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%ofhospitaladmissio

2、nsandupto30%ofadmissionstointensivecareunits.CLASSIFICATIONPrerenalazotemiaIntrinsicrenalazotemiaPostrenalazotemiaETIOLOGYOFARFPrerenalAzotemiaIntravascularVolumeDepletionDecreasedCardiacOutputSystemicVasodilatationRenalVasoconstrictionPharmacologicAgents(ACEIorNSAIDs

3、)ETIOLOGYOFARFPostrenalAzotemiaUretericObstructionBladderNeckObstructionUrethralObstructionETIOLOGYOFARFIntrinsicRenalAzotemiaDiseasesInvolvingLargeRenalVesselsDiseasesofGlomeruliAndMicrovasculatureAcuteTubuleNecrosisDiseasesoftheTubulointerstitium急性肾小管坏死AcuteTubuleNe

4、crosis（ATN）ETIOLOGYOFATNRenalIschemia（50%）Nrphrotoxins（35%）ExogenousEndogenousPATHOPHYSIOLOGYOFATNIntrarenalVasoconstrictionTubularDysfunctionRoleofHemodynamicalterationsinATNReductioninTotalRenalBloodFlowRegionalDisturbanceinRenalBloodFlowandOxygenSupplyEdothelin(ET

5、)/NO(EDNO)OtherEndothelialVasoconstrctorsTheTubulo-glomerularFeedBackRoleofTubuleDysfunctioninATNTwoMajorTubularAbnormalities:ObstrctionBackleakMetabolicResponsesofTubulecellstoInjuryATPDepletionCellSwellingIntyacellularFreeCalcium↑IntyacellularAcidosisPhospholipase

6、ActivationProteaseActivationOxidantInjuryInflammatoryResposePathologyClinicalPresentationofATNTheClinicalCourseofATN：TheInitiationPhaseTheMaintenancePhaseTheRecoveryPhaseTheInitiationPhaseGFR↓LastingHoursorDaysEvidenceoftrueVolumeDepletionDecreecedEffectiveCirculatory

7、VolumeTreatmentwithNSAIDsorACEITheMaintenancePhaseGRR5~10ml/minLasting1~2WeeksOliguricARFhighcatabolismNonoliguricARFUremicSyndromeHighCatabolicStateDailyIncreaseinBUN>10.1~17.9mmol/LDailyIncreaseinSerumCreatinine>176.8μmol/LDailyIncreaseinSerumPotassium>1~2mmol/LDail

8、yDecreaseinSerumHCO3－>2mmol/LTheUremicSyndromeGeneralComplicationsofARF：GastrointestinalCardiovascularRespiratoryNeurologicH