中国医科大学附属第一医院：《内科学》课程教学资源（PPT课件讲稿，双语版）急性肾衰竭

急性肾衰竭 Acute renal failure CARF)

急性肾衰竭 Acute Renal Failure （ARF）

DEFINITIONS AND INCIDENCE UAcute renal failure(ArF)is a syndrome characterized by rapid decline in glomerular filtration rate(GFR) and retention of nitrogenous waste products such as blood urea nitrogen(BUN)and creatinine U aRF complicates approximately 5% of hospital admissions and up to 30% of admissions to Intensive care units

DEFINITIONS AND INCIDENCE ❑Acute renal failure (ARF) is a syndrome characterized by rapid decline in glomerular filtration rate(GFR) and retention of nitrogenous waste products such as blood urea nitrogen (BUN) and creatinine. ❑ ARF complicates approximately 5% of hospital admissions and up to 30% of admissions to intensive care units

CLASSIFICATION Prerenal azotemia Intrinsic renal azotemia Postrenal azotemia

CLASSIFICATION ⚫ Prerenal azotemia ⚫ Intrinsic renal azotemia ⚫ Postrenal azotemia

ETIOLOGY OF ARF Prerenal azotemia Intravascular Volume depletion Decreased Cardiac Output Systemic Vasodilatation Renal vasoconstriction Pharmacologic Agents (ACEI or NSAIDs)

ETIOLOGY OF ARF Prerenal Azotemia ▪ Intravascular Volume Depletion ▪ Decreased Cardiac Output ▪ Systemic Vasodilatation ▪ Renal Vasoconstriction ▪ Pharmacologic Agents (ACEI or NSAIDs)

ETIOLOGY OFARE Postrenal azotemia a Ureteric Obstruction a Bladder Neck obstruction 凵 Urethral Obstruction

ETIOLOGY OF ARF Postrenal Azotemia ❑ Ureteric Obstruction ❑ Bladder Neck Obstruction ❑ Urethral Obstruction

ETIOLOGY OF ARF Intrinsic Renal azotemia 4 Diseases Involving Large renal vessels Diseases of Glomeruli And microvasculature A Acute Tubule necrosis Diseases of the Tubulointerstitium

ETIOLOGY OF ARF Intrinsic Renal Azotemia ❖ Diseases Involving Large Renal Vessels ❖ Diseases of Glomeruli And Microvasculature ❖ Acute Tubule Necrosis ❖ Diseases of the Tubulointerstitium

急性肾小管坏死 Acute Tubule necrosis CAN)

急性肾小管坏死 Acute Tubule Necrosis （ATN）

ETOLOGYOF ATN Renal Ischemia (50%) ● Nephrotoxins(35%) Exogenous Endogenous

ETIOLOGY OF ATN ⚫ Renal Ischemia（50%） ⚫ Nrphrotoxins （35%） Exogenous Endogenous

PATHOPHYSIOLOGY OF ATN Intrarenal vasoconstriction ● Tubular Dysfunction

PATHOPHYSIOLOGY OF ATN ⚫ Intrarenal Vasoconstriction ⚫ Tubular Dysfunction

Role of Hemodynamic alterations in atn X Reduction in Total renal blood Flow Regional disturbance in Renal blood flow and oxygen Supply Edothelin(Et)/NO (EDNO) X Other endothelial vasoconstrctors X The Tubulo-glomerular Feed back

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