1
Acute Renal Failure
2005-3-10
Huashan Hospital,Fudan University
2
Definitions
? Rapid decline in GFR
3
Classification
? Prerenal ARF
? Intrinsic renal ARF
? Postrenal ARF
4
Prerenal ARF
? Intravascular volume deletion
? Decreased cardiac output
? Systemic vasodilatation
? Renal vasoconstriction
? Pharmacologic agents
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
6
Postrenal ARF
? Ureteric obstruction
? Bladder neck obstruction
? Urethral obstruction
7
Acute Tubule Necrosis
? Etiology
? Pathology
? Pathophysiology
? Clinical features
? Differentiation
? Management
8
Etiology
? Ischemia
? Exogenous toxins
? Endogenous toxins
9
Pathology
? Focal loss of tubular epithelium cells
? Exposure of basement membrane
? Loss of proximal tubular brush border
? Necrosis in the outer medulla
10
Pathophysiology
? Hemodynamic abnormalities
? Tubule obstruction
? Back-leakage
11
Clinical Features
? Oliguric phase
? Polyuric phase
? Recovery phase
12
Oliguric Phase
? Oliguria
? progressively increased BUN and SCr
? Disorders of fluid and electrolyte
? Hemodynamic disorders
? ARDS
? MODS
? Infection
13
Polyuric Phase
? Polyuria
? Decreased BUN and SCr
14
Recovery Phase
? Rena function recover
15
Laboratory Assessment of ATN
? Blood test
? Urinary findings
? Renal biopsy
16
Differentiation
? Fractional excretion of Na
? Urinary Na concentration
? Urinary creatinine / plasma creatinine
? Urinary specific gravity
? Urine osmolality
? Plasma BUN / Cr
? Renal failure index
17
Management
? Prevention
? Maintenance of fluid and electrolyte balance
? Provision of adequate nutrition
? Treatment of infection
? Treatment of uremia
Acute Renal Failure
2005-3-10
Huashan Hospital,Fudan University
2
Definitions
? Rapid decline in GFR
3
Classification
? Prerenal ARF
? Intrinsic renal ARF
? Postrenal ARF
4
Prerenal ARF
? Intravascular volume deletion
? Decreased cardiac output
? Systemic vasodilatation
? Renal vasoconstriction
? Pharmacologic agents
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
6
Postrenal ARF
? Ureteric obstruction
? Bladder neck obstruction
? Urethral obstruction
7
Acute Tubule Necrosis
? Etiology
? Pathology
? Pathophysiology
? Clinical features
? Differentiation
? Management
8
Etiology
? Ischemia
? Exogenous toxins
? Endogenous toxins
9
Pathology
? Focal loss of tubular epithelium cells
? Exposure of basement membrane
? Loss of proximal tubular brush border
? Necrosis in the outer medulla
10
Pathophysiology
? Hemodynamic abnormalities
? Tubule obstruction
? Back-leakage
11
Clinical Features
? Oliguric phase
? Polyuric phase
? Recovery phase
12
Oliguric Phase
? Oliguria
? progressively increased BUN and SCr
? Disorders of fluid and electrolyte
? Hemodynamic disorders
? ARDS
? MODS
? Infection
13
Polyuric Phase
? Polyuria
? Decreased BUN and SCr
14
Recovery Phase
? Rena function recover
15
Laboratory Assessment of ATN
? Blood test
? Urinary findings
? Renal biopsy
16
Differentiation
? Fractional excretion of Na
? Urinary Na concentration
? Urinary creatinine / plasma creatinine
? Urinary specific gravity
? Urine osmolality
? Plasma BUN / Cr
? Renal failure index
17
Management
? Prevention
? Maintenance of fluid and electrolyte balance
? Provision of adequate nutrition
? Treatment of infection
? Treatment of uremia
