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IRA[1] (1)

IRA[1] (1)

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Published by KatarynaPatriche

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Published by: KatarynaPatriche on Jan 03, 2010
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09/05/2010

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INSUFICIEN T A RENALA ACUTA (IRA)
DEFINITIE
:Sindrom clinico-biologic provocat de suspendarea brusca a functiei renale;caracterizat prin:
oligurie: scaderea diurezei sub 1 ml/kg/ora la sugar, sub 0,5 ml/kg/ora lacopilul sau sub 300 ml/m2/zi la copilul mare;
tulburari hidro-electrolitice si acido-bazice,
alterarea excretiei substantelor azotate si a altor cataboliti (retentie deuree, creatinina, acid uric, fosfati, sulfati)
EPIDEMIOLOGIE
Variaza în functie de vârsta, zona geografica; se întâlneste cu o frecventamai mica la copil decit la adult; avand si o evolutie mai rapida; mortalitatemai mica la copil.
CLASIFICARE ETIOLOGICA11.Insuficienta acuta prerenala:
► socul hipovolemic
: deshidratare acuta, hemoragii, arsuri, diabet insipid
hipoxia severa
: detresa respiratorie (la nou-nascut), înec
soc infectios
2.Insuficienta renala intrinseca
: afectarea parenchimului renal intereseazafunctia glomerulara, tubulara sau ambele.
 
afectarea glomerulara primara
: glomerulonefrite, sd.nerotic;
nefrita interstitiala
-
medicamente
:
antibiotice, interferon-infectii sistemice: hepatita virala cu virus B sau virus Epstein- Barr
 
afectari sistemice
:
SHU, LES, granulomatoza Wegener, endocarditabacteriana;
 
afectiuni vasculare
: ocluzie de a.renala, tromboza v. renala;
 
toxice
-
medicamente
:-
AINS, antibiotice, chimioterapice;
 
- metale grele si solventi organici: plumb,mercur, etilenglicol;
-
toxine endogene: hemoglobina, mioglobina, acid uric;
3.Insuficienta acuta postrenala:
datorata scaderii/anularii presiunii eficiente defiltrare;- in boli obstructive(hidronefroze, stricturi uretrale,valva de uretra) tumori,litiaza;
PATOGENIE
1
 
Necroza corticala sau tubulara
HemoragieDeshidratare severaSepsisArsura termicaAsfixie
Necroza tubulara proximala
ToxineTetraclorura de carbonEtilenglicolSulfamideKanamicinaMercur, plumb
 
Afectare glomerulara
SHU Nefrita acuta rapid progresiva, Sd. Goodpasture,LES,Vasculita
Ischemie prelungita
Obstructie tubulara si vasculara
Acid uricMioglobinurieTromboza vena renala
IRA

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