Acute renal failure (ARF) is a common and serious problem in clinical medicine. It is characterized by an abrupt reduction (usually within a 48-h period) in kidney function. This results in an accumulation of nitrogenous waste products and other toxins. Many patients become oliguria (low urine output) with subsequent salt and water retention. In patients with pre-existing renal impairment, a rapid decline in renal function is termed ‘acute on chronic renal failure’. The nomenclature of ARF is evolving and the term acute kidney injury (AKI) is being increasingly used in clinical practice.
AKI is not a single disease state with a uniform etiology, but a consequence of a range of different diseases and conditions. The most useful practical classification comprises three main groupings: (i) prerenal, (ii) renal, or (iii) postrenal. More than one category may be present in an individual patient.
This is caused by impaired perfusion of the kidneys with blood, and is usually a consequence of decreased intravascular volumes (hypovolemia) and/or decreased intravascular pressures.
The signs and symptoms of AKI are often nonspecific and the diagnosis can be confounded by coexisting clinical conditions. The patient may exhibit signs and symptoms of volume depletion or overload, depend upon the precipitating conditions, a course of the disease and prior treatment.
In hospitalized patients, AKI is usually diagnosed incidentally by the detection of increasing serum creatinine and/or a reduction in urine output.
Maintaining appropriate fluid balance in AKI is a critical component of the clinical management of the patient.
can be measured following insertion of a central venous catheter, and is a measure of the pressure in the large systemic veins and the right atrium produced by venous return.
Serum electrolytes including potassium, bicarbonate, calcium, phosphate and acid–base balance should be measured on a daily basis.
Dietary potassium should be restricted to less than 40 mmol/ day and potassium supplements and potassium-sparing diuretics removed from the treatment schedule.
It may be treated orally with sodium bicarbonate 1–6g/day in divided doses, or 50–100 mmol of bicarbonate ions (preferably as isotonic sodium bicarbonate 1.4% or 1.26%, 250–500mL over 15–60 min) intravenously may be used.
It is indicated in a patient with AKI when kidney function is so poor that life is at risk. However, it is desirable to introduce renal replacement therapy early in AKI, as complications and mortality are reduced if the serum urea level is kept below 35 mmol/L.
The common types of renal replacement therapy used in clinical practice are:
This post was last modified on May 25, 2017 5:10 pm
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