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 are Postrenal are
3 Classification • Prerenal ARF • Intrinsic renal ARF • Postrenal ARF
Prerenal arF 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 Ischemia 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