Godin M, Le Roy F, Legallicier B
Service de néphrologie, Hôpital de Boisguillaume, Centre hospitalier universitaire de Rouen.
Rev Prat. 1995 Sep 1;45(13):1627-32.
Prerenal acute renal failure is defined as a reduction in the glomerular filtration rate due to a primary disturbance in renal hemodynamics in the absence of any structural kidney damage. In case of moderate hypotension or hypovolemia, a number of adaptative systemic and intrarenal responses preserve renal perfusion and filtration rates, particularly by inducing a marked reduction in preglomerular arteriolar resistance and an increase in postglomerular resistance. However, these mechanisms are inherently limited. In the presence of advanced circulatory failure or iatrogenic pharmacologic interventions compromising these renal defense mechanisms, prerenal failure becomes evident. Therefore, prerenal failure may occur during acute hemodynamic disturbances due to hypovolemia or systemic vasodilatation, in severe cardiac failure, in cirrhosis with ascites, and in certain clinical situations following administration of nonsteroidal antiinflammatory agents or angiotensin converting enzyme inhibitors. The treatment depends on the underlying cause.
在没有任何肾脏结构损伤的情况下，由于肾脏血流动力学的原发性紊乱导致肾小球滤过率降低。在中度低血压或血容量不足的情况下，一系列适应性的全身和肾内反应可维持肾灌注和滤过率，特别是通过显著降低肾小球前小动脉阻力和增加肾小球后阻力来实现。然而，这些机制本质上是有限的。在存在严重循环衰竭或医源性药物干预从而损害这些肾脏防御机制的情况下，肾前性肾衰竭就会变得明显。因此，肾前性肾衰竭可能发生在因血容量不足或全身血管扩张导致的急性血流动力学紊乱期间、严重心力衰竭时、肝硬化腹水患者中以及在使用非甾体类抗炎药或血管紧张素转换酶抑制剂后的某些临床情况下。治疗取决于潜在病因。
