【持续性肾脏替代治疗CRRT英文ppt课件】Acute Renal Failure, Fluid Management and Renal Replacement Therapy.pptVIP

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【持续性肾脏替代治疗CRRT英文ppt课件】Acute Renal Failure, Fluid Management and Renal Replacement Therapy.ppt

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【持续性肾脏替代治疗CRRT英文ppt课件】Acute Renal Failure, Fluid Management and Renal Replacement Therapy

Anemia Erythropoietin decrease Erythropoietin: stimulates bone marrow to produce red blood cells. Toxic wastes suppress the ability of bone marrow to produce red blood cells. Bleeding Platelet abnormality Normal or a little decreased platelet number Platelet dysfunction Epistaxis, GI bleeding, bruising, hemoptysis ARF VS ALI Mortality ARF: 30-40% ALI: 35% BOTH: 80% ARF VS ALI Effect of ARF on lung ( Experimental studies) Increase pulmonary vascular permeability, macrophage medicated in part Salt and water transporters disorder: lung fluid retention ARF VS ALI Effect of mechanical ventilator on kidney ( Experimental studies) Systemic hemodynamic change( VR, CO ) Anti-natriuretic, anti-diuretic effect Augmentation of inflammatory milieu Outline Renal function Acute renal failure Complication of ARF Management Renal replacement therapy Management ?? Prevention ?? Etiology treatment ?? Prevention additional injury ?? Establish diuresis ?? Treatment of complication ?? Conservative measurement ?? Renal replacement therapy Prevention Identification of high-risk patients for pharmacologic agents-induced nephrotoxicity iodinated radiocontrast medium, NSAIDs Aggressive surveillance for nephrotoxin-induced renal dysfunction cisplatin, amphotericin B, aminoglycoside Use of volume expansion in selected clinical settings Hyperpigmenturia: hemoglobinuria, myoglobinuria Crystaluria: uric acid, acyclovir, methotrexate, sulfonamides Minimalization of catheters use to avoid nosocomial sepsis Etiology Treatment Correct postrenal factor Correct prerenal factor Treat underlying sepsis Stop nephrotoxic drugs Establish Diuresis Volume expansion/hydration osmotic diuretics and loop diuretics: mannitol, furosemide renal vasodilators: dopamine (1-2ug/kg/min), atrial natriuretic peptid Evaluation of intravascular volume Guide of Volume Expansion CVP 8-14 cm H2O (5-2 rule) PAWP 12-16 mmHg (7-3 rule) Urine output 0.5-1.0ml/kg/hour Weighing the patient daily Insensible wat