内科学课件整理-35acute renal failure.pptVIP

Acute Kidney Injury-Acute renal failure The Early Report of ARF “The disease seems in general to come on suddenly. The peculiar symptom is a sudden diminution of secretion of urine, which soon amounts to a complete suspension of it. The affliction is probably at first considered as retention; but the catheter being employed, the bladder is found to be empty. . . after several days, the patient begins to talk incoherently, and shows a tendency to stupor. This increases gradually to perfect coma, which in a few days more is fatal. . . ” John Abercombie (1780 –1828) sudden (i.e.,hours to days) reduction in urine volume Profile Rapid decrease in renal function over days to weeks, causing a accumulation of nitrogenous products in the blood. Often results from major trauma, illness, or surgery but in some cases is caused by a rapidly progressive, intrinsic renal disease. Symptoms include anorexia, nausea, and vomiting, progressing to seizures and coma if the condition is untreated. Fluid, electrolyte, and acid-base disorders develop quickly. Diagnosis is based on laboratory tests of renal function, including serum creatinine, renal failure index, and urinary sediment . Other tests are needed to determine the cause. Treatment is directed at the cause but also includes fluid and electrolyte management and sometimes dialysis. Epidemiology Variable (inconsistent definitions, different population) Based on new definition, AKI occurs approximately 7% in hospitalized patients Mortality: Variable depend on etiology The Modern Understanding of ARF ARF to AKI Definition is based on absolute increase in serum creatinine (Scr) and oliguria New concepts in Definition What’s the new definition? Early single-center and multicenter Cohort studies , administrative database studies Definitions were different Hou et al. Am J Med 74: 243–248, 1983 New concepts in Definition The Second International Consensus Confere