急性肾衰竭专题知识讲座.ppt

,单击此处编辑母版标题样式,*,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,急性肾衰竭专题知识讲座,DEFINITIONS AND INCIDENCE,Acute 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.,ARF complicates approximately 5%of hospital admissions and up to 30%of admissions to,intensive care units.,CLASSIFICATION,Prerenal azotemia,Intrinsic renal azotemia,Postrenal azotemia,ETIOLOGY OF ARF,Prerenal Azotemia,Intravascular Volume Depletion,Decreased Cardiac Output,Systemic Vasodilatation,Renal Vasoconstriction,Pharmacologic Agents,(,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,Diseases of Glomeruli And Microvasculature,Acute Tubule Necrosis,Diseases of the Tubulointerstitium,急性,肾小管坏死,Acute Tubule Necrosis,（ATN）,ETIOLOGY OF ATN,Renal Ischemia（50%）,Nrphrotoxins （35%）,Exogenous,Endogenous,PATHOPHYSIOLOGY OF ATN,Intrarenal Vasoconstriction,Tubular Dysfunction,Role of Hemodynamic alterations in ATN,Reduction in Total Renal Blood,Flow Regional Disturbance in,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:,Obstrction,Backleak,Metabolic Responses of Tubule cells to Injury,ATP Depletion,Cell Swelling,Intyacellular Free Calcium,IntyacellularAcidosis,Phospholipase Activation,Protease Activation,Oxidant Injury,Inflammatory Respose,Pathology,Clinical Presentation of ATN,The Clinical Course of ATN：,The Initiation Phase,The Maintenance Phase,The Recovery Phase,The Initiation Phase,GFR,Lasting Hours or Days,Evidence of true Volume Depletion,Decreeced Effective Circulatory Volume,Treatment with NSAIDs or ACEI,The Maintenance Phase,GRR 5 10 ml/min,Lasting 1 2 Weeks,Oliguric ARF,high catabolism,Nonoliguric ARF,Uremic Syndrome,High Catabolic State,Daily Increase in BUN 10.117.9 mmol/L,Daily Increase in Serum Creatinine 176.8mol/L,Daily Increase in Serum Potassium 12 mmol/L,Daily Decrease in Serum HCO,3,2 mmol/L,The Uremic Syndrome,General Complications of ARF：,Gastrointestinal,Cardiovascular,Respiratory,Neurologic,Hematologic,Infectious,The Uremic Syndrome,Homeostatic Disorder of water，Electrolyte and Acid-alkali Balance：,Volume Overload,Metabolic Acidosis,Hyperkalemia,Hyponatremia,Hypocalcemia,Hyperphosphatemia,The Recovery Phase,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,Lab Examination,Blood Routine Test and Chemistry Assays:,Animia,RBC,Hb,BUN and Scr,Na,，K,Ca,2,，P,3+,pH，AG，HCO,3,Lab Examination,Diagnostic Index,Prerenal,Renal,Specific Gravity 1.020 1.010,Osmolality(mOsm/Kg H,2,O)500 300,Urinary Na,+,(mmol/L)20,Ucr/Scr 40 8 20 5L/d),Management of ARF(四）,Hyperkalemia,K,+,6mmol/L,10%Calcium Gluconate 10-20ml,5%Sodium Bicarbonate 100-200ml,20%Glucose 3ml/kg.h+Insulin 0.5U/kg.h,Dialysis,Management of ARF(五）,Metabolic Acidosis,HCO,3,15mmol/L:,5%,Sodium Bicarbonate 100-250ml,Dialysis,Management of ARF,Other Electrolyte Disorder,Infection,Hart failure,Dialysis,