ACUTE RENAL FAILURE
Sudden
reduction in renal function (oliguria / anuria with urine output <
1ml/kg/hr) with azotemia (raised s/creatinine)
Evaluation
- History of anunia, oliguria, hematuria, dysuria, throat / skin
infection, drug intake, vomiting / diarrhea, burns
- Dehydration, puffy face, edema, ascites, effusion
- Vital signs T,P,R,BP.
- Visceromegaly : Liver, Kidney, bladder,
- signs of heart failure
- Funduscopy along with signs of CNS involvement
Investigation:
- CBC, ESR
- S/Na, K+, Urea, creatinine
- Ca, P, ASOT, C3, ABG
- Urine examination + c/s
- ABD USG esp KUB areas
- CXR, ECG for K+
Management
- Pass IV line
- Flow sheet:
- T, P, R, B.P, strict Intake / output record
- Conscious level assessment
- If anunia / shock, give 20 ml / kg N/saline or Ringer lactate
rapidly over ½ hr, then assess.
- Watch for passage of urine
- Give 90 ml/kg N/Saline in 3 hrs, again review progress.
- In case of persistent oliguria / anuria and normal BR, give
Furosemide IV 2 mg/kg. If no improvement, repeat furosemide 4 mg/kg within
2 hrs.
- If hypertension exists, give antihypertensives Nifedifine 0.2 –
0.5 mg / kg/dose or Labetolol / Captopril. If hypertensive encephalopathy,
Sublingual
- Nifedifine or Apresoline 0.5—1.5 mg / kg / day
- Fluid is restricted in established renal failure with only 400
ml/M2/24 hr + Urine / Stool output.
- Give 300 Cal/M2/day as Glucose solution (10%)
- Watch for hyperkalemia (prolonged PR interval, ST wave changes,
peak T-Wave, wide QRS). Manage with following measures :
- Give Calcium Gluconate (10%) 1-2ml/kg slow, dilute with cardiac
monitoring
- Inj. NAHCO3 1-2 ml/kg
- Nebulized Ventolin
- Glucose 0.5-1 gm/kg followed by 0.1/unit insulin/kg
- Kayexalate ion exchange resins like Na/Polystyrene sulfonate
- Acidosis: Do ABG, calculate base deficit, give bicarb
- Treat hyperphosphatemia
with Aluminium hydroxide gel 1ml/kg/d orally with food.
- Antibiotics. (give Penicillin in poststreptococcal AGN, treat
UTI appropriately.)
- Peritoneal Dialysis indications :
Uncontrolled
fluid overload, uncontrolled hyperkalemia, resistant metabolic acidosis,
Encephalopathy, pericarditis, uncontrolled azotemia
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