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肾前性氮质血症(功能性肾功能不全)或急性肾小管坏死所引起的急性肾功能衰竭临床上常难以鉴别。测定滤过钠的排出部分(简称FeNa)可帮助鉴别。因为急性少尿期肾小管处理钠的方式不同,在肾前性氮质血症者,肾小管回吸收钠增强;而急性肾小管坏死者,钠的回吸收受限制,所以二者的FeNa不同。肾前性氮质血症可继发于各种原因的循环衰竭(如急性心肌梗死,心瓣膜病,开放式心脏手术,败血症等),血液和体液大量丢失(胃肠道、肾或手术)的低血容量者。其诊断依据:循环衰竭在改善了心脏功能,利尿,纠正休克后,尿量及肌酐清除率迅速恢复。低血容量在输血、补液及补电解质后有同样效果。急性肾小管坏死发生于肾毒性药物(如庆大霉素、
Acute renal failure caused by prerenal azotemia (functional renal insufficiency) or acute tubular necrosis is often clinically difficult to identify. Determination of sodium filtration part of the discharge (referred to as FeNa) can help identify. Because acute oliguric tubular treatment of sodium in different ways, in patients with prerenal azotemia, renal tubular absorption increased sodium; and acute tubular necrosis, sodium absorption back to limit, so the two different FeNa . Prerenal azotemia can be secondary to circulatory failure for a variety of reasons (eg acute myocardial infarction, valvular heart disease, open heart surgery, septicemia, etc.), massive loss of blood and body fluids (gastrointestinal, renal or surgical) Of hypovolemia. The diagnosis is based on: circulatory failure in improving cardiac function, diuretic, correct shock, rapid recovery of urine output and creatinine clearance. Low blood volume after transfusion, fluid replacement and electrolyte have the same effect. Acute tubular necrosis occurs in nephrotoxic drugs (such as gentamicin,