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Differential Diagnosis of Acute Renal Failure 臺灣大學附設醫院外科 4B 加護病房實習報告   報告者 :  李浩遠  (Intern,  學號 :  B8601076)  臺北醫學大學醫學系七年級
Definition  ,[object Object]
Prerenal Disease   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Prerenal Disease   ,[object Object],[object Object],[object Object]
Prerenal Azotemia Caused by True Volume Depletion   ,[object Object],[object Object],[object Object]
Prerenal Azotemia Caused by Advanced Liver Disease  ,[object Object],[object Object],[object Object],[object Object]
Prerenal Azotemia Caused by Congestive Heart Failure  ,[object Object],[object Object],[object Object]
Prerenal Azotemia Caused by  Renal arterial disease   ,[object Object]
Prerenal ARF of Newborns and Infants ,[object Object],[object Object],[object Object],[object Object]
Prerenal ARF of Newborns and Infants ,[object Object]
Prerenal ARF of  Children   ,[object Object],[object Object],[object Object],[object Object]
Symptoms and Signs of  Prerenal Failure  ,[object Object],[object Object]
Symptoms and Signs of  Prerenal Failure   ,[object Object]
Intrinsic Renal Failure   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Intrinsic Renal Failure   ,[object Object]
Intrinsic Renal Failure   ,[object Object]
Intrinsic Renal Failure   ,[object Object],[object Object]
Intrinsic Renal Failure   ,[object Object]
Intrinsic Renal Failure   ,[object Object]
Acute Tubular Necrosis  ,[object Object],[object Object],[object Object],[object Object]
Acute Tubular Necrosis  ,[object Object],[object Object],[object Object]
Acute Tubular Necrosis  ,[object Object],[object Object],[object Object]
Acute Tubular Necrosis  ,[object Object],[object Object],[object Object]
Major Causes of Acute Tubular Necrosis  ,[object Object],[object Object],[object Object],[object Object],[object Object]
Intrinsic ARF of Children  ,[object Object],[object Object]
Post-renal ARF ,[object Object],[object Object],[object Object]
Post-renal ARF ,[object Object]
FeNa ,[object Object],[object Object],[object Object],[object Object]
FeNa ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Urine output  (>400 mL/d)  Acute interstitial nephritis, acute glomerulonephritis, partial obstructive nephropathy, nephrotoxic and ischemic ATN, radiocontrast-induced ARF, and rhabdomyolysis ,[object Object],(100-400 mL/d) Prerenal failure, hepatorenal syndrome ,[object Object],Urinary tract obstruction, renal artery obstruction, rapidly progressive glomerulonephritis, bilateral diffuse renal cortical necrosis ,[object Object]
Urinalysis   Acute interstitial nephritis, pyelonephritis   WBC casts   Glomerulonephritis, malignant HTN   RBC casts   ATN, glomerulonephritis, interstitial nephritis Granular casts
Urinalysis   prerenal and postrenal failure, HUS/thrombotic thrombocytopenic purpura (TTP), preglomerular vasculitis, or atheroembolism Normal  Acyclovir, sulfonamides, methotrexate, ethylene glycol toxicity, radiocontrast agents   Crystall-uria   Acute allergic interstitial nephritis, atheroembolism Eosino-philuria
Complete blood count   multiple myeloma   Anemia and rouleaux formation  SLE or TTP   Leukopenia and thrombocytopenia   common in ARF   Leukocytosis
Complete blood count   liver disease or hepatorenal syndrome. Coagulation disturbances  allergic interstitial nephritis, polyarteritis nodosa, or atheroemboli  Eosinophilia  TTP or atheroemboli  Microangiopathic anemia
Blood chemistry  common complication of ARF   Hypocalcemia (moderate)  Hyperkalemia  rapidly progressive liver failure and hepatorenal syndrome  Elevations in liver transaminases  rhabdomyolysis and myocardial infarction  Creatine phosphokinase (CPK) elevations
Urine indices  <20   >40   Urine/plasma creatinine ratio   <10-15   >20   Plasma BUN/creatinine ratio   >40   <15-20   Urine sodium (mEq/L)   <500   >500   Urine osmolality (mOsm/kg H 2 O)   <1.012   >1.018   Urine specific gravity ATN  prerenal ARF
Laboratory Findings in the Differential Diagnosis of Acute Renal Failure:
Laboratory Findings in the Differential Diagnosis of Acute Renal Failure:
References  Akposso K, Hertig A, Couprie R, et al: Acute renal failure in patients over 80 years old: 25-years' experience [In Process Citation]. Intensive Care Med 2000 Apr; 26(4): 400-6   3 Druml W: Prognosis of Acute Renal Failure. Nephron 1996; 53: 8-15   4 Klahr S, Miller SB: Acute oliguria. N Engl J Med 1998 Mar 5; 338(10): 671-5   2 Liano F, Pascual J: Epidemiology of acute renal failure: a prospective, multicenter, community-based study. Madrid Acute Renal Failure Study Group. Kidney Int 1996 Sep; 50(3): 811-8   1
References  Ragaller MJ, Theilen H, Koch T: Volume replacement in critically ill patients with acute renal failure. J Am Soc Nephrol 2001 Feb; 12 Suppl 17: S33-9   6 Moghal NE, Brocklebank JT, Meadow SR: A review of acute renal failure in children: incidence, etiology and outcome. Clin Nephrol 1998 Feb; 49(2): 91-5   5
References  Renal Failure, Acute September 17, 2002   eMedicine.com, Inc.  8 San A, Selcuk Y, Tonbul Z, Soypacaci Z: Etiology and prognosis in 438 patients with acute renal failure. Ren Fail 1996 Jul; 18(4): 593-9   7

