顾勇－急性肾衰

nullAcute Renal FailureAcute Renal Failure2005-3-10 Huashan Hospital,Fudan UniversityDefinitionsDefinitionsRapid decline in GFRClassificationClassificationPrerenal ARF Intrinsic renal ARF Postrenal ARFPrerenal ARFPrerenal ARFIntravascular volume deletion Decreased cardiac output Systemic vasodilatation Renal vasoconstriction Pharmacologic agents Intrinsic ARFIntrinsic ARFDiseases involving large renal vessels Diseases involving renal microvasculature Diseases of glomeruli Diseases characterized by injury to renal tubules Diseases of the tubulointerstitiumPostrenal ARFPostrenal ARFUreteric obstruction Bladder neck obstruction Urethral obstructionAcute Tubule NecrosisAcute Tubule NecrosisEtiology Pathology Pathophysiology Clinical features Differentiation ManagementEtiologyEtiologyIschemia Exogenous toxins Endogenous toxinsPathologyPathologyFocal loss of tubular epithelium cells Exposure of basement membrane Loss of proximal tubular brush border Necrosis in the outer medullaPathophysiologyPathophysiologyHemodynamic abnormalities Tubule obstruction Back-leakageClinical FeaturesClinical FeaturesOliguric phase Polyuric phase Recovery phaseOliguric PhaseOliguric PhaseOliguria progressively increased BUN and SCr Disorders of fluid and electrolyte Hemodynamic disorders ARDS MODS Infection Polyuric PhasePolyuric PhasePolyuria Decreased BUN and SCrRecovery PhaseRecovery PhaseRena function recoverLaboratory Assessment of ATNLaboratory Assessment of ATNBlood test Urinary findings Renal biopsyDifferentiationDifferentiationFractional excretion of Na Urinary Na concentration Urinary creatinine / plasma creatinine Urinary specific gravity Urine osmolality Plasma BUN / Cr Renal failure indexManagementManagementPrevention Maintenance of fluid and electrolyte balance Provision of adequate nutrition Treatment of infection Treatment of uremia