Acute renal failure - develops over hours, days, weeks, renal dysfunction.
Impaired renal blood flow and cause intoxication 90% of all cases.
Causes
- acute heart failure (Including cardiogenic shock arrhythmia);
- septic, anaphylactic shocks;
- prolonged vomiting, diarrhea, Bums, dehydration resulting from major surgery, prolonged use of diuretics, or laxatives;
- blood loss;
- cirrhosis liver ascites;
- nephrotic syndrome;
- peritonitis;
- poisons - bites of poisonous snakes and insects;, organic solvents - glycols, carbon tetrachloride, dichloroethane; heavy metals - mercury, lead, gold, copper, arsenic, barium; X-ray contrast agents; drugs - antibiotics (gentamicin, cyclosporine); bacterial toxins - sepsis;
- crush syndrome;
- electrical accident;
- frostbite;
- long asthmatic status;
- coma;
- destruction of red blood cells;
- uric acid crystals (gout, myeloma, Cytostatics treatment of leukemia);
- oxalates;
- inflammation of kidney tissue;
- blockage of the urinary tract (ureter blockage stones, tumor compression);
- spinal cord lesions.
Symptoms of acute renal failure
Initial stage.
1-3 days - the period of the initial action factors (shock, sepsis, poisoning). Predominant symptoms of the main disease.
Oliguric stage.
Develops within 1-3 days. after exposure to adverse factors.
Typical manifestations following: reducing the volume of urination (urinary day allocated less than 500 ml / day most patients 3-10% - urine less than 100 ml / day.); 10-30% of patients develop excessive urination, swelling, lethargy, loss of appetite, nausea, vomiting (watch the first few days), drowsiness, lethargy appear muscular twitching, irregular heartbeat, increased blood pressure - in some patients, shortness of breath, abdominal pain, liver enlargement.
Step Recovery diuresis.
Early stage - Days 5-10: gradual increase in urine output over 500 ml / day.
Step polyuria: ameliorated by decreasing the level of urea and creatinine in the blood and restore the balance of the internal environment.
stage recovery.
Full recovery of kidney function. The duration of 1 year or more.
Diagnostics
- Blood analysis;
- Urinalysis;
- Urine culture;
- Determination of total blood volume;
- ECG;
- Arteriography (suspected narrowing of the renal artery or a dissecting aneurysm of the abdominal aorta);
- Cavagraphy (upward with suspected thrombosis IVC);
- ultrasound;
- Isotopic dynamic scanning kidney;
- Tomography;
- cystochromoscopy;
- Retrograde pyelography.
Treatment of acute renal failure
- The patients are subject to mandatory hospitalization.
- Exception causes leading to acute renal failure - discontinuation of medication, treatment of infective diseases, poison removal and others.
- furosemide at a dose of 100-400 mg / in the presence effect - at a dose of 2-3 mg / kg / a in combination with mannitol at a dose of 0.5-1 g / kg / in through a separate catheter.
- dopamine 2-3 mcg / kg / min. If no effect or growth creatinine 6-12 hours introduction is stopped.
- Infusion therapy glucose-saline (isotonic sodium chloride solution, glucose solution).
- Correction of anemia: red blood cell transfusions. Erythropoietin drugs are not used.
- plasmapheresis: Leaving the plasma substitute fresh frozen plasma, albumin solution.
- Hemodialysis or peritoneal dialysis: indications - urea content in plasma is greater than 24 mmol / l potassium for more than 7 mmol / l, uremic toxicity (sedation, nausea, vomiting). Contraindications - hemorrhagic syndrome, shock, only operation that produced on the abdominal organs. If it is impossible dialysis - washing stomach and intestine a large number of weak liquor sodium hydrogen carbonate (10 l solution of 2 times a day) by using special probes and dual siphon enemas.
Course and prognosis
In uncomplicated probability of full recovery of renal functions in patients who have experienced an episode of acute renal failure, it is 90% for the next 6 weeks. Full recovery functions noted in 35-40% of cases, partial - 10-15% transition into chronic renal insufficiency - 1-3%.