腎病——急性腎衰竭(英文）課件

1、腎病急性腎衰竭(英文） Acute Renal Failure （ARF）腎病急性腎衰竭(英文）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 admi

2、ssions and up to 30% of admissions to intensive care units.腎病急性腎衰竭(英文）l Prerenal azotemia l Intrinsic renal azotemial Postrenal azotemia 腎病急性腎衰竭(英文） Prerenal Azotemia Intravascular Volume Depletion Decreased Cardiac Output Systemic Vasodilatation Renal Vasoconstriction Pharmacologic Agents (ACEI or

3、NSAIDs)腎病急性腎衰竭(英文） Postrenal Azotemiaq Ureteric Obstructionq Bladder Neck Obstructionq Urethral Obstruction腎病急性腎衰竭(英文） Intrinsic Renal Azotemia v Diseases Involving Large Renal Vesselsv Diseases of Glomeruli And Microvasculaturev Acute Tubule Necrosisv Diseases of the Tubulointerstitium 腎病急性腎衰竭(英文）

4、Acute Tubule Necrosis （ATN）腎病急性腎衰竭(英文）l Renal Ischemia（50%）l Nrphrotoxins （35%） Exogenous Endogenous 腎病急性腎衰竭(英文）l Intrarenal Vasoconstrictionl Tubular Dysfunction腎病急性腎衰竭(英文）v Reduction in Total Renal Blood Flow Regional Disturbance in Renal Blood Flow and Oxygen Supplyv Edothelin (ET) / NO (EDNO)v O

5、ther Endothelial Vasoconstrctorsv The Tubulo-glomerular Feed Back腎病急性腎衰竭(英文） Two Major TubularAbnormalities: Obstrction Backleak腎病急性腎衰竭(英文）q ATP Depletionq Cell Swellingq Intyacellular Free Calciumq IntyacellularAcidosisq Phospholipase Activationq Protease Activationq Oxidant Injuryq Inflammatory Re

6、spose腎病急性腎衰竭(英文）腎病急性腎衰竭(英文） The Clinical Course of ATN： The Initiation Phase The Maintenance Phase The Recovery Phase腎病急性腎衰竭(英文）lGFRlLasting Hours or DayslEvidence of true Volume DepletionlDecreeced Effective Circulatory VolumelTreatment with NSAIDs or ACEI腎病急性腎衰竭(英文）lGRR 5 10 ml/minlLasting 1 2 Wee

7、kslOliguric ARF lhigh catabolismlNonoliguric ARFlUremic Syndrome腎病急性腎衰竭(英文）lDaily Increase in BUN 10.117.9 mmol/LlDaily Increase in Serum Creatinine 176.8mol/LlDaily Increase in Serum Potassium 12 mmol/LlDaily Decrease in Serum HCO 3 2 mmol/L腎病急性腎衰竭(英文） General Complications of ARF： Gastrointestinal

8、 Cardiovascular Respiratory Neurologic Hematologic Infectious腎病急性腎衰竭(英文） Homeostatic Disorder of water，Electrolyte and Acid-alkali Balance： Volume Overload Metabolic Acidosis Hyperkalemia Hyponatremia Hypocalcemia Hyperphosphatemia腎病急性腎衰竭(英文） The Period of Repair and Regeneration of Renal Tissue: Gr

9、adual Increase in Urine Output “Post-ATN” Diuresis Fall in BUN and Scr Recovery of GFR/ Tubule function腎病急性腎衰竭(英文） Blood Routine Test and Chemistry Assays: Animia, RBC , Hb BUN and Scr Na ，K,Ca2，P3+ pH ，AG ，HCO3 腎病急性腎衰竭(英文） Diagnostic Index Prerenal Renal Specific Gravity 1.020 1.010 Osmolality(mOsm

10、/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 腎病急性腎衰竭(英文）v Radiologic Evaluation: Plain Abdominal film Renal Ultrasonography IVP Renal angiographyv Renal Biopsy 腎病急性腎衰竭(英文） prerenal azotemia pos

11、trenal azotemia Glomerulonephritis/Vasculitis HUS/TTP Interstitial Nephritis Renal Artery Thrombosis Renal vein thrombosis腎病急性腎衰竭(英文）q Correction of Reversible causes q Prevention of additional Injuryq Maintaining Fluid balance腎病急性腎衰竭(英文） Maintaining Fluid balance Fluid Intake ： 500ml + The Amount of Urine in The Preceding 24 Hours腎病急性腎衰竭(英文） Nutritionq Enegy Intake:147kj/dq Dietary Protein: 0.8g/kg.dq CRRT ( fluid 5L/d)腎病急性腎衰竭(英文） Hyperkalemia K+6mmol/L 10%Calcium Gluconate 10-20ml 5% Sodium Bicarbonate 100-200ml 20% Glucose 3ml/kg.h+Insulin 0.5U