肾病——急性肾衰竭(英文）课件

1、肾病急性肾衰竭(英文） Acute Renal Failure （ARF）肾病急性肾衰竭(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.肾病急性肾衰竭(英文）l Prerenal azotemia l Intrinsic renal azotemial Postrenal azotemia 肾病急性肾衰竭(英文） Prerenal Azotemia Intravascular Volume Depletion Decreased Cardiac Output Systemic Vasodilatation Renal Vasoconstriction Pharmacologic Agents (ACEI or

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

4、Acute Tubule Necrosis （ATN）肾病急性肾衰竭(英文）l Renal Ischemia（50%）l Nrphrotoxins （35%） Exogenous Endogenous 肾病急性肾衰竭(英文）l Intrarenal Vasoconstrictionl Tubular Dysfunction肾病急性肾衰竭(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肾病急性肾衰竭(英文） Two Major TubularAbnormalities: Obstrction Backleak肾病急性肾衰竭(英文）q ATP Depletionq Cell Swellingq Intyacellular Free Calciumq IntyacellularAcidosisq Phospholipase Activationq Protease Activationq Oxidant Injuryq Inflammatory Re

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

7、kslOliguric ARF lhigh catabolismlNonoliguric ARFlUremic Syndrome肾病急性肾衰竭(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肾病急性肾衰竭(英文） General Complications of ARF： Gastrointestinal

8、 Cardiovascular Respiratory Neurologic Hematologic Infectious肾病急性肾衰竭(英文） Homeostatic Disorder of water，Electrolyte and Acid-alkali Balance： Volume Overload Metabolic Acidosis Hyperkalemia Hyponatremia Hypocalcemia Hyperphosphatemia肾病急性肾衰竭(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肾病急性肾衰竭(英文） Blood Routine Test and Chemistry Assays: Animia, RBC , Hb BUN and Scr Na ，K,Ca2，P3+ pH ，AG ，HCO3 肾病急性肾衰竭(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 肾病急性肾衰竭(英文）v Radiologic Evaluation: Plain Abdominal film Renal Ultrasonography IVP Renal angiographyv Renal Biopsy 肾病急性肾衰竭(英文） prerenal azotemia pos

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