glomerular filtration mences in the metanephric kidney at about 9 to 12 weeks of gestation， the full plement of nephrons is present at 36 weeks of gestation . ◆ low reserve capacity ， inmature regulatory mechanism， easy to dysfunction 。 ◆ the renal function(calculated by body weight or body surface area) reaches a value parable to adult at 1 to 2 years of age. glomerular filtration rate ◆ neonate the first week of birth : glomerular filtration↓ 2 –yearold: adult level ◆ pathology extra moisture and solute can not excretion in time →edema the reabsorption and the excretory function of renal tubule ◆ glomerulotubular balance neonate has already possess glomerulotubular balance ， but inmature。 acidbase balance ◆ kidney→excret H＋ 、 reabsorb HCO3－ → acidbase balance ◆ at 2 weeks after birth the urine PH get the adult level ◆ at 2 years old the capability of ammonia excretion close to adult level ◆ renal threshold of HCO3－ in neonate is low。 Scr (mg/dl) ( K： 1歲 infant of lowbirth weight =； 1歲 mature infant = ； 2～ 12歲 = ) Cystatin C ( Cys C ) ◆ proteinuria quantitative examination 150mg/d tubular proteinuria 1g/24Hr， small molecule proteinuria ◆ nonselective proteinuria 、 selective proteinuria urine IgG/serum IgG selective proteinuria index = urine alb/serum alb index＜ selective, ＞ nonselective EXAMNATION OF THE KIDNEY DISEASE EXAMNATION OF THE KIDNEY DISEASE EVALUATION OF THE KEDNEY AND URINARY TRACT proximal renal tubule urineβ2－ MG urine trace protein series urine enzyme examination Naceto βglucosaminidase （ NAG） EXAMNATION OF THE KIDNEY DISEASE EVALUATION OF THE KEDNEY AND URINARY TRACT medullary loop and distal tubule urinometry urine osmotic pressure free water scavenger Mos test EXAMNATION OF THE KIDNEY DISEASE EVALUATION OF THE KEDNEY AND URINARY TRACT disreabsorpion intravenous pyelography （ IVP） retrograde cystopyelography nephrogram EXAMNATION OF THE KIDNEY DISEASE EVALUATION OF THE KEDNEY AND URINARY TRACT endocrine in kidney： out of kidney： target an out of kidney : degradation imaging examination vesicoureteral reflux renal puncture biopsy 負壓吸引針 負壓吸引針 TRUCORE? 活檢槍 TRUCORE? 活檢槍 glomerular diseases typing clinical typing 1. primary glomerular diseases 1).glomerulonephritis acute glomerulonephritis glomerular diseases typing clinical typing 1. primary glomerular diseases 1). glomerulonephritis rapidly progressive glomerulonephritis glomerular diseases typing clinical typing 1. primary glomerular diseases 1). glomerulonephritis persistent glomerulonephritis glomerular diseases typing clinical typing 1. primary glomerular diseases 1). glomerulonephritis chronic glomerulonephritis glomerular diseases typing clinical typing 1. primary glomerular diseases 2 ). nephrotic syndrome