(精编)【持续性肾脏替代治疗CRRT英文精品课件】肾脏替代治疗病人的管理.pptVIP

Lower urinary tract infections Cystitis Ureterovesical reflux Complications of nephrotic syndrome Massive proteinuria Hypoalbuminemia Edema Lipiduria Hyperlipidemia Increased coagulation Renal insufficiency Treatment of nephrotic syndrome Renal biopsy to determine specific cause Steroids Immunosuppressive agents ACEIs can decrease proteinuria Cholesterol lowering agents Heparin to reduce coagulability Limit sodium intake Acute Renal Failure Reversible clinical syndrome whereby there is sudden and pronounced loss of kidney function Occurs over hours to days Results in kidneys failure to excrete nitrogenous wastes Causes of Acute Renal Failure Intrarenal actual parenchymal damage Prolonged renal ischemia from myoglobinuria (rhabdo, trauma, burns), hemoglobinuria (transfusion reaction, hemolytic anemia) Nephrotoxic agents like aminoglycosides, radiopaque contrast, heavy metals, solvents, NSAIDs, ACEIs, acute glomerulonephritis Causes of Acute Renal Failure Prerenal 60-70% of cases Volume depletion as seen in hemorrhage, renal losses from diuretics, GI losses from vomiting, diarrhea Impaired cardiac output 2ndary to MI, heart failure, dysrhythmias, cardiogenic shock Vasodilation from sepsis, anaphylaxis, antihypertensive meds Causes of acute renal failure Postrenal Urinary tract obstruction by calculi, tumors, BPH, blood clots Phases of Acute Renal Failure Initiation occurs with the insult Oliguria with urinary output less than 400ml/24h . rising potassium, BUN, Cr. Not responsive to fluid challenges. Diuresis period— gradual increase in urinary output. Beginning recovery. Renal function gradually improves Recovery—may take 3-12 months. May have permanent reduction in functioning of 1%-3%. Key features of ARF Prerenal-hypotension, tachycardia, decreased CO, decreased urinary output, lethargy intrarenal and postrenal—oliguria or anuria, hypertension, tachycardia, SOB, orthopnea, n/v, generalized edema and weight gain, lethargy, confusion Nonoliguric form also e