人生沒有綵排 每天都是直播

Kidney function worsening

  Acute kidney injury: 

    (1)<48hrs,Cr上升>/= 0.3, >50% (2)Urine <0.5ml/kg/hr,大於6hrs

  Chronic kidney disease

    >/=3 month of reduced eGFR(<60) or kidney damage

DD

(1) Pre renal: (BUN/Cr>20)

 Hypovolumn: shock, heart failure, poor liver function, BUN從腎臟回收

 Renal artery stenosis

 Steroid: 本身造成BNU輕微上升 

 GI bleeding: GI 大量吸收blood, BUN上升

 ACEi/ARB/NSAID

(2) Post renal: 排除簡單,可以盡快r/o

  Nephrolithiasis

  Maligancy (prostate)

  BPH

  Retroperitoneal fibrosis

  Anti cholinergic agnet

(3) intrinsic renal

 1.Acute tubular necrosis

   Ischemia: from pre renal

   Toxic: drug(Amphotericin B, Cisplatin)

             Pigments(Hb, myoglobin) 

             Protein(Ig light chains)

             Crystals(UA, MTX, acyclovir)

   Contrast induced AKI

 2.Acute interstital nephritis

   Allergy(NSAID, panicillin, sulfa)

   Infection

   Infiltration(lymphoma, leukemia)

   Autoimmune(Sjögren's syndrome, SLE)

 3.Glomerulonephritis

 4.Small vessel dz

   Embolisom(cholesterol, emboli, thrombus)

   MAHA(microangiopathic hemolytic anemia)(HUS/TTP/DIC/preeclampia)

   Anti phospholipid syndrome

   Malignant HTN