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Evaluation and Management of Acute Renal Failure 范揚智醫師  95/10/12
腎臟的功能 調節水份 調節酸鹼 調節電解質 尿液的形成 內分泌器官–  Vitamin D, erythropoietin, RAS
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Blood Urea Nitrogen (BUN) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Creatinine ,[object Object],[object Object],[object Object],[object Object]
GFR Estimation by Plasma Creatinine ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Factors that affect serum creatinine concentration   Positive interference with picric acid assay for creatinine  Increase Ketoacidosis  Inhibition of tubular creatinine secretion  Increase  Use of cimetidine, trimethoprim Transient increase in creatinine generation (increase may be blunted by transient increase in GFR)  Increase  Ingestion of cooked meat  Reduced creatinine generation (common in children, women, and older and malnourished patients)  Decrease Reduced muscle mass  Decreased GFR(increase is blunted by increased tubular secretion of creatinine and by reduced creatinine generation) Increase Kidney Disease  Mechanism (comment)   Effect on serum creatinine Factor
Acute Renal Failure ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group
The facts you need to know about ARF ,[object Object],[object Object],[object Object],[object Object],[object Object]
The facts you need to know about ARF ,[object Object],[object Object],[object Object],[object Object],[object Object]
Symptoms and Signs of Renal Failure ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Symptoms and Signs of Renal Failure ,[object Object],[object Object],[object Object],[object Object]
A: Cr, BUN B: H, P, K C: NaCl
Classification of ARF Acute Renal Failure Pre-renal Intrinsic Post-renal Glomerular Interstitial Vascular Tubular
Pre-renal ARF ,[object Object],[object Object],[object Object],[object Object]
Pre-renal ARF ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pre-renal ARF ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Intrinsic Renal Causes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Intrinsic Renal Causes
Intrinsic Renal Causes ,[object Object],[object Object],[object Object],[object Object],[object Object]
Intrinsic Renal Causes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Post-renal Causes of ARF ,[object Object],[object Object]
Post-renal Causes of ARF ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Investigations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Investigations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Investigations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
FeNa =  (urine Na x plasma Cr)     (plasma Na x urine Cr) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
More FeNa ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
I s the renal failure really acute?   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Management  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Prevention ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Etiology Treatment ,[object Object],[object Object],[object Object],[object Object]
Conservative Measurement ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Guide of Volume Expansion ,[object Object],[object Object],[object Object],[object Object],[object Object]
Dietary modification ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Conservative Measurement
Indication of Dialysis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Take Home Points ,[object Object]
Take Home Points ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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13 Evaluation And Management Of Acute Renal Failure

  • 1. Evaluation and Management of Acute Renal Failure 范揚智醫師 95/10/12
  • 2. 腎臟的功能 調節水份 調節酸鹼 調節電解質 尿液的形成 內分泌器官– Vitamin D, erythropoietin, RAS
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  • 7. Factors that affect serum creatinine concentration Positive interference with picric acid assay for creatinine Increase Ketoacidosis Inhibition of tubular creatinine secretion Increase Use of cimetidine, trimethoprim Transient increase in creatinine generation (increase may be blunted by transient increase in GFR) Increase Ingestion of cooked meat Reduced creatinine generation (common in children, women, and older and malnourished patients) Decrease Reduced muscle mass Decreased GFR(increase is blunted by increased tubular secretion of creatinine and by reduced creatinine generation) Increase Kidney Disease Mechanism (comment) Effect on serum creatinine Factor
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  • 9. The Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group
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  • 14. A: Cr, BUN B: H, P, K C: NaCl
  • 15. Classification of ARF Acute Renal Failure Pre-renal Intrinsic Post-renal Glomerular Interstitial Vascular Tubular
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Editor's Notes

  1. 31