【持续性肾脏替代治疗CRRT英文精品课件】AKI.pptVIP

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Underlying cause Signs and symptoms of uraemia Nausea vomiting Hiccups Drowsiness Frank seizures(encephalopathy) Oliguria Facial puffiness: on off Mild hypertension Acidotic breathing Bleeding diathesis Thirst Orthostatic dizziness Orthostatic hypotension Tachycardia Reduced JVP Decreased skin turgor Dry mucous membranes Reduced axillary sweating Hx of progressive fall in urine output and body weight recent initiation of treatment with NSAIDS, ACEI, ARBs Careful clinical exam. May reveal stigmata of chronic liver disease portal hypertension, advanced cardiac failure, sepsis, or other causes of reduced effective arterial blood volume. Usually follows renal hypoperfusion from hypovolaemic or septic shock folowing major surgery. Hx of radiocontrast imaging or ingestion of nephrotoxins. Flank pain may be a prominent feature BP may be very high in malignant hypertension Flank pain Suprapubic pain Severe Colicky pain Symptoms of prostatic dx Symptoms of autonomic dysfunction in neurogenic bladder. Stage Increase in Serum Creatinine Urine Output 1 150%-200% increase from baseline OR 0.3 mg/dl increase from baseline in48h 0.5 ml/kg/h for 6 h 2 200-300% increase from baseline 0.5 ml/kg/h for 12 h 3 300% increase from baseline OR 0.5 mg/dl increase if baseline4mg/dl OR Any RRT given 0.3 ml/kg/h for 24 h OR Anuria for 12 h GFR criteria Urine output Increase in Serum Creatinine stage Risk of renal injury Injury to the kidney Failure of kidney function GFR decrease 25% GFR decrease 50% GFR decrease 75% 0.5 ml/kg/hr for 6 h 0.5 ml/kg/hr for 12h 0.3 ml/kg/h for 24 h OR Anuria for 12 h 1.5-2 times baseline OR 0.3 mg/dl increase from baseline 2-3 times baseline 3 times baseline OR 0.5 mg/dl increase if baseline4mg/dl OR Any RRT given 1 2 3 Loss of kidney function End-stage disease Persistent renal failure for 4 weeks Persistent renal failure for 3