急性肾衰竭的知识介绍.pptxVIP

急性肾衰竭的知识介绍第1页/共30页第2页/共30页CLASSIFICATION Prerenal azotemia Intrinsic renal azotemia Postrenal azotemia 第3页/共30页ETIOLOGY OF ARF Prerenal Azotemia Intravascular Volume Depletion Decreased Cardiac Output Systemic Vasodilatation Renal Vasoconstriction Pharmacologic Agents (ACEI or NSAIDs)第4页/共30页ETIOLOGY OF ARF Postrenal Azotemia Ureteric Obstruction Bladder Neck Obstruction Urethral Obstruction第5页/共30页ETIOLOGY OF ARF Intrinsic Renal Azotemia Diseases Involving Large Renal Vessels Diseases of Glomeruli And Microvasculature Acute Tubule Necrosis Diseases of the Tubulointerstitium 第6页/共30页急性肾小管坏死 Acute Tubule Necrosis （ATN）第7页/共30页ETIOLOGY OF ATN Renal Ischemia（50%） Nrphrotoxins（35%） Exogenous Endogenous 第8页/共30页PATHOPHYSIOLOGY OF ATN Intrarenal Vasoconstriction Tubular Dysfunction第9页/共30页Role of Hemodynamic alterations in ATN Reduction in Total Renal Blood Flow Regional Disturbance in Renal Blood Flow and Oxygen Supply Edothelin (ET) / NO (EDNO) Other Endothelial Vasoconstrctors The Tubulo-glomerular Feed Back第10页/共30页 Role of Tubule Dysfunction in ATN Two Major TubularAbnormalities: Obstrction Backleak第11页/共30页Metabolic Responses of Tubule cells to Injury ATP Depletion Cell Swelling Intyacellular Free Calcium↑ Intyacellular　Acidosis Phospholipase Activation Protease Activation Oxidant Injury Inflammatory Respose第12页/共30页Pathology第13页/共30页Clinical Presentation of ATN The Clinical Course of ATN： The Initiation Phase The Maintenance Phase The Recovery Phase第14页/共30页The Initiation PhaseGFR↓Lasting Hours or DaysEvidence of true Volume DepletionDecreeced Effective Circulatory VolumeTreatment with NSAIDs or ACEI第15页/共30页The Maintenance PhaseGRR 5 ~ 10 ml/minLasting 1 ~ 2 WeeksOliguric ARF high catabolismNonoliguric ARFUremic Syndrome第16页/共30页High Catabolic StateDaily Increase in BUN 10.1~17.9 mmol/LDaily Increase in Serum Creatinine 176.8μmol/LDaily Increase in Serum Potassium 1~2 mmol/LDaily Decrease in Serum HCO 3 －2 mmol/L第17页/共30页The Uremic Syndrome Gene