686肾替代性治疗.ppt

Renal Replacement Therapy(RRT)腎替代性治療
By R4董國盈
Acute Kidney Injury (AKI)[Acute Renal Failure ARF]
Prevention
Identification of high-risk patients for pharmacologic agents-induced nephrotoxicity
iodinated radiocontrast medium, NSAIDs
Aggressive surveillance for nephrotoxin-induced renal dysfunction
cisplatin, amphotericin B, aminoglycoside
Use of volume expansion in selected clinical settings
Hyperpigmenturia: hemoglobinuria, myoglobinuria
Crystaluria: uric acid, acyclovir, methotrexate, sulfonamides
Minimalization of catheters use to avoid ial sepsis
Etiology Treatment
Correct postrenal factor
Correct prerenal factor
Treat underlying sepsis
Stop nephrotoxic drugs
Evaluation of intravascular volume
Guide of Volume Expansion
CVP 8-14 cm H2O
PAWP 12-16 mmHg
Urine output -
Weighing the patient daily
Insensible water loss from the skin and respiratory tract (500 ml/day)
Conservative Measurement
Fluid balance
Careful monitoring of I/O and body weight
Fluid restriction
(usually less than 1 L/day in oliguric ARF)
Total intake < urine output + extrarenal losses
Electrolytes and acid -base balance
hyperkalemia
hyponatremia
Keep serum bicarbonate >15
hyperphosphatemia
Treat hypocalcemia only if symptomatic
Uremia-nutrition
Restriction protein but maintain caloric intake
Carbohydrate ≥ 100gm/day to minimize ketosis and protein catabolism
Drug
Review all medication, Stop magnesium-containing medication
Adjusted dosage for renal failure, Readjust with improvement of GFR
Conservative Measurement
Dietary modification
Total caloric intake– 35~ 50 kcal/kg/day
to avoid catabolism
Salt restriction– 2~4 g/day
Potassium intake– 40 meq/day
Phosphorus intake– 800 mg/day