【持续性肾脏替代治疗CRRT英文ppt课件】Acute Renal Failure.ppt

代理报关委托书委托报关协议关于审理城镇房屋租赁合同纠纷案件司法解释有关劳务派遣制度设计及对劳务派遣行业的影响分析糖皮质激素在呼吸系统疾病中的合理应用严重脓毒症导致急性肺损伤病人自发利尿现象的观察分析 Acute Renal Failure Jayanti Jasti, M.D. Emory Johns Creek Hospital Definition Sudden decrease in GFR over a period of hours to days resulting in the failure of the kidney to excrete nitrogenous waste products and maintain fluid and electrolyte homeostasis. Clinically seen as rise in serum creatinine by 50% above baseline or increase by 0.5 mg/dl. Measurement of Renal Function Cockroft-Gault Formula GFR = (140-age in yrs) x Lean body wt(kg)/ S.Cr x 72 Adjustment made for the gender. MDRD and modified MDRD Complicated, Laboratory reports it! Adjustment made for the gender and race. Creatinine Clearance CrCl = U.Cr x U.vol/ S.Cr x 1440 Serum Creatinine as a marker Steady state between creatinine production and excretion is required. Creatinine production is dependent on muscle mass Drugs which interfere with proximal tubular secretion of creatinine. Trimethoprim, Triamterene, Cimetidine,probenecid, amiloride etc., Drugs which interfere with creatinine measurement in the lab. Ascorbic acid, cephalosporins etc., Blood Urea Nitrogen BUN increases in volume depleted states due to reabsorption in the proximal tubules and in the collecting ducts. BUN can be high with out RF. Hypercatabolic states, protein loading, steroids etc., BUN can be low even with RF Severe malnourishment, liver disease, low protein diet etc., Types of ARF ARF ARF/CKD Anuric (50ml of urine output/day) Oliguric (400 ml/day) Non-oliguric (400 ml/day) Etiology of ARF Prerenal Renal hypoperfusion, no structural damage to the kidneys, Cr normalizes in 24-72 hours with correction of hypoperfused state. Post-renal Obstruction to the urine flow, either unilateral/bilateral, intra-ureteral or extra-ureteral or bladder neck or intra-pelvis (renal pelvis). Intra-renal Damage or inflammation within the kidney, may be primary renal or part of systemic disease.