【持续性肾脏替代治疗crrt英文精品课件】acute kidney injury(91p)

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1、AcuteKidneyInjuryN.GaneshYadlapalli,M.D.AssistantProfessorofMedicineUniversityofCincinnatiOverviewofAKIDefinitionofAKIPathophysiologyPre-renalRenal:glomerular,tubular,interstitialandvascular.Postrenal:obstruction.ClinicalfeaturesInvestigationsTreatmentPreventionAKIDefinitionSuddenrapid

2、dropinGFR,asmeasuredbyserumcreatininelevel,overhourstodays.AKI:Anabruptincreaseinserumcreatinineofatleast0.3mg/dlor1.5foldofbaselinewithin48hours.StageI:IncreaseinCreatinine1.5to2foldStageII:IncreaseinCreatinine>2.0to3foldStageIII:IncreaseinCreatinine>3.0timesorDialysisrequirement(orap

3、eakcreatinineof>4.0mg/dlwithatleasta0.5mg/dlincrease)DiagnosticCriteriaforAKIAcuteKidneyInjuryNetworkConsensusStatement,2007AKISerumCreatininePathophysiologyPathophysiologyAKI:PathophysiologyReasonsforAKIConsults(n=748)Pre-renal21%RenalATN45%ARForCRI13%GN4%AIN2%AED1%Obstruction10%Liano

4、etal.KidneyInt1996;50:811.AKI:PrerenalPrerenal“True”Volumedepletion-Bloodloss-GIorRenallossesIntravascularVolumeDepletionEffectivecirculatingvolumedepletion-Congestiveheartfailure-Cirrhosis-Nephrosis-Sepsis/vasodilatedstatesHistoryDrymucosa,skinturgorHypotensionOliguriaHistoryEdematous

5、statesBloodVolumeCardiacPumpdysfunctionVasodilationGlomerularautoregulationAKI:IntraRenalGlomerularVascularTubulesInterstitialIntraRenal-GlomerularDiseasePathology:FocalanddiffuseglomerulonephritisCresenticGNHallmark:RedbloodcellcastsHematuria,HTNIntraRenal-VascularDiseaseCommoncauses:

6、MalignantHTNVasculitisThromboembolicdiseaseIntraRenal--AcuteTubularNecrosis85%-intrinsicAKIHistologicchangesEpithelialsloughingLuminalocclusionCommoncausesIschemiaToxicRhabdomyolysis/myoglobinuriaAKI:TubulesATNa)NeprotoxicagentsDrugs:Amphotercin,aminoglycosidesMyoglobin,hemoglobin,radi

7、o-contrastb)IschemicinjuryProlongedprerenalstate,ShockArterialcrossclampingduringAAAandCABGAfferentarteriolarconstrictionsectoseverehypercalcemia.Tubularobstructiona)CrystalinducedtubularobstructionsAllopurinol,sulpha,HIVmeds,methotrexateAKI:AcuteInterstitialNephritis10%-intrinsicA