~Teachingcenter的醫學筆記~

急性腎衰竭
可以分為腎前、腎性、腎後

尿素氮 = BUN = blood urea nitrogen，單位mg/dL，正常值6~22 mg/dL
尿滲透壓 = urinary osmolality，單位mOsm/L，正常值500~850 mOsm/L
※脫水狀態：800-1400 mOsm/L；過量飲水：40-80 mOsm/L
尿鈉 = urinary sodium，單位mEq/L，正常值未界定(但正常狀態多為>20)
鈉排出率 = FENa = fractional excretion of sodium，單位%，正常值未界定
※FENa = (尿鈉/尿肌酐酸)/(血清鈉/血清肌酐酸) × 100%
 

Indication for Hemodialysis
(adapted from Sabiston Textbook of Surgery – The Biological Basis of Modern Surgical Practice, 19^th edition, p304)
= Serum potassium > 6.5 mEq/L
= Blood urea nitrogen > 90 mg/dL
= Persistent metabolic acidosis
= Acute fluid overload
= Uremic symptoms (pericarditis, encephalopathy, anorexia)
= Removal of toxins
= Platelet dysfunction causing bleeding
= Hyperphosphatemia with hypercalcemia

個人比較喜歡以下急洗腎的標準：

（一）寡尿症(<500cc/day)持續24小時

（二）無尿症(<50cc)持續12小時

（三）嚴重酸血症(pH<7.1~7.2)

（四）高血鉀症(K+>6.5 mEq/L)

（五）氮血症(BUN>85 mg/dl)

（六）器官急性水腫(如肺水腫)

（七）尿毒性心包膜炎

（八）尿毒性腦病變