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| Arf |
Arf
It is a life threatning condition with abrupt impairment of renal function resulting in retension of nitrogenous wastes.Oliguria n anuria is prominant feature. Etiology-pre renal-acute gastroenteritis,haemorrhage, shock,chf. Intrinsic-acute tubular necrosis, gn,hus,renal vein thrombosis. Post renal-calculus,post urethral valve. Pathophysiology-gfr n rbf r markedly decreased.Intravascularcoagulation plays role in sepsis n hus.Ischemic changes.Nephrotoxic agents cause damage. C/f-h/o anuria or oliguria.Features of underlying ilnes.In acute tubular necosis-dehydration.Oliguric phase n diuretic phase.. Lab invest-cbc n measurement of bld urea, creatinine,electrolytes,ph,bicarbonate.Ekg n chest x ray. Usg is ideal imaging tool in arf. Management-1.fluid n electrolytes-it is guided by intake n output analysis,wt., physical exam n sr.Na.. 2.Diet- 0.8 -1.0g per kg protien in infant n 50-60cal per kg. Treatment of complication-1.Fluid overload-std guidlines.Venesection. 2. Hyperkalemia-cal,na.Bicar, salbutamol,i.V glu with insulin, exchange resins. 3.Metabolic acidosis-na.Bicarbonate, dialysis in case of persistance. 4.Hypertension-leads 2 encephalopathy n heart failure. Symptomatic treated by infusion of nitroprusside,frusemide,labetalol,nifedipine. 5.Hyponatremia- ass with encephalopathy,lethargy n seizures.Fluid restriction,hypertonic saline. Supportive care-icu,urine col,antibiotics. Dialysis-2 remove endogenous n exogenous toxins.Indications-severe hyper kalemia,chf,pul oedema,sever acidosis,etc.Both haemo n peritoneal dialysis r effective.
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