【持续性肾脏替代治疗crrt英文精品课件】 arf

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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