文档介绍：急性肾衰竭
Acute Renal Failure
(ARF)
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.
plicates approximately 5% of hospital admissions and up to 30% of admissions to
intensive care units.
CLASSIFICATION
Prerenal azotemia
Intrinsic renal azotemia
Postrenal azotemia
ETIOLOGY OF ARF
Prerenal Azotemia
Intravascular Volume Depletion
Decreased Cardiac Output
Systemic Vasodilatation
Renal Vasoconstriction
Pharmacologic Agents (ACEI or NSAIDs)
ETIOLOGY OF ARF
Postrenal Azotemia
Ureteric Obstruction
Bladder Neck Obstruction
Urethral Obstruction
ETIOLOGY OF ARF
Intrinsic Renal Azotemia
Diseases Involving Large Renal Vessels
Diseases of Glomeruli And Microvasculature
Acute Tubule Necrosis
Diseases of the Tubulointerstitium
急性肾小管坏死
Acute Tubule Necrosis
(ATN)
ETIOLOGY OF ATN
Renal Ischemia(50%)
Nrphrotoxins (35%)
Exogenous
Endogenous
PATHOPHYSIOLOGY OF ATN
Intrarenal Vasoconstriction
Tubular Dysfunction
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