Acute renal failur1

Acute renal failur1 - suggests CRF. Urinary tract...

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Acute renal failure Acute renal failure is significant deterioration in renal function (over hrs/days) manifesting as abrupt and sustained increased creatinine and urea (normal 70-150 micromol/l and 2.5-6.7 mmol/L). ARF is also referred to as acute kidney injury. Symptoms Remember the AMBUSH!!! o Anaemia – reduced EPO o Metabolic acidosis – due to reduced H+ secretion. Causes hyperventilation, tachycardia o Bone pain – due to reduced vitamin D production. o Uraemia – uraemic fetor, malaise, pruritis, uraemic frost o Salt and water overload – hypertension and oedema o Hyperkalaemia – muscle weakness, arrhythmias (wide QRS and heart block) Usually, ARF occurs in context of circulatory disturbance e.g. severe illness, sepsis, trauma or surgery. More common in patients with DM, hypertension and elderly Acute Renal Failure Vs Chronic Renal Failure? Absence of anaemia, hypocalcaemia and hyperphosphataemia suggests ARF. History of diabetes mellitus, hypertension or long duration of symptoms/abnormal blood tests
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Unformatted text preview: suggests CRF. Urinary tract obstruction? • Suspect in patients with single functioning kidney, history of stones, BPH or previous pelvic surgery. • Examine for palpable bladder, pelvic mass or enlarged prostate. • Urgent Renal US to check for obstruction Causes o Pre-renal – Renal hypoperfusion due to hypovolaemia, sepsis, congestive cardiac failure, cirrhosis, renal artery stenosis, rhabdomyolysis (myoglobin released post crushing injury block the renal tubules leading to acute tubular necrosis!) or drugs such as NSAIDS/ACEI o Intrinsic - Acute tubular necrosis (damage to tubular cells caused by ischaemia), nephrotoxins, drugs (aminoglycosides, s), radiological contrast agents, uric acid crystals or myeloma. Vasculitis, glomerulonephritis, cholesterol emboli. o Post-renal – Urinary tract obstruction due to BPH, bilateral stones, clots, tumour (in tract or extra-mural – abdominal/pelvic malignancy), retroperitoneal fibrosis...
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This note was uploaded on 12/04/2011 for the course ANTHRO 2000 taught by Professor Monicaoyola during the Fall '10 term at Broward College.

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Acute renal failur1 - suggests CRF. Urinary tract...

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