2 intrarenal factor Causes (1)acute tubular necrosis, ATN 2/3 Characteristic acute renal ischemia acute renal poisoning (1)parenchymal hemoglobinuria, (2 )oliguric myoglobinuria nonoliguric (2)renal disease 16
16 Causes (1) acute tubular necrosis,ATN 2/3 acute renal ischemia acute renal poisoning hemoglobinuria, myoglobinuria (2) renal disease Characteristic (1) parenchymal (2) oliguric ~ nonoliguric ~ 2 intrarenal factor
Differentiation between the two re urine functionaRy organic RF specific gravity >1.020 <1.015 OP(mmol/L) 700 <250 Na(mmol/L) <20 >40 UrCr/Srcr >40 <20 Sediment norma Necros is epithelial cells, RBC, casts albuminur ia Manicol test ur ine vo l Tur ine volume 17
17 Differentiation between the two RF urine functionalRF organic RF specific gravity > 1.020 < 1.015 OP(mmol/L) > 700 < 250 Na(mmol/L) < 20 > 40 UrCr/SrCr > 40 < 20 Sediment normal Manicol test urine volume urine volume Necrosis epithelial cells,RBC,casts, albuminuria
3 Postrenal factor Causes Kidney stone tumor obstruction of necrosis tissue Characteristic early stage: obstructive late stage: organic
18 Causes Kidney stone, tumor, obstruction of necrosis tissue Characteristic early stage: obstructive ~ late stage: organic ~ 3 Postrenal factor
Mechanism Obstruction Bowman’ s capsule of the urinary pI ressure tract Net filtration pressure GRF↓ Oliguria, anuria 19
19 Mechanism Obstruction of the urinary tract Bowman’s capsule pressure↑ Net filtration pressure↓ GRF↓ Oliguria, anuria
Section 2 Pathogenesis Glomerular factor ①RBF (1) Net filtration pressure L BP<60mmHg Co↓ RBF BP(5070 mmHg)>GFR(1/2-23) BP(40mmHg)x→GFR=0 Urinary obstruction > intracapsular pressure
20 Section 2 Pathogenesis ① RBF （1） Net filtration pressure BP < 60mmHg CO RBF BP (50-70mmHg) GFR (1/2 – 2/3) BP(40mmHg) GFR = 0 Urinary obstruction intracapsular pressure 1 Glomerular factor