Acute renal failure is caused by a variety of causes of acute renal dysfunction, and the resulting accumulation of nitrogen in the blood of metabolites and water and electrolyte, acid-base balance disorders and a series of pathophysiological changes, is a common clinical and serious One of the symptoms may also coexist with the dysfunction of other organs and constitute multiple organ dysfunction syndrome.
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Significant reduction in urine output is the most prominent manifestations of impaired renal function.Adult 24 hours urine output less than 400ml called oliguria, urine volume less than 100ml called anuria.When the 24-hour urine output is less than 500m1, even if the maximum penetration (pressure) of 1000mmol / L, is still not enough to maintain the balance of solute, and there will be varying degrees of azotemia.But urine is not the only indicator of acute renal failure.
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Sometimes 24 hours urine output more than 800ml, but the hematoma creatinine, urea nitrogen increased, known as non-oliguric acute renal failure, more common in surgery and trauma, easy to ignore.Disease causeRenal exercise normal function requires adequate blood circulation, complete cell function and smooth fluid flow within the renal tubules. According to the different causes and early treatment of differences, clinical acute renal failure is divided into three categories.1, prerenalDue to dehydration, bleeding, shock and other factors caused by reduced blood volume, can cause renal blood perfusion pressure, can not maintain normal glomerular filtration rate caused by oliguria.Early stage is a functional change, the kidney itself is no structural damage, but if not treated in time, can develop renal parenchymal damage and become acute renal failure.
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2, post-renal sexDue to bilateral renal ureter or isolated renal ureteral obstruction caused by a sharp decline in renal function. Common causes: stones, pelvic tumor compression ureter and so on. Resuscitation after renal function can be restored.
3, kidneyVarious causes of acute renal damage, acute tubular necrosis is the main form of renal ischemia and poisoning for its major lesions.Renal ischemia: caused by bleeding, septic shock, serum allergy.Kidney poisoning caused by renal toxic substances.The occurrence of acute renal failure is an intricate process, is still continuing to study, but known renal vasoconstriction and glomerular degeneration and necrosis of the main reasons.
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①, renal ischemiaWhen the renal blood flow decreased, renal perfusion pressure decreased glomerular filtration rate (GFR) decreased. GFR can be adjusted at different mean arterial pressures. When the mean arterial pressure drops to <90mmHg, the GFR decreases, and when it falls to 60mmHg, the GFR drops by half.②, renal tubular epithelial cells degeneration and necrosisNephrotoxic substances or renal ischemia can make renal tubular cells degeneration and necrosis, leading to renal tubular fluid leakage and renal tubular obstruction, acute renal failure (AFR) persistent main factors.The mechanism of renal tubular cell necrosis is:Renal cell damage after metabolic calcium influx, the cytoplasmic calcium increased significantly, activated calcium-dependent enzyme, leading to renal tubular hypoxia injury. Oxygen free radicals and other toxic substances can directly damage the renal tubules.
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③, renal tubular mechanical blockageIs the main factor in the persistence of acute renal failure. Shedding of mucosal, cell debris, Tamm-Horsfall protein can cause renal tubular obstruction after ischemia; filtration pressure reduction more emphasis on this damage.Severe crush or hemolysis produced by hemoglobin, myoglobin can also lead to tubular obstruction.④, ischemia - reperfusion injuryRenal ischemia - reperfusion will aggravate organ damage.Substantial damage to parenchymal cells, neutrophil isolation and the release of oxidative substances and other harmful substances, exacerbate renal parenchymal damage.The release of oxygen free radicals, so that renal tubular epithelial cell lipid peroxidation lead to cell dysfunction or even death.Reperfusion injury can also cause abnormal vascular function.
4, non-oliguric acute renal failureIs due to the amount and extent of nephron damage and fluid dynamics caused by inconsistencies.When only part of the renal tubular cell degeneration and necrosis and renal tubular obstruction, renal tubular and glomerular damage is inconsistent, and some renal unit blood flow does not reduce the blood vessels and no significant contraction and vascular resistance is not high, it will Non-oliguric acute renal failure.
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