Causes Prerenal failure -diseases that compromise renal perfusion Decreased effective arterial blood volume- Hypovolemia CHF, liver failure, sepsis Renal arterial disease - Renal arterial stenosis (atherosclerotic, fibromuscular dysplasia), embolic disease (septic, cholesterol)
Causes • Prerenal failure - Diseases that compromise renal perfusion ➢ Decreased effective arterial blood volume - Hypovolemia, CHF, liver failure, sepsis ➢ Renal arterial disease - Renal arterial stenosis (atherosclerotic, fibromuscular dysplasia), embolic disease (septic, cholesterol)
肾前性因素 休克的原因(失血、失液、感染、急性心衰 严重过敏反应)和其它(肝肾综合征) ADH个 有效循环血量↓ Ad个 血压降低 肾灌流压↓ 肾血管收缩 肾血流量↓ 肾小球有效滤过压↓ GFRn 尿量↓ 肾前性急性肾功能衰竭的发生机制
肾前性急性肾功能衰竭的发生机制 肾前性因素 休克的原因（失血、失液、感染、急性心衰、 严重过敏反应）和其它（肝肾综合征） ADH 有效循环血量 Ald 血压降低 肾灌流压 肾血管收缩 肾血流量 肾小球有效滤过压 GFR 尿量
Intrinsic renal failure- Diseases of the renal parenchyma, specifically involving the renal tubules, glomeruli, interstitium ATN, ischemia, toxins(eg, aminoglycosides, radiocontrast, heme pigments, cisplatin, myeloma light chains, ethylene glycol) Interstitial diseases- Acute interstitial nephritis, drug reactions, autoimmune diseases (eg, systemic lupus erythematosus [SLE]) infiltrative disease(sarcoidosis, lymphoma), infectious agents (Legionnaire disease, hantavirus Acute glomerulonephritis Vascular diseases-Hypertensive crisis, polyarteritis nodosa, vasculitis
• Intrinsic renal failure - Diseases of the renal parenchyma, specifically involving the renal tubules, glomeruli, interstitium ➢ ATN, ischemia, toxins (eg, aminoglycosides, radiocontrast, heme pigments, cisplatin, myeloma light chains, ethylene glycol) ➢ Interstitial diseases - Acute interstitial nephritis, drug reactions, autoimmune diseases (eg, systemic lupus erythematosus [SLE]), infiltrative disease (sarcoidosis, lymphoma), infectious agents (Legionnaire disease, hantavirus) ➢ Acute glomerulonephritis ➢ Vascular diseases - Hypertensive crisis, polyarteritis nodosa, vasculitis
Postrenal failure- diseases causing urinary obstruction from the level of the renal tubules to the urethra Tubular obstruction from crystals(eg, uric acid, calcium oxalate acyclovir, sulfonamide, methotrexate, myeloma light chains Ureteral obstruction -Retroperitoneal tumor retroperitonea fibrosis(methysergide, propranolol, hydralazine), urolithiasis papillary necrosiS Urethral obstruction- Benign prostatic hypertrophy; prostate cervical, bladder colorectal carcinoma bladder hematoma bladder stone: obstructed Foley catheter; neurogenic bladder
• Postrenal failure - Diseases causing urinary obstruction from the level of the renal tubules to the urethra ➢ Tubular obstruction from crystals (eg, uric acid, calcium oxalate, acyclovir, sulfonamide, methotrexate, myeloma light chains) ➢ Ureteral obstruction - Retroperitoneal tumor, retroperitoneal fibrosis (methysergide, propranolol, hydralazine), urolithiasis, papillary necrosis ➢ Urethral obstruction - Benign prostatic hypertrophy; prostate, cervical, bladder, colorectal carcinoma; bladder hematoma; bladder stone; obstructed Foley catheter; neurogenic bladder
atheroembolic renal disease AIN glomerulonephritis-vasculitis urinary tract obstruction acute on chronic renal failure prerenal ATN 10 20 30 40 50 Causes of ARF in tertiary care hospital setting
Causes of ARF in tertiary care hospital setting