Acute renal failure

Acute renal failure

Acute renal failure

DEF.

Rapid Reversible deterioration in renal function sufficient to result in accumulation of nitrogenous waste in body.

ETIOPATHOLOGY.

1 At rest 25% of co to kidney

2 in prerenal :- inadequate perfusion lead to decrease GFR lead to oliguria




3 post renal: obstruction of urine out flow


CAUSES.

A) prerenal
     1) hypovolumeia
:-hemorrhage
-sever vomiting
-diarrhne
- los of plasma
:-burn
:-pancreatitis
:- excess of diuretics
:- diabetic ketoacidosis

      2 reduce co
:-heart failure septic shock

     3 renal vessel disease
 :- renal artery occlusion

     4drug
:-ace inhibitor

B) renal
   1 glomular. -GN
   2 interstitial- drug infection
   3 act tubular necrosis
        --malaria.
        INJURY
        heavy metal.
        septic Abortion
    4 vascular
        vasculitis
        Renal artery occlusion

C) post renal
        1 extrarenal obstruction
        prostatic enlargement
       urethral stenosis

        2 intrarenal obstruction
          uric acid crystal

          slough papilla

C/F

1 Low blood Pressure

2 falling urine output

3 acute tubular necrosis is  most imp cause of it .it consist
    a) oliguric phase
         1 wit fluid overload n azotaemia .
         2 Elevation of JVP
         3 Pedal edema
         4 ascitis
         5 pulmonary edma.
         6 HyperK

    b) maintainance  phase:-
          1 low urine output

    c ) diuretic phase.:-
        1 polyuria lead to dehydration and hypoNa hypoK



4 40% of ATN develop NON OLIGURIC RENAL FAILURE

5 GN typically hav HT proteinuria hematuria

6 obstruction hav loin pain hematuria.

7 Sym of uremia:-
vomiting
pluritius
asterix
pericardial rub.



Investigation.:-

1 elevated blood urea

2 elevated blood creatin

3 hypoNa

4 hyperK hypoCa

5 hyperPo4

6 urine show
red cel cast.
Proteinuria .
Graularcast.

7 ECG

8 chest x ray

9 kidney biospy

10 USG


aMANAGEMENT

1 CORRECTING fluid  and electro imbalance

2 underlying cause

3 hyperK TREATMENT

4 acidosis by NaHCO3

5 loop diuretic. Mannitol

6 hemodialysis

        Indication. 1symptomatic uremia
           2 Sr.Creatinin > 8 mg/dl
            3 resistant hyperK
           4refractoy pulmonary edema

7 dietary protein restriction

8 salt restriction

9 energy in form CHO

10 RPGN is treated by corticosteroid