Yucha C B, Shapiro J I
University of Colorado School of Nursing, Denver, USA.
Lippincotts Prim Care Pract. 1997 Sep-Oct;1(4):388-98.
Acute renal failure remains a devastating syndrome associated with a high mortality rate. Accurate and rapid etiologic diagnosis is critical, since it may be possible to stop the injurious process and prevent further progression of renal insufficiency. To do this, one must understand and differentiate among the three broad categories of disorders that can cause acute renal failure-prerenal, postrenal, and intrarenal processes. This article compares and contrasts these three categories in regard to causes and predisposing factors, history and physical examination, urinalysis, and urine chemistries. Treatment focuses on correcting prerenal and postrenal factors; treating acute complications, such as hyperkalemia, hyponatremia, acidosis, and pulmonary edema; optimizing cardiac output and renal blood flow; and adjusting doses of drugs consistent with renal failure.
急性肾衰竭仍然是一种与高死亡率相关的毁灭性综合征。准确而快速的病因诊断至关重要，因为有可能阻止损伤过程并防止肾功能不全的进一步进展。要做到这一点，必须了解并区分可导致急性肾衰竭的三大类疾病——肾前性、肾后性和肾内性病变。本文就病因和易感因素、病史和体格检查、尿液分析以及尿生化方面对这三类疾病进行了比较和对比。治疗重点在于纠正肾前性和肾后性因素；治疗急性并发症，如高钾血症、低钠血症、酸中毒和肺水肿；优化心输出量和肾血流量；以及根据肾衰竭调整药物剂量。
