复旦大学附属中山医院：《内科学》课程教学资源（PPT讲稿）顾勇－急性肾衰 Acute Renal Failure

Acute renal failure 2005-3-10 Huashan Hospital, Fudan University

1 Acute Renal Failure 2005-3-10 Huashan Hospital,Fudan University

Definitions Rapid decline in gFr

2 Definitions • Rapid decline in GFR

Classification Prerenal arF Intrinsic renal arF Postrenal are

3 Classification • Prerenal ARF • Intrinsic renal ARF • Postrenal ARF

PrerenalarF Intravascular volume deletion Decreased cardiac output Systemic vasodilatation Renal vasoconstriction Pharmacologic agents

4 Prerenal ARF • Intravascular volume deletion • Decreased cardiac output • Systemic vasodilatation • Renal vasoconstriction • Pharmacologic agents

IntrinSic are Diseases involving large renal vessels Diseases involving renal microvasculature Diseases of glomeruli Diseases characterized by injury to renal tubules Diseases of the tubulointerstitium

5 Intrinsic ARF • Diseases involving large renal vessels • Diseases involving renal microvasculature • Diseases of glomeruli • Diseases characterized by injury to renal tubules • Diseases of the tubulointerstitium

Postrenal are Ureteric obstruction Bladder neck obstruction Urethral obstruction

6 Postrenal ARF • Ureteric obstruction • Bladder neck obstruction • Urethral obstruction

Acute Tubule necrosis Etiology Pathology Pathophysiology Clinical features Differentiation Management

7 Acute Tubule Necrosis • Etiology • Pathology • Pathophysiology • Clinical features • Differentiation • Management

Etiology schemia Exogenous toxins Endogenous toxins

8 Etiology • Ischemia • Exogenous toxins • Endogenous toxins

Pathology Focal loss of tubular epithelium cells Exposure of basement membrane LoSs of proximal tubular brush border Necrosis in the outer medulla

9 Pathology • Focal loss of tubular epithelium cells • Exposure of basement membrane • Loss of proximal tubular brush border • Necrosis in the outer medulla

Pathophysiology Hemodynamic abnormalities Tubule obstruction Back-leakage

10 Pathophysiology • Hemodynamic abnormalities • Tubule obstruction • Back-leakage