acute renal failure课件

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1、ACUTERENALFAILUREShahzadQureshiM.D.DivisionofNephrologyLoyolaUniversityMedicalCenterObjectivesDefineandreviewclassificationofARFEpidemiologyofARFMeasurementofkidneyfunctionPathophysiologyofARFManagementandtreatmentofARFReviewclinicalcasesWhatisARF?A)Increas

2、einserumCreatinine0.5mg/dL.B)AnincreaseinserumCreatinineofmorethen50%frombaseline.C)AreductioninthecalculatedCreatinineClearanceof50%RIFLEClassification2004ADQIgroupclassificationRisk(R)-IncreaseCrx1.5orDecreaseGFRx25%orUO<0.5ml/kg/hrx6hrsInjury(I)-Increase

3、Crx2.0orDecreaseGFRx50%orUO<0.5ml/kg/hrx12hrsFailure(F)-IncreaseCrx3.0orDecreaseGFRx75%oranuriax12hoursLoss(L)-PersistentARF,completelossofkidneyfunctionx4weeks(needingRRT)EndStageKidneyDisease(E)-Lossofkidneyfunctionx3monthsMeasurementofKidneyFunctionSerum

4、CreatinineSerumcreatinineisareflectionofcreatinineclearanceCreatinineproductionisdeterminedbymusclemassandmustbeinterpretedwithrespecttopt’sage,weightandsex.CreatinineisfilteredandsecretedandtendstooverestimateGFR.Certaindiseasesandmedicationsinterferewithc

5、orrelationbetweenserumCrandGFR.(i.e..Acuteglomerulonephritis,trimethoprim,cimetidine)SerumCreatinine(cont.)Cockcroft-GaultequationCrCx=(140-agey)(weightkg)(0.85iffemale)/(72Xserumcreatininemol/L)MDRD(ModifiedDietandRenalDisease)GFR,inmL/minper1.73mm2=  186.

6、3X((serumcreatinine)exp[-1.154])X(Ageexp[-0.203])X(0.742iffemale)X(1.21ifAfricanAmerican)SerumCreatinine(cont.)NoneoftheequationsaccuratelydetermineGFRinARF.(AssumeCrisstable)MoreaccuratetechniquesinvolvenuclearmedicinestudiesandGFRscans.Newbiochemicalmarke

7、rsinvestigated(i.e..CystatinC)Epidemiology5%ofhospitalizedpatientsdev.ARF.0.5%ofthesepatientsrequiredialysis.20%ofcriticalcareadmissionsdev.ARF.HospitalacquiredARFusuallydevelopsinthesettingofICUsecondarytomultisystemorganfailure.CausesofARFinHospitalizedPa

8、tients45%ATNIschemia,Nephrotoxins21%PrerenalCHF,volumedepletion,sepsis10%Urinaryobstruction4%Glomerulonephritisorvasculitis2%AIN1%AtheroemboliMortality/MorbidityMortalityratesrangefrom7-80%dependingonp