肾病课件——急性肾衰竭(英文）

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1、急性肾衰竭AcuteRenalFailure（ARF）DEFINITIONSANDINCIDENCEAcuterenalfailure(ARF)isasyndromecharacterizedbyrapiddeclineinglomerularfiltrationrate(GFR)andretentionofnitrogenouswasteproductssuchasbloodureanitrogen(BUN)andcreatinine.ARFcomplicatesapproximately5%ofhospitaladmission

2、sandupto30%ofadmissionstointensivecareunits.CLASSIFICATIONPrerenalazotemiaIntrinsicrenalazotemiaPostrenalazotemiaETIOLOGYOFARFPrerenalAzotemiaIntravascularVolumeDepletionDecreasedCardiacOutputSystemicVasodilatationRenalVasoconstrictionPharmacologicAgents(ACEIorNSAIDs)E

3、TIOLOGYOFARFPostrenalAzotemiaUretericObstructionBladderNeckObstructionUrethralObstructionETIOLOGYOFARFIntrinsicRenalAzotemiaDiseasesInvolvingLargeRenalVesselsDiseasesofGlomeruliAndMicrovasculatureAcuteTubuleNecrosisDiseasesoftheTubulointerstitium急性肾小管坏死AcuteTubuleNecro

4、sis（ATN）ETIOLOGYOFATNRenalIschemia（50%）Nrphrotoxins（35%）ExogenousEndogenousPATHOPHYSIOLOGYOFATNIntrarenalVasoconstrictionTubularDysfunctionRoleofHemodynamicalterationsinATNReductioninTotalRenalBloodFlowRegionalDisturbanceinRenalBloodFlowandOxygenSupplyEdothelin(ET)/NO

5、(EDNO)OtherEndothelialVasoconstrctorsTheTubulo-glomerularFeedBackRoleofTubuleDysfunctioninATNTwoMajorTubularAbnormalities:ObstrctionBackleakMetabolicResponsesofTubulecellstoInjuryATPDepletionCellSwellingIntyacellularFreeCalcium↑IntyacellularAcidosisPhospholipaseActiv

6、ationProteaseActivationOxidantInjuryInflammatoryResposePathologyClinicalPresentationofATNTheClinicalCourseofATN：TheInitiationPhaseTheMaintenancePhaseTheRecoveryPhaseTheInitiationPhaseGFR↓LastingHoursorDaysEvidenceoftrueVolumeDepletionDecreecedEffectiveCirculatoryVolume

7、TreatmentwithNSAIDsorACEITheMaintenancePhaseGRR5~10ml/minLasting1~2WeeksOliguricARFhighcatabolismNonoliguricARFUremicSyndromeHighCatabolicStateDailyIncreaseinBUN>10.1~17.9mmol/LDailyIncreaseinSerumCreatinine>176.8μmol/LDailyIncreaseinSerumPotassium>1~2mmol/LDailyDecrea

8、seinSerumHCO3－>2mmol/LTheUremicSyndromeGeneralComplicationsofARF：GastrointestinalCardiovascularRespiratoryNeurologicH