,单击此处编辑母版标题样式,*,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,急性肾衰竭,Acute Renal Failure,（ARF）,急性肾衰竭 Acute Renal Fail,1,DEFINITIONS AND INCIDENCE,Acute renal failure(ARF)is a syndrome characterized by rapid decline in glomerular filtration rate(GFR)and retention of nitrogenous waste products such as blood urea nitrogen(,BUN,)and creatinine.,ARF complicates approximately 5%of hospital admissions and up to 30%of admissions to,intensive care units.,DEFINITIONS AND INCIDENCEAcu,2,CLASSIFICATION,Prerenal azotemia,Intrinsic renal azotemia,Postrenal azotemia,CLASSIFICATION Prerenal azot,3,ETIOLOGY OF ARF,Prerenal Azotemia,Intravascular Volume Depletion,Decreased Cardiac Output,Systemic Vasodilatation,Renal Vasoconstriction,Pharmacologic Agents,(,ACEI or NSAIDs,),ETIOLOGY OF ARF Preren,4,ETIOLOGY OF ARF,Postrenal Azotemia,Ureteric Obstruction,Bladder Neck Obstruction,Urethral Obstruction,ETIOLOGY OF ARF,5,ETIOLOGY OF ARF,Intrinsic Renal Azotemia,Diseases Involving Large Renal Vessels,Diseases of Glomeruli And Microvasculature,Acute Tubule Necrosis,Diseases of the Tubulointerstitium,ETIOLOGY OF ARF Intrin,6,急性,肾小管坏死,Acute Tubule Necrosis,（ATN）,急性肾小管坏死 Acute Tubule,7,ETIOLOGY OF ATN,Renal Ischemia（50%）,Nrphrotoxins （35%）,Exogenous,Endogenous,ETIOLOGY OF ATN Renal Ischem,8,PATHOPHYSIOLOGY OF ATN,Intrarenal Vasoconstriction,Tubular Dysfunction,PATHOPHYSIOLOGY OF ATN Intrar,9,Role of Hemodynamic alterations in ATN,Reduction in Total Renal Blood,Flow Regional Disturbance in,Renal Blood Flow and Oxygen,Supply,Edothelin(ET)/NO(EDNO),Other Endothelial Vasoconstrctors,The Tubulo-glomerular Feed Back,Role of Hemodynamic alteration,10,Role of Tubule Dysfunction in ATN,Two Major TubularAbnormalities:,Obstrction,Backleak,Role of Tubule Dysfunction i,11,Metabolic Responses of Tubule cells to Injury,ATP Depletion,Cell Swelling,Intyacellular Free Calcium,IntyacellularAcidosis,Phospholipase Activation,Protease Activation,Oxidant Injury,Inflammatory Respose,Metabolic Responses of Tubule,12,Pathology,Pathology,13,Clinical Presentation of ATN,The Clinical Course of ATN：,The Initiation Phase,The Maintenance Phase,The Recovery Phase,Clinical Presentation of ATN,14,The Initiation Phase,GFR,Lasting Hours or Days,Evidence of true Volume Depletion,Decreeced Effective Circulatory Volume,Treatment with NSAIDs or ACEI,The Initiation PhaseGFR,15,The Maintenance Phase,GRR 5 10 ml/min,Lasting 1 2 Weeks,Oliguric ARF,high catabolism,Nonoliguric ARF,Uremic Syndrome,The Maintenance PhaseGRR 5 1,16,High Catabolic State,Daily Increase in BUN 10.117.9 mmol/L,Daily Increase in Serum Creatinine 176.8mol/L,Daily Increase in Serum Potassium 12 mmol/L,Daily Decrease in Serum HCO,3,2 mmol/L,High Catabolic StateDaily Incr,17,The Uremic Syndrome,General Complications of ARF：,Gastrointestinal,Cardiovascular,Respiratory,Neurologic,Hematologic,Infectious,The Uremic Syndrome Gen,18,The Uremic Syndrome,Homeostatic Disorder of water，Electrolyte and Acid-alkali Balance：,Volume Overload,Metabolic Acidosis,Hyperkalemia,Hyponatremia,Hypocalcemia,Hyperphosphatemia,The Uremic Syndrome Homeosta,19,The Recovery Phase,The Period of Repair and Regeneration,of Renal Tissue:,Gradual Increase in Urine Output,“Post-ATN”Diuresis,Fall in BUN and Scr,Recovery of GFR/Tubule function,The Recovery Phase The Peri,20,Lab Examination,Blood Routine Test and Chemistry Assays:,Animia,RBC,Hb,BUN and Scr,Na,，K,Ca,2,，P,3+,pH，AG，HCO,3,Lab Examination Blood Routine,21,Lab Examination,Diagnostic Index,Prerenal,Renal,Specific Gravity 1.020 1.010,Osmolality(mOsm/Kg H,2,O)500 300,Urinary Na,+,(mmol/L)20,Ucr/Scr 40 8 20 5L/d),Management of ARF(三）Nutr,27,Management of ARF(四）,Hyperkalemia,K,+,6mmol/L,10%Calcium Gluconate 10-20ml,5%Sodium Bicarbonate 100-200ml,20%Glucose 3ml/kg.h+Insulin 0.5U/kg.h,Dialysis,Management of ARF(四）,28,Management of ARF(五）,Metabolic Acidosis,HCO,3,15mmol/L:,5%,Sodium Bicarbonate 100-250ml,Dialysis,Management of ARF(五）,29,Management of ARF,Other Electrolyte Disorder,Infection,Hart failure,Dialysis,Management of ARF Other Elect,30,急性肾衰竭课件,31,