第13讲急性肾损伤AKI.pptxVIP

急性肾损伤Acute Kidney Injury (AKI); 肾 脏 解 剖 Anatomy of the Kidney ;正常肾脏功能Renal function;急性肾衰定义（ARF)DEFINITION;急性肾损伤（AKI ）诊断标准;AKI 分类;肾前性急性肾损伤 Prerenal　ＡKI 肾脏的低灌注引起的肾小球滤过率急骤下降在AKI中占55%。 Renal hypoperfusion is responsible for 55% of the AKI. ;病因 Etiology;血容量不足 Intravascular Volume depletion;高血液粘稠度 Hyperviscosity Syndromes 多发性骨髓瘤Multiple myeloma 巨球蛋白血症 macroglobulinemia ;全身或肾血管收缩 Systemic or Renal Vasoconstriction 药物a-Adrenergic agonists or high-dose dopamine 手术 Surgery 肝肾综合症Hepatorenal syndrome ;血管扩张 SystemicVasodilatation 过敏Anaphylaxis 抗高血压药Antihypertensive drugs 败血症Sepsis 药物过量Medicine overdosage ;心搏出不足 Reduced Cardiac Output 心源性休克Cardiogenic shock 充血性心衰Congestive heart failure 心包填塞Pericardial tamponate 肺栓塞Massive pulmonary embolism ;病理生理Pathophysiology;症状和体征Symptoms and signs;实验室Laboratory Tests 血液浓缩（白蛋白，血球压积）， Hemoconcentration 尿比重1.030, Urine specific gravity1.030 尿渗透压500mosm/kgH2O, Urine osmolality 500mOsm/kgH2O 尿钠20mEq/l, Urine sodium20mEq/L 血尿素氮/血肌酐20 BNU/Scr20 , 钠排泄系数（FENa）1% Fractional excretion of sodium1% UNa Pcr FENa= —— × 100% PNa Ucr ;处理Management;扩容后利尿 Diuresis must be avoid before fluid replacement 甘露醇25g静滴Mannitol 25g/iv gtt 速尿100mg（200mg）静注Furosemide 100mg/iv ( 200mg) ;肾后性AKI 主要病因 Main causes：结石 Calculus 肿瘤Tumor 手术Operation 前列腺增生Hypertrophy of the prostate解剖畸形Anatomy abnormality ;肾后性衰竭;肾实质性AKI  ;病因Etiology 肾缺血 肾毒素 内源性 外源性; 发病机制MECHANISM 肾血流动力学改变REDAUCTION AND REDISTRIBUTION OF RENAL BLOOD 肾小管堵塞DEPOSITION OF TUBULAR DEBRIS WITH TUBULAR OBSTRUCTION 肾小管反漏BACK-LEAKE OF FILTERED TUBUFLAR FLUID 白细胞侵润细胞因子作用 WBC INFILTRATION AND ROLE OF FACTORS 弥散性血管内凝血D.I.C.;Acute tubular necrosis. the pale swollen cortex and the congested medulla are obvious ;临床表现Clinical Presentation;起始期;维持期;恢复期 尿量 〉400ML Scr、 BUN 开始下降 尿量、BUN Scr 正常;诊断DIAGNOSIS 原发病因CAUSE