Acute Renal Failure 2005-3-10  Huashan Hospital,Fudan University Definitions Rapid decline in GFR Classification Prerenal ARF Intrinsic renal ARF Postrenal ARF Prerenal ARF Intravascular volume deletion Decreased cardiac output Systemic vasodilatation Renal vasoconstriction Pharmacologic agents 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 ARF Ureteric obstruction Bladder neck obstruction Urethral obstruction Acute Tubule Necrosis Etiology Pathology Pathophysiology Clinical features Differentiation Management 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 Pathophysiology Hemodynamic abnormalities Tubule obstruction Back-leakage Clinical Features Oliguric phase Polyuric phase Recovery phase Oliguric Phase Oliguria progressively increased BUN and SCr Disorders of fluid and electrolyte Hemodynamic disorders ARDS MODS Infection Polyuric Phase Polyuria Decreased BUN and SCr Recovery Phase Rena function recover Laboratory Assessment of ATN Blood test Urinary findings Renal biopsy Differentiation Fractional excretion of Na Urinary Na concentration Urinary creatinine / plasma creatinine Urinary specific gravity Urine osmolality Plasma BUN / Cr Renal failure index Management Prevention Maintenance of fluid and electrolyte balance Provision of adequate nutrition Treatment of infection Treatment of uremia * * * *