腎病——急性腎衰竭(英文）

1、整理課件 Acute Renal Failure （ARF）整理課件qAcute renal failure (ARF) is a syndrome characterized by rapid decline in glomerular filtration rate(GFR) and retention of nitrogenous waste products such as blood urea nitrogen (BUN) and creatinine. q ARF complicates approximately 5% of hospital admissions and up

2、to 30% of admissions to intensive care units.整理課件l Prerenal azotemia l Intrinsic renal azotemial Postrenal azotemia 整理課件 Prerenal Azotemia Intravascular Volume Depletion Decreased Cardiac Output Systemic Vasodilatation Renal Vasoconstriction Pharmacologic Agents (ACEI or NSAIDs)整理課件 Postrenal Azotem

3、iaq Ureteric Obstructionq Bladder Neck Obstructionq Urethral Obstruction整理課件 Intrinsic Renal Azotemia v Diseases Involving Large Renal Vesselsv Diseases of Glomeruli And Microvasculaturev Acute Tubule Necrosisv Diseases of the Tubulointerstitium 整理課件 Acute Tubule Necrosis （ATN）整理課件l Renal Ischemia（5

4、0%）l Nrphrotoxins （35%） Exogenous Endogenous 整理課件l Intrarenal Vasoconstrictionl Tubular Dysfunction整理課件v Reduction in Total Renal Blood Flow Regional Disturbance in Renal Blood Flow and Oxygen Supplyv Edothelin (ET) / NO (EDNO)v Other Endothelial Vasoconstrctorsv The Tubulo-glomerular Feed Back整理課件

5、Two Major TubularAbnormalities: Obstrction Backleak整理課件q ATP Depletionq Cell Swellingq Intyacellular Free Calciumq IntyacellularAcidosisq Phospholipase Activationq Protease Activationq Oxidant Injuryq Inflammatory Respose整理課件整理課件 The Clinical Course of ATN： The Initiation Phase The Maintenance Phase

6、 The Recovery Phase整理課件lGFRlLasting Hours or DayslEvidence of true Volume DepletionlDecreeced Effective Circulatory VolumelTreatment with NSAIDs or ACEI整理課件lGRR 5 10 ml/minlLasting 1 2 WeekslOliguric ARF lhigh catabolismlNonoliguric ARFlUremic Syndrome整理課件lDaily Increase in BUN 10.117.9 mmol/LlDaily

7、 Increase in Serum Potassium 12 mmol/LlDaily Decrease in Serum HCO 3 2 mmol/L整理課件 General Complications of ARF： Gastrointestinal Cardiovascular Respiratory Neurologic Hematologic Infectious整理課件 Homeostatic Disorder of water，Electrolyte and Acid-alkali Balance： Volume Overload Metabolic Acidosis Hype

8、rkalemia Hyponatremia Hypocalcemia Hyperphosphatemia整理課件 The Period of Repair and Regeneration of Renal Tissue: Gradual Increase in Urine Output “Post-ATN” Diuresis Fall in BUN and Scr Recovery of GFR/ Tubule function整理課件 Blood Routine Test and Chemistry Assays: Animia, RBC , Hb BUN and Scr Na ，K,Ca

9、2，P3+ pH ，AG ，HCO3 整理課件 Diagnostic Index Prerenal Renal Osmolality(mOsm/Kg H2O) 500 300 Urinary Na+ (mmol/L) 20 Ucr/Scr 40 8 20 10-15 Renal Failure Index 1 Fractional Excretion of Na+ 1 Urine Sediment Hyaline Brown ranular 整理課件v Radiologic Evaluation: Plain Abdominal film Renal Ultrasonography IVP R

10、enal angiographyv Renal Biopsy 整理課件 prerenal azotemia postrenal azotemia Glomerulonephritis/Vasculitis HUS/TTP Interstitial Nephritis Renal Artery Thrombosis Renal vein thrombosis整理課件q Correction of Reversible causes q Prevention of additional Injuryq Maintaining Fluid balance整理課件 Maintaining Fluid balance Fluid Intake ： 500ml + The Amount of Urine in The Preceding 24 Hours整理課件 Nutritionq Enegy Intake:147kj/dq CRRT ( fluid 5L/d)整理課件 Hyperkalemia K+6mmol/L 10%Calcium Gluconate 10-20ml 5% Sodium Bicarbonate