Case of acute renal failure
11
د.اﺣﻤﺪ ﻋﺰو
ARF: is the sudden decline in
r
enal function (hours-weeks), with associated
decrease in GFR and urine output, and increased blood urea nitrogen
(azotemia) and serum
creatinine.
Causes
Uremia S&S
Symptoms:
Weakness.
Tiredness.
Easily fatigability.
Nausea
central cause (waste products in the blood stimulate the vomiting centers,
rise of ICP which called brain edema), local cause (GIT causes like gastric upset and
edema of gut wall).
CNS problems
uremic encephalopathy.
Bleeding tendencies
hematuria, GIT bleeding, skin bleeding
all are due to
platelets dysfunction and affected liver function and fragility of blood vessels.
Sings:
General signs:
Earthy color
due to deposition of urea metabolite and due to anemia (pallor).
Bleeding tendency in skin and mucus membrane.
Pallor of the hand.
Brown sign in nails.
Large volume pulse.
Case of acute renal failure
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Flapping tremor.
Site of dialysis could lead to fistula (in radial artery).
Hypertension (cause and result).
Elevated JVP
due to hypervolemia (could be normal if patient in
acute failure ordehydrated).
Central venous catheter
in femoral, jugular, cervical veins,
Signs of anemia in the mouth
cheilosis, atrophy of papillae.
Eye
pallor, jaundice due to liver disease (cause or result or systemic disease).
Bilateral pitting edema.
Local sings:
Abdomen
ascites, scar, small size kidney.
Genetalia
scrotal edema, hydrocele, examine external urethral meatus.
PR
palpate the prostate.
Per-vaginal examination.
Chest examination
plural effusion, pericarditis, acute heart failure.
Foly catheter types
KUB(how to interpret):1-name 2-markers(Rt&Lt) &AP &position(projector from Ant.
and reciever from post.)
3-sex(from name & shape of plevis)
4-lower two rib +upper part of femur+symphesis pubis)
Lumber vertabrae(
ﻣﮭم ﺟدا ﺗﺷوﻓﮫ اﺣﺗﻣﺎل ﻋﻧدھﺎ
OA changes )
(واﺣﺗﻣﺎل ﺗﺣﺗﺎج ﻧﺎظور وﻧﺳوﯾﻠﮭﺎ ﯾﻠﮭﺎ ﺑﺎل
lithiotomy posion)
Stone shadow appear in colon shadow ----So Do CT
Ureteric catheter __to allow the urine bypass obstruction temporarily
Case of acute renal failure
13
Mx of ARF
1-differiantiate b/t Surgical & medical case
-Hx
-Ex :to conforn the uremia
-UOP (measered by bottle or foly cathter)
*oliguria<400mm
*anuria<100mm/24hr
2-Investigation ;
GUE: value--
Osmolarity if increased-----pre-renal cause
-imaging study:-X-Ray (plain&KUB)
-CT
-U/S
-IVU--is C/I bz of uremia
**CT advantages:-no contrast
-extrarenal pathology
-cortical thickness
-grade of hydronephrosis
-3D coronal sagital section
3-give pt chance of spontaneous resolution by fluid challange-
By giving-N/S 500cc with
-1-2hr with lazix(20-40mg)
-depend on the hymodynamic state of pt
-can also give osmotic solution
If enhanced what does it mean= prerenal or small stone has been bypassed
4-Temporary measures are:-pain relief inj.
-NSAID
-Pethedin (which better than morphin bz :morphin having :
High spasmotic activty which increase the pain of obstruction
-IVF (especially prerenal)
-Antiemetic
-ABiotic if there is inf.:fever& abnormal GUE & CBC
5-admit to hospital -And do ureteric cather
-percutaneos nephrostomy
advantage -under local Anaesthesia
-less invasive
Disadvantage:-
ﻣﺎ ﺳﻤﻌﺘﮭﺎ وﻻ اﺣﺪ ﻛﻠﻲ ﻋﻠﯿﮭﺎ
6-Definitive measure : Rx of underlying medical or surgical cause
Done by:H.A.Abdulkarim