ARF中国医科大肾病课件.pptVIP

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 Oxidant Injury Inflammatory Respose Pathology Clinical Presentation of ATN The Clinical Course of ATN： The Initiation Phase The Maintenance Phase The Recovery Phase The Initiation Phase GFR↓ Lasting Hours or Days Evidence of