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ID:22050457
大小:11.38 MB
页数:65页
时间:2018-10-26
《【持续性肾脏替代治疗crrt英文精品课件】 arf》由会员上传分享,免费在线阅读,更多相关内容在教育资源-天天文库。
1、AcuteRenalFailureRapidlossofglomerularfiltrationandtubularfunctionleadingtoabnormalwater,electrolyteandsolutebalanceOccursoverhourstodaysUsuallyassociatedwitholiguria.Somepatientsdevelopnon-oliguricARFeg.AfterradiocontrastmediaAcute-onchronicrenalfailureAetiologyofARFPre-renalRen
2、alGlomerularTubulointerstitialVascularPost-renalAetiologyofARFGlomerularRPGNTubulointerstitialAcutetubularnecrosisAcutetubulointerstitialnephritisInfectionCastnephropathyVascularThromboticmicroangiopathyCholesterolemboliVasculitisAcutetubularnecrosisProlongedhypoperfusionDrugs–NS
3、AIDs,ACEinhibitorsDirecttoxicityDrugs–eg.Aminoglycosides,cisplatinRadiocontrastagentsHaempigmentsSnakevenomHeavymetals–lead,mercuryAssociatedwithnephroticsyndromeARFinICUARFiscommonintheICUARFisanindependentfactorforprognosisintheICUTheincidenceofARFintheICU40–60%comparedto1-3%in
4、thewardARFstillhasamortalityof50%sinceitoccursinverysickpatientswithmultiorganfailureARFinICUPredisposingfactorstoARFincludeoldagesepsispreexistingrenaldiseaseheartdiseaseandchronicliverdiseaseMechanicalventilationhasanadverseeffectonrenalbloodflowandGFRandsubsequentrenalfunction
5、ModeratedeclineinrenalfunctioncanaffecttheoutcomeEvenariseofcreatinineof.5mg/dlcanaffecttheoutcomeAcutetubularnecrosisTubulardilatationLossofbrushborderEpithelialcellvacuolationDetachmentofepithelialcellsGranularcastsHyperchromasiaoftubularnucleiMitosesCalcificationInterstitialoe
6、demaInterstitialinflammationNucleatedrbcsinvasarectaARFPATHOGENSISLossofintactornecrotictubularcellsOcclusionoftubularcellsbydebrisThedeclineinrenalfunctionisoftenmoreprominentthantheseverityofhistologicalchangesManynephronsdraintoasinglecollectingductthereforeobstructionoffewduc
7、tscauseseverrenaldysfunctionARFPATHOGENSISTheischemicdamageismostseverintheearlyproximaltubulesandthickascendinglobeMedullaryhypoxiaplaymajorroleinthesusceptibilitytoischemicdamagePooroxygenationleadtointracellularaccumulationofcalciumdepletionofATPandapoptosisleadingtocelldeatho
8、rsloughingofviablecellsARFPATHOGENESISEn
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