腎病——急性腎衰竭英文

1、急性腎衰竭,Acute Renal Failure （ARF）,DEFINITIONS AND INCIDENCE,Acute renal failure (ARF) is a syndrome characterized by rapid decline in glomerular filtration rate(GFR) and retention of nitrogenous wa

2、ste products such as blood urea nitrogen (BUN) and creatinine. ARF complicates approximately 5% of hospital admissions and up to 30% of admissions to intensive care units.,,CLASSIFICATION,Prerenal azot

3、emia Intrinsic renal azotemia Postrenal azotemia,,ETIOLOGY OF ARF,Prerenal Azotemia,Intravascular Volume Depletion Decreased Cardiac Output Systemic Vasodilatation Renal Vasoconstriction Pharmacologic Agent

4、s (ACEI or NSAIDs),ETIOLOGY OF ARF,Postrenal Azotemia Ureteric Obstruction Bladder Neck Obstruction Urethral Obstruction,ETIOLOGY OF ARF,Intrinsic Renal Azotemia Diseases Involving Large Renal Vessels Dise

5、ases of Glomeruli And Microvasculature Acute Tubule Necrosis Diseases of the Tubulointerstitium,急性腎小管壞死,Acute Tubule Necrosis （ATN）,ETIOLOGY OF ATN,Renal Ischemia（50%） Nrphrotoxins （35%）

6、 Exogenous Endogenous,PATHOPHYSIOLOGY OF ATN,Intrarenal Vasoconstriction Tubular Dysfunction,Role of Hemodynamic alterations in ATN,Reduction in Total Renal Blood Flow Regional Disturbance in

7、 Renal Blood Flow and Oxygen Supply Edothelin (ET) / NO (EDNO) Other Endothelial Vasoconstrctors The Tubulo-glomerular Feed Back,,Role of Tubule Dysfunction in ATN,Two Major TubularAbnormalities:

8、 Obstrction Backleak,Metabolic Responses of Tubule cells to Injury,ATP Depletion Cell Swelling Intyacellular Free Calcium↑ Intyacellular　Acidosis Phospholipase Activation

9、 Protease Activation Oxidant Injury Inflammatory Respose,Pathology,,Clinical Presentation of ATN,The Clinical Course of ATN： The Initiation Phase The Maintenance Phase

10、 The Recovery Phase,The Initiation Phase,GFR↓Lasting Hours or DaysEvidence of true Volume DepletionDecreeced Effective Circulatory VolumeTreatment with NSAIDs or ACEI,The Maintenance Phase,GRR 5 ~ 10 ml/minLast

11、ing 1 ~ 2 WeeksOliguric ARF high catabolismNonoliguric ARFUremic Syndrome,High Catabolic State,Daily Increase in BUN >10.1~17.9 mmol/LDaily Increase in Serum Creatinine >176.8μmol/LDaily Increase in Serum Pot

12、assium >1~2 mmol/LDaily Decrease in Serum HCO 3 －>2 mmol/L,The Uremic Syndrome,General Complications of ARF： Gastrointestinal Cardiovascular Respiratory

13、 Neurologic Hematologic Infectious,The Uremic Syndrome,Homeostatic Disorder of water，Electrolyte and Acid-alkali Balance： Volume Overload Metaboli

14、c Acidosis Hyperkalemia Hyponatremia Hypocalcemia Hyperphosphatemia,The Recovery Phase,The Period of Repair and Regeneration of Renal Tissue: Gradual In

15、crease in Urine Output “Post-ATN” Diuresis Fall in BUN and Scr Recovery of GFR/ Tubule function,Lab Examination,Blood Routine Test and Chemistry Assays: Animia, RBC ↓, Hb ↓

16、 BUN and Scr↑ Na ＋ ↓ ，K＋↑,Ca2＋↓，P3+ ↑ pH ↓，AG ↑，HCO3－ ↓,Lab Examination,Diagnostic Index Prerenal Renal Specific Gravity > 1.020 ~ 1.010 Osm

17、olality(mOsm/Kg H2O) > 500 ~ 300 Urinary Na+ (mmol/L) 20 Ucr/Scr > 40 8 20 1 Fraction

18、al Excretion of Na+ 1 Urine Sediment Hyaline Brown ranular,,,,Lab Examination,Radiologic Evaluation: Plain Abdominal film Renal Ultrasonography

19、 IVP Renal angiography Renal Biopsy,Diagnosis Differentiation：,prerenal azotemia postrenal azotemia Glomerulonephritis/Vasculitis HUS/T

20、TP Interstitial Nephritis Renal Artery Thrombosis Renal vein thrombosis,Management of ARF (一),Correction of Reversible causes Prevention of additional

21、 Injury Maintaining Fluid balance,Management of ARF (二),Maintaining Fluid balance Fluid Intake ： 500ml + The Amount of Urine in The Preceding 24 Hours,Management of ARF (三）,Nutrition E

22、negy Intake:147kj/d Dietary Protein: 0.8g/kg.d CRRT ( fluid > 5L/d),Management of ARF (四）,Hyperkalemia K+6mmol/L 10%Calcium Gluconate 10-20ml 5% Sodium Bicarbonate 100-200ml 20% Gluco

23、se 3ml/kg.h+Insulin 0.5U/kg.h Dialysis,Management of ARF (五）,Metabolic Acidosis HCO3－< 15mmol/L : 5% Sodium Bicarbonate 100-250ml Dialysis,Management of ARF,Other Electrolyte Disorder In