《肝肾综合征》课件.ppt

肝肾综合征概述(Hepatorenal-Syndrome,HRS);1、基本概念;⑵、特点;;2、发病机理(pathophysiology);;HRS的病理生理学图示;二次损伤学说;3、诊断标准;; 诊断标准：;3.Absence of shock, ongoing bacterial infection, and current or recent treatment with nephrotoxic drugs 4. Absence of gastrointestinal fluid losses (repeated vomiting or intense diarrhea). ;5. Absence of renal fluid losses (weight loss 0.5 kg/day for 5 days in patients with ascites without peripheral edema or 1 kg/day in patientswith peripheral edema). ; 6. No sustained improvement in renal function (decrease in serum creatinine to 1.5 mg/dL [135 mol/L] or increase in creatinine clearanceto 40 mL/min) after diuretic withdrawal and expansion of plasma volume with 1.5 L of isotonic saline.;7. Proteinuria 0.5 g/day and no ultrasonographic evidence of obstructive uropathy or parenchymal renal disease.;Additional criteria1. Urine volume 500 mL/day.2. Urine sodium 10 mmol/day.3. Urine osmolarity greater than plasma osmolarity.4. Urine red blood cells 50 per high power field.5. Serum sodium concentration 130 mmol/L.;鉴别诊断;Infections;Circulatory failure;Differential Diagnosis;4、临床分型;;;;5、预防：;;;;;;6、治疗;;;药物治疗;侵入性治疗;肝移植;治疗思路：;;谢 谢！