Sunday, August 29, 2010

Signs and Symptoms of Acute Renal Failure

Is this a sudden drop in kidney function, usually characterized by higher levels of blood urea nitrogen (BUN, BUN) and creatinine, oliguria (less than 500 ml of urine within 24 hours), the hyperkalemia, and sodium retention.
Acute renal failure is divided as follows
  • Prerenal - results from the conditions of interruption of blood flow in the kidneys, which reduces renal perfusion (hypovolemia, shock, hemorrhage, burns, impaired cardiac output, diuretics).
  • Postrenal - the obstruction of urine flow.
  • Intrarenal - results of a kidney injury (ischemia, toxins, immunological processes, system and blood vessels).
The disease progresses through three distinct phases of clinical anuric oliguric, diuretic, and recovery is primarily distinguished by changes in urine and serum creatinine and urea. Complication of ARF include dysrhythmias, increased susceptibility to infection, electrolyte imbalance, gastrointestinal bleeding from stress ulcers, and multiorgan failure. Untreated ARF can also describe the progress of chronic renal failure, renal failure and terminal uremia, or death from related causes.
  • Anuric-oliguric phase: urine volume below 400 ml per 24 hours, increased serum creatinine, urea, uric acid, organic acids, potassium and magnesium should be 3-5 days in infants and children 10-14 days and young adults.
  • Diuretic phase: begins when the urine output exceeds 500 ml per 24 hours, ending with the BUN and creatinine are increasing, the length available.
  • Recovery phase: asymptomatic; take several months to a year, some scars may remain.
  • In functional kidney disease: decreased tissue turgor, dry mucous membranes, weight loss, flat neck veins, hypotension, tachycardia.
  • In the post-renal disease: changes difficulty urinating in the flow of urine.
  • The intrarenal disease: presentation of different, usually a swelling may have fever, rash.
  • Nausea, vomiting, diarrhea, lethargy and may also occur.
Test Evaluation
  1. Urinalysis shows proteinuria, hematuria, casts. urine chemistry distinguishes different forms of ARF (renal replacement therapy, post-renal, intrarenal).
  2. Levels of creatinine and urea 2.Serum are high, blood gas (ABG) level of electrolytes in serum may be invalid.
  3. Untrasonography Renal estimate the size and treat kidney exclude obstructive uropathy.
Pharmacological and therapeutic interventions:
  • Surgical barriers may be necessary.
  • Corrections surplus or deficit of base fluids.
  • Correction and control of the biochemical balance.
  • Restore and maintain blood pressure with IV fluids and vasopressors.
  • Maintain adequate food: diet low additional amino acids and vitamins.
  • Initiation of hemodialysis, peritoneal dialysis, or continuous renal replacement therapy in patients with progressive azotemia and other potentially fatal complications.
  • Monitor the volume of urine for 24 hours following the clinical course of the disease.
  • Monitor BUN, creatinine and electrolytes.
  • Level monitoring of GBS as necessary to evaluate the acid-base balance.
  • Weigh the patient to provide the index of fluid balance.
  • Measuring blood pressure at different times of the day in the supine, sitting and standing positions.
  • Adjust fluid intake to prevent volume overload and dehydration.
  • Watch arrhythmias and heart failure with hyperkalemia, electrolyte imbalance and fluid overload. Is resuscitation equipment available in case of cardiac arrest.
  • Beware of urinary tract infections, urinary catheter, and remove as soon as possible.
  • Use of pulmonary critical care, because the incidence of pulmonary edema, and infection is high.
  • Providing wound care.
  • We carbohydrate diet rich in carbohydrates, because they have more protein and energy savings to provide extra calories.
  • Institute seizure precautions. Benefits padded rails and airways, and suction devices at the bedside.
  • Encourage and assist the patient to turn and go because the drowsiness and lethargy may limit activity.
  • Explain that the patient may experience residual renal defects for a long period after the acute illness.
  • Encourage the patient to report a routine urine test, and other research.
  • Recommend the resumption of activity gradually, because muscle weakness will be present from the excessive catabolism.

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