急性肾衰竭.ppt

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    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.

    * ARF complicates 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

    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

    Role of Tubule Dysfunction

    in ATN

    Two Major TubularAbnormalities:

    Obstrction

    Backleak

    Metabolic Responses of

    Tubule cells to Injury

    * ATP Depletion

    * Cell Swelling

    * Intyacellular Free Calcium↑

    * Intyacellular Acidosis

    * Phospholipase Activation

    * Protease Activation ......

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