Acute Renal Failure
First Things First (assess & treat for the following)
- Is there an acute increase in BUN or serum creatinine?
- Is pt oliguric (100-500 mL/d), anuric (< 100 mL/d) or polyuric (>500 mL/d)?
- If anuric, think complete urinary tract obstruction, bilateral renal arterial or venous occlusion, bilateral cortical necrosis, overwhelming acute tubular necrosis (ATN) or glomerular nephritis (GN).
- If polyuric, think recovery phase ATN, interstitial nephritis, partial intermittent obstruction, postobstructive renal failure (RF).
- Place bladder catheter to rule out or relieve lower urinary tract obstruction.
- Collect urine sample for analysis, lytes & creatinine prior to interventions (eg, diuretics).
- Assess & correct volume status & electrolyte abnormalities.
- Avoid further renal insult such as hypovolemia, hypotension, nephrotoxins.
- Adjust dosages of all renally excreted drugs.
- Identify & aggressively treat potentially reversible causes of RF.
- Is it prerenal, renal or postrenal?
- Hypovolemia (GI, renal, skin losses, hemorrhage, third-spacing)
- Decreased effective intravascular volume (hypoalbuminemia, cirrhosis, nephrotic syndrome, left ventricular cardiac failure, vasodilator therapy, anesthetics, anaphylaxis, sepsis)
- Renal artery occlusion
- Autoregulatory failure in states of renal hypoperfusion, due to NSAIDs, ACE inhibitors
- Acute GN (Goodpasture’s, SLE, Henoch-Schonlein, poststreptococcal)
- Vasculitis/immune complex disorders: hemolytic uremic syndrome (HUS), thrombotic thrombocytopenic purpura (TTP), polyarteritis nodosa (PAN), Wegener’s granulomatosis
- Malignant HTN
- Bilateral renal vein thrombosis
- Acute interstitial nephritis (AIN)
- Toxins (eg, aminoglycosides, cyclosporine, myoglobin)
- Drug hypersensitivity
- Immunologic disorders
- Ureteral obstruction (bilateral or solitary kidney)
- Lower tract obstruction (bladder neck or urethra)
- Intrarenal: tubular occlusion (eg, crystals, protein, pyogenic debris, stones, blood clots, papillary necrosis)
Acute Renal Failure has been found in Pocket ICU Management
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