acuterenal faiure foreign student 病理生理学双语课件.ppt

Acute Renal Failure(ARF) To excrete urine and waste products To regulate the balance of water and electrolytes To regulate the BP To involve in endocrine regulation: - Renin - Erythropoietin (EPO) - Vitamin D3 - Prostaglandin (PG) So, every part of the renal system should be intact in structure, otherwise, it is hard to ensure its function, including original urine producing, diluting and concentrating, endocrine regulatory function etc. 2. definition Acute Renal Failure (ARF)： an acute and severe syndrome which shows a abrupt and sustained decline in kidney’s ability to clear toxic substances in blood, leading to an accumulation of metabolic waste, manifesting azotemia, hyperkalemia, metabolic acidosis, and often accompanied by oliguria or anuria. ●Characteristics： (1) Abrupt sustained decline in GFR (2) Rising serum urea and creatinine (3) Loss of water and salt homeostasis (4) Life threatening metabolic change (5) Occurs over hours or days (6) Incidence about 140 ppm per year (7) High mortality classification: prerenal ARF intrarenal ARF postrenal ARF Pre-renal ARF (1) Causes of prerenal ARF hypovolemia haemorrhage, burns, fluid loss，hypotension, cardiogenic shock, sepsis renal hypoperfusion renal vasoconstriction, drugs, liver diseases, renal vascular diseases (thrombosis, DIC) feature: reversibility (2) Causes of intrarenal ARF Diseases of the renal parenchyma ① ATN（acute tubular necrosis） prolonged ischaemia (50%), direct toxicity (35%): fish gall, aminoglycoside(Gentamycin), mercury, arsenic(As), myoglobin, sepsis ② vascular disease vasculitis, infarction ③ diseases of glomerulus or arterioles RPGN (rapidly progressive glomerulonephritis) HUS (haemolytic uraemic syndrome) SLE (systemic lupus erythematosus) vasculitis ④ tubule-interstitial nephritis Drug related paraneoplastic (3) Causes of postrenal ARF ureter calculi, carcinoma, fibrosis, straitness