Acute Renal Failure

Nephrology

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Etiology

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Clinical feature
Prerenal Renal(Intrinsic) Postrenal
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Hypovolemia

- Flank & lower abdomen

Edema, HTN Active urine sediment Allergic Sx & eosinophilia

(thirst, weight loss, decrease pain of skin tugor,

Tachycardia, hypotension, Orthostatic hypotension, Decrease of JVP)

- Hematuria - Frequency - Urgency
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- Change of urine volume

Dysuria

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Morphological feature

Prerenal ARF- renal hypoperfusion , no damage of renal parenchyma

Renal(Intrinsic) ARF- structural injury Mostly ATN- Ischemic ATN (no damage renal parenchyma) Nephrotoxic ATN (damage of renal parenchyma by toxic effect) l Postrenal ARF- urinary tract obstruction
l

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Treatment
Prerenal Renal(Intrinsic) Postrenal
l

Recovery of BP & vascular volume

No special treatment ! Urologic evalution

1. According to kinds of body fluid, But , Conservative treatment is posdetermination of replacement flu- sible Bladder catheterization id 1. Treatment & Control of complicaa.hemorrhage tion Packed RBCs+ hypotonic 2. Supplement of calory and prosaline(0.45% saline) tein(preventing of catabolism) b.plasma(e.g. burn,pancretitis) 3. If is hypervolemia, limitation of Isotonic saline salt(1-2g/day), limitation of c. Urinary or GI fluid loss water(1L/day), using Half(if severe, isotonic saline) diuretics(loop diuretics + thiazide) 2. supplement of potassium, bicar- 4. Metabolic acidosis: if is PH <7.2 bonate or HCO3<15, using of IV sodium bicarbonate 5. avoid of ACEi, NSAID, contrast etc.

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The end

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