急性腎衰竭

AcuteRenalFailure

（ARF）2021/7/91DEFINITIONSANDINCIDENCEAcuterenalfailure(ARF)isasyndromecharacterizedbyrapiddeclineinglomerularfiltrationrate(GFR)andretentionofnitrogenouswasteproductssuchasbloodureanitrogen(BUN)andcreatinine.ARFcomplicatesapproximately5%ofhospitaladmissionsandupto30%ofadmissionstointensivecareunits.2021/7/92CLASSIFICATION

PrerenalazotemiaIntrinsicrenalazotemiaPostrenalazotemia2021/7/93ETIOLOGYOFARF

PrerenalAzotemia

IntravascularVolumeDepletion

DecreasedCardiacOutput

SystemicVasodilatationRenalVasoconstriction

PharmacologicAgents(ACEIorNSAIDs)2021/7/94ETIOLOGYOFARF

PostrenalAzotemia

UretericObstructionBladderNeckObstructionUrethralObstruction2021/7/95ETIOLOGYOFARF

IntrinsicRenalAzotemia

DiseasesInvolvingLargeRenalVesselsDiseasesofGlomeruliAndMicrovasculatureAcuteTubuleNecrosisDiseasesoftheTubulointerstitium第一課件網(wǎng)網(wǎng)站

2021/7/96急性腎小管壞死

AcuteTubuleNecrosis

（ATN）2021/7/97ETIOLOGYOFATNRenalIschemia（50%）

Nrphrotoxins（35%）

ExogenousEndogenous

2021/7/98PATHOPHYSIOLOGYOFATN

IntrarenalVasoconstrictionTubularDysfunction2021/7/99RoleofHemodynamicalterations

inATNReductioninTotalRenalBloodFlowRegionalDisturbanceinRenalBloodFlowandOxygenSupplyEdothelin(ET)/NO(EDNO)OtherEndothelialVasoconstrctorsTheTubulo-glomerularFeedBack2021/7/9109、人的價值，在招收誘惑的一瞬間被決定。2023/2/32023/2/3Friday,February3,202310、低頭要有勇氣，抬頭要有低氣。2023/2/32023/2/32023/2/32/3/20234:35:30PM11、人總是珍惜為得到。2023/2/32023/2/32023/2/3Feb-2303-Feb-2312、人亂于心，不寬余請。2023/2/32023/2/32023/2/3Friday,February3,202313、生氣是拿別人做錯的事來懲罰自己。2023/2/32023/2/32023/2/32023/2/32/3/202314、抱最大的希望，作最大的努力。03二月20232023/2/32023/2/32023/2/315、一個人炫耀什么，說明他內(nèi)心缺少什么。。二月232023/2/32023/2/32023/2/32/3/202316、業(yè)余生活要有意義，不要越軌。2023/2/32023/2/303February202317、一個人即使已登上頂峰，也仍要自強不息。2023/2/32023/2/32023/2/32023/2/32021/7/911RoleofTubuleDysfunction

inATN

TwoMajorTubularAbnormalities:

ObstrctionBackleak2021/7/912MetabolicResponsesof

TubulecellstoInjuryATPDepletionCellSwellingIntyacellularFreeCalcium↑Intyacellular

AcidosisPhospholipaseActivationProteaseActivationOxidantInjuryInflammatoryRespose2021/7/913Pathology2021/7/914ClinicalPresentationofATN

TheClinicalCourseofATN：

TheInitiationPhaseTheMaintenancePhaseTheRecoveryPhase2021/7/915TheInitiationPhaseGFR↓LastingHoursorDaysEvidenceoftrueVolumeDepletionDecreecedEffectiveCirculatoryVolumeTreatmentwithNSAIDsorACEI2021/7/916TheMaintenancePhaseGRR5~10ml/minLasting1~2WeeksOliguricARFhighcatabolismNonoliguricARFUremicSyndrome第一課件網(wǎng)網(wǎng)站

2021/7/917HighCatabolicStateDailyIncreaseinBUN>10.1~17.9mmol/LDailyIncreaseinSerumCreatinine>176.8μmol/LDailyIncreaseinSerumPotassium>1~2mmol/LDailyDecreaseinSerumHCO3－>2mmol/L2021/7/918TheUremicSyndrome

GeneralComplicationsofARF：

GastrointestinalCardiovascularRespiratoryNeurologicHematologicInfectious2021/7/919TheUremicSyndrome

HomeostaticDisorderofwater，ElectrolyteandAcid-alkaliBalance：

VolumeOverloadMetabolicAcidosisHyperkalemiaHyponatremiaHypocalcemiaHyperphosphatemia2021/7/920TheRecoveryPhase

ThePeriodofRepairandRegenerationofRenalTissue:GradualIncreaseinUrineOutput“Post-ATN”DiuresisFallinBUNandScrRecoveryofGFR/Tubulefunction2021/7/921LabExamination

BloodRoutineTestandChemistryAssays:

Animia,RBC↓,Hb↓BUNandScr↑Na

＋↓

，K＋↑,Ca2＋↓，P3+↑pH↓，AG↑，HCO3－↓2021/7/922LabExamination

DiagnosticIndex

Prerenal

RenalSpecificGravity>1.020~1.010Osmolality(mOsm/KgH2O)>500~300UrinaryNa+(mmol/L)<10>20Ucr/Scr>40<20UUN/BUN>8<3BUN/Scr>20<10-15RenalFailureIndex<1>1FractionalExcretionofNa+<1>1UrineSedimentHyalineBrownranular

2021/7/923LabExamination

RadiologicEvaluation:

PlainAbdominalfilmRenalUltrasonographyIVPRenalangiography

RenalBiopsy2021/7/924DiagnosisDifferentiation：prerenalazotemiapostrenalazotemiaGlomerulonephritis/VasculitisHUS/TTPInterstitialNephritisRenalArteryThrombosisRenalveinthrombosis第一課件網(wǎng)網(wǎng)站

2021/7/925ManagementofARF(一)

CorrectionofReversiblecausesPreventionofadditionalInjuryMaintainingFluidbalance2021/7/926ManagementofARF(二)

MaintainingFluidbalance

FluidIntake：

500ml+TheAmountofUrineinThePreceding24Hours2021/7/927ManagementofARF(三）

Nutrition

EnegyIntake:147kj/dDietaryProtein:0.8g/kg.dCRRT(fluid>5L/d)2021/7/928ManagementofARF(四）

Hyperkalemia

K+<6mmol/LRestrictionofDietaryPotassiumIntakeK+-BindingIonExchangeResins

K+>6mmol/L

10%CalciumGluconate10-20ml5%SodiumBicarbonate100-200ml20%Glucose3ml/kg.h+Insulin0.5U/kg.hDialysis2021/7/929ManagementofARF(五）

MetabolicAcidosis

HCO3－<15mmol/L:5%SodiumBicarbonate100-250mlDialysis2021/7/930ManagementofARFOtherElectrolyteDisorderInfectionHartfailureDialysis2021/7/9319、人的價值，在招收誘惑的一瞬間被決定。03-2月-2303-2月-23Friday,February3,202310、低頭要有勇氣，抬頭要有低氣。***2/3/20234:35:30PM11、人總是珍惜為得到。03-2月-23**Feb-2303-Feb-2312、人亂于心，不寬余請。***Friday,February3,202313、生氣是拿別人做錯的事來懲罰自己。03-2月-2303-2月-23**03Feb