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| 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
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