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1、Acute Renal Failure (ARF),Chengwu Liu 2015,2,1. Review of renal structure and physiology 2. Definition of ARF 3. Causes and classification 4. Pathogenesis (acute tubular necrosis，ATN) 5. Alterations of metabolism and function 6. Prevention and treatment,outline,3,To excrete urine and waste products
2、To regulate the balance of water and electrolytes To regulate the BP To involve in endocrine regulation: - Renin - Erythropoietin (EPO) - Vitamin D3 - Prostaglandin (PG),review,The main functions of kidney,1. review,4,review,The renal structure,5,review,review,review,Cortex,Medula,review,Nephrotic s
3、yndrome: Edema Proteinuria Hyperlipidemia Hypoproteinemia,The Structure of the Glomerulus,The Juxtaglomerular Apparatus,review,10,review,Net Filtration Pressure,NFP,BHP,60 out,COP,25 in,CP,review,review,adrenal gland cortex,Juxtaglomerular apparatus, cell,renin,angiotensinogen,angiotensin ,angiotens
4、in ,liver,lung,ACE,Vessel constriction,aldosterone,H2O,Na+ reabsorption,BP,Endocrine function of kidney: Activation of RAAS,BP, Na+, sympathetic N(+),review,14,So, every part of the renal system should be intact in structure, otherwise, it is hard to ensure its function, including original urine pro
5、ducing, diluting and concentrating, endocrine regulatory function etc.,review,15,2. definition Acute Renal Failure (ARF)： an acute and severe syndrome which shows a abrupt and sustained decline in kidneys ability to clear toxic substances in blood, leading to an accumulation of metabolic waste, mani
6、festing azotemia, hyperkalemia, metabolic acidosis, and often accompanied by oliguria or anuria.,definition,16,Characteristics： (1) Abrupt sustained decline in GFR (2) Rising serum urea and creatinine (3) Loss of water and salt homeostasis (4) Life threatening metabolic change (5) Occurs over hours
7、or days (6) Incidence about 140 ppm per year (7) High mortality,characters,classification:,prerenal ARF intrarenal ARF postrenal ARF,bladder,ureter,kidney,3. cause and classification,18,Pre-renal ARF,(1) Causes of prerenal ARF hypovolemia haemorrhage, burns, fluid loss，hypotension, cardiogenic shock
8、, sepsis renal hypoperfusion renal vasoconstriction, drugs, liver diseases, renal vascular diseases (thrombosis, DIC) feature: reversibility,causes and classification,renal angiography,straitness,causes and classification,20,(2) Causes of intrarenal ARF,Diseases of the renal parenchyma ATN（acute tub
9、ular necrosis） prolonged ischaemia (50%), direct toxicity (35%): fish gall, aminoglycoside(Gentamycin), mercury, arsenic(As), myoglobin, sepsis vascular disease vasculitis, infarction,causes and classification,21, diseases of glomerulus or arterioles RPGN (rapidly progressive glomerulonephritis) HUS
10、 (haemolytic uraemic syndrome) SLE (systemic lupus erythematosus) vasculitis tubule-interstitial nephritis Drug related paraneoplastic,causes and classification,Immune complex glomerulonephritis,causes and classification,Immune complex deposition in the glomerulus (B). B, immunofluorescence microgra
11、ph stained with fluorescent anti-IgG from a patient with diffuse proliferative lupus nephritis.,causes and classification,24,(3) Causes of postrenal ARF,ureter calculi, carcinoma, fibrosis, straitness bladder prostatic hypertrophy or malignancy, carcinoma, calculi,causes and classification,type caus
12、es clinical features,prerenal intrarenal postrenal,renal hypoperfusion: early stage of shock,oliguria or anuria, azotemia, urineNa+,kidneys organic changes: prolonged renal ischemia nephrotoxin,oliguric: nonoliguric:,obstruction of ureter and urethra by calculus or carcinoma,abrupt anuria, aggravati
13、on of azotemia,causes and classification,summary,26,(1) Change of renal hemodynamics： Renal hypoperfusion: the progressive stage of shock,4. Pathogenesis of ARF: (ATN),27,Renal vasoconstriction： The activation of Renin-Angiotensin System(RAS) Catecholamine: adrenaline, noradrenaline Unbalance of pro
14、staglandin / TXA2 Endothelin (ET) Others: NO, TNF, ADH, PAF( platelet activating factor),Swelling of epithelial cells,Necrosis of epithelial cells,Ischemia, hypoxia,Poisonous agents: Mercury, Plumbum, Gentamycin,Oliguria, anuria, waste accumulation,(+),Hypoperfusion,(2) Injury of renal tubules:,Cons
15、triction of afferent arteriole,Effective filtrating pressure ,GFR, Na+ reabsorption,Na+ load in macula densa,RAS(+),Backflow of ultrafiltrate,Obstruction of tubules,pathogenesis,efferent arteriole,tubular epithelial cells,ultrafiltrate,oliguria, anuria,The mechanism of backflow of ultrafiltrate,inte
16、rstitial,edema,debris, necrotic cells,oppress,effectless filtration,urine flow,injured,tubular,cells,pathogenesis,ATN and interstitial edema,pathogenesis,pathogenesis,Acute tubular necrosis in the allograft,pathogenesis,34,(3) renal cell injury: endothelial cell, mesangial cell ATP, ion pump impaired: ischemia, shock OFR : ischemia / reperfusion Glutathione clean