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04 Differential Diagnosis Of Acute Renal Failure

  • 1. Differential Diagnosis of Acute Renal Failure 臺灣大學附設醫院外科 4B 加護病房實習報告 報告者 : 李浩遠 (Intern, 學號 : B8601076) 臺北醫學大學醫學系七年級
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  • 31. Urinalysis Acute interstitial nephritis, pyelonephritis WBC casts Glomerulonephritis, malignant HTN RBC casts ATN, glomerulonephritis, interstitial nephritis Granular casts
  • 32. Urinalysis prerenal and postrenal failure, HUS/thrombotic thrombocytopenic purpura (TTP), preglomerular vasculitis, or atheroembolism Normal Acyclovir, sulfonamides, methotrexate, ethylene glycol toxicity, radiocontrast agents Crystall-uria Acute allergic interstitial nephritis, atheroembolism Eosino-philuria
  • 33. Complete blood count multiple myeloma Anemia and rouleaux formation SLE or TTP Leukopenia and thrombocytopenia common in ARF Leukocytosis
  • 34. Complete blood count liver disease or hepatorenal syndrome. Coagulation disturbances allergic interstitial nephritis, polyarteritis nodosa, or atheroemboli Eosinophilia TTP or atheroemboli Microangiopathic anemia
  • 35. Blood chemistry common complication of ARF Hypocalcemia (moderate) Hyperkalemia rapidly progressive liver failure and hepatorenal syndrome Elevations in liver transaminases rhabdomyolysis and myocardial infarction Creatine phosphokinase (CPK) elevations
  • 36. Urine indices <20 >40 Urine/plasma creatinine ratio <10-15 >20 Plasma BUN/creatinine ratio >40 <15-20 Urine sodium (mEq/L) <500 >500 Urine osmolality (mOsm/kg H 2 O) <1.012 >1.018 Urine specific gravity ATN prerenal ARF
  • 37. Laboratory Findings in the Differential Diagnosis of Acute Renal Failure:
  • 38. Laboratory Findings in the Differential Diagnosis of Acute Renal Failure:
  • 39. References Akposso K, Hertig A, Couprie R, et al: Acute renal failure in patients over 80 years old: 25-years' experience [In Process Citation]. Intensive Care Med 2000 Apr; 26(4): 400-6 3 Druml W: Prognosis of Acute Renal Failure. Nephron 1996; 53: 8-15 4 Klahr S, Miller SB: Acute oliguria. N Engl J Med 1998 Mar 5; 338(10): 671-5 2 Liano F, Pascual J: Epidemiology of acute renal failure: a prospective, multicenter, community-based study. Madrid Acute Renal Failure Study Group. Kidney Int 1996 Sep; 50(3): 811-8 1
  • 40. References Ragaller MJ, Theilen H, Koch T: Volume replacement in critically ill patients with acute renal failure. J Am Soc Nephrol 2001 Feb; 12 Suppl 17: S33-9 6 Moghal NE, Brocklebank JT, Meadow SR: A review of acute renal failure in children: incidence, etiology and outcome. Clin Nephrol 1998 Feb; 49(2): 91-5 5
  • 41. References Renal Failure, Acute September 17, 2002 eMedicine.com, Inc. 8 San A, Selcuk Y, Tonbul Z, Soypacaci Z: Etiology and prognosis in 438 patients with acute renal failure. Ren Fail 1996 Jul; 18(4): 593-9 7

Editor's Notes

  1. Breakthrough Therapy for Sleep Difficulties Introduction Getting a restful night of sleep should not be a difficult task. Unfortunately, the inability to sleep is a regular source of frustration and anxiety for as many as half of adults. Today, physicians have many more treatment options than ever before for patients with sleep problems. SONATA * (zaleplon) is the first of a new generation of sleep medications. SONATA is unrelated to benzodiazepines, barbiturates, or other drugs with known hypnotic properties. SONATA has been proven effective as a sleep inducer. In clinical trials, SONATA reduced the time to sleep onset without impairing next-day functioning. SONATA gives patients options. Patients can attempt to fall asleep naturally before they decide to use a sleep medication. SONATA can be taken before bedtime or later, if patients experience trouble falling asleep. Because of this flexibility, SONATA may be taken only on those nights when the patient actually experiences the symptoms of insomnia and at anytime during the night (provided one remains in bed 4 or more hours before becoming active again). SONATA is also fast acting. With treatment, patients fall asleep quickly, within 30 minutes or less, and can wake up ready to function after a restful sleep. This slide presentation will introduce you to the important new prescription sleep medication called SONATA. It is hoped that you find the following information on the management of insomnia educational and useful in your practice. * trademark