【持续性肾脏替代治疗CRRT英文ppt课件】Acute Kidney Injury （AKI）.ppt

Acute Kidney Injury;Definition of AKI;AKI definition: pRIFLE;pRIFLE Criteria;; Ultrasound Illustration of Normal {LEFT} and Echogenic {RIGHT} Kidneys ;Pre-renal azotemia: pathophysiology;Hypovolemia CHF Nephrotic syndrome Hepatorenal syndrome Mal-distributive shock;;Acute Kidney Risk: Pre-renal Azotemia;Intrinsic AKI: pathogenesis;Case illustration; What additional HISTORY do you need to determine the reason for poor UOP? ;Additional information to determine reason for OLIGURIA;Additional history.........;Etiology of obstructive uropathy? a) UPJO b) Urethral diverticulum c) Bladder neck obstruction d) Post Urethral Stenosis;Diagnostic studies;Doppler ultrasonography in AKI;DIAGNOSIS: MATERNAL EXPOSURE TO ANGIOTENSIN II RECEPTOR BLOCKER;Case Illustration; Anorexia: brain anorectic serotonin + reduces NPY [appetite stimulant] CKD: Wt loss from low calorie + inflam cytokines (IL-1), anemia + MA OTC drug therapy: herbal medications, NSAID Fluid deficit + body weakness Question: If this is acute on CKD, what are the expected physical and lab findings? ;Answers: Acute on CKD; the expected Px / lab findings;Physical findings in the patient;Determine the stage of kidney INJURY using pRIFLE criteria;pRIFLE Criteria; Thus she has Acute kidney failure + and duration likely >> 5 mo Therefore ESKD; chronic dialysis is most probably required. ;Immediate + long term therapeutic concerns? ;Immediate + long term therapeutic concerns? ;Urine test;Immediate + long term therapeutic concerns? ;Immediate + long term therapeutic concerns? ;Cell degeneration;Clinical MX: Early (or pre-renal) AKI;Fluid Mx in early (or pre-renal) AKI;Clinical MX: Oliguric late (or intrinsic) AKI;Clinical Mx: Non-oliguric late (intrinsic) AKI;Renal replacement modality: