内科学 急性肾衰竭-顾勇【荐】.ppt

Acute Renal Failure： Gu Yong Division of Nephrology Huashan Hospital Affiliated to Fudan University ARF 1. Definition and concept 2.Pathogenesis 3.Pathology and pathophysiology 4. Acute tubular necrosis 5.Special type of ARF 6.Handling of ARF Definition of ARF Syndrome Quick decline of GFR A series of clinical manifestation Accumulation of nitrogen-containing tastes Incidence of ARF Common hospitalization：5% ICU： 30% Features of ARF Kidney：complete restoration of function High incidence of complication High morbidity mortality Other organs damage Classification of ARF Prerenal：Hypoperfusion, functionality：55%-60% Renal： 35%-40% Postrenal：urinary tract： 5% Causes of prerenal ARF Low volume: bleeding, lost from G-I, kidney, skin, third space Low cardiac output: myocardium, valve, Systemic vasodilatation: medicine, infection, allergy,liver failure Renal arterial systole：shock, medicine,liver failure Renal ARF Renal great vessels Glomerule Acute tubular necrosis：ischemia/poisoning Tubules and interstitium Postrenal ARF Position: Ureter bladder neck Anterior urethra Cause： Stone, coagulated blood, Crystal,edema, deligation Tumor, fibrosis, stenosis, prostate gland etc. ATN Pathology Pathophysiology Course of disease Diagnosis and differential diagnosis Complication Decline of GFR in ARF Abnormal renal hemodynamics Tubular impairment: obstruction, back flow Factors involved in renal hemodynamics Endothelin： increasing receptor blocking EDNO： decreasing Others：Platelet Activating Factor (PAF) Adenosine Medulla edema Tubuloglomerular feedback: TGF Tubular impairment Obstruction： Caducous epithelial cells and components Cast Back flow: Impaired integrity of epithelial cells According to histology: tubular cells fall off and necrosis, cast Metabolic change after tubular cell damage Decreased ATP Cellular swelling Increased intracellular calcium Intr