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Renal Failure

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الكلية كلية الطب     القسم  الجراحة     المرحلة 4
أستاذ المادة الاء عبد الوهاب خليل البياتي       25/05/2017 06:20:49
Renal Failure Prof.Abdulrazzaq Al Salman
Acute renal failure: The new terminology acute kidney injury (AKI):
AKI is a condition in which the glomerular filtration rate is abruptly reduced, causing a sudden retention of endogenous and exogenous metabolites (urea, potassium, phosphate, sulfate, creatinine, administered drugs) that are normally cleared by the kidneys. The urine volume is usually low (<400 mL/day). If renal concentrating mechanisms are impaired, the daily urine volume may be normal or even high (high-output or nonoliguric renal failure). In extreme cases, anuria occurs
(urine output completely shuts down) in acute kidney injury.
The causes of AKI are listed
I. Prerenal: The term prerenal denotes inadequate renal perfusion or lowered effective arterial circulation. The most common cause
1. Dehydration(due to renal or extrarenal fluid losses from diarrhea, vomiting, excessive use of diuretics, and so on.)
2. Vascular collapse due to sepsis, antihypertensive drug therapy,
“third spacing”
3. Reduced cardiac output.
Prerenal causes are usually reversible if treated promptly, but a delay in therapy may allow it to progress to a fixed intrinsic renal failure
(eg, acute tubular necrosis).
Clinical feature: patients usually complain of thirst or of dizziness in the upright posture ( orthostatic dizziness). Weight losses reflect the degree of dehydration. Physical examination frequently reveals decreased skin turgor, collapsed neck veins, dry mucous membranes, and, most importantly, excessive orthostatic or postural changes in blood pressure (defined as a systolic drop >20 or a diastolic drop >10 mm Hg) and pulse.
Management: The urine volume is usually low. Accurate assessment
may require bladder catheterization followed by hourly.
Rapid intravenous administration of 300–500 mL of physiologic saline is the usual initial treatment. Urine output is measured over the subsequent 1–3 hours. A urine volume increase of >50 mL/h is considered a favorable response that warrants continued intravenous infusion.
In states of dehydration, fluid losses must be rapidly corrected to treat oliguria. If oliguria and hypotension persists in a well-hydrated patient, vasopressor drugs are indicated in an effort to correct the hypotension associated with sepsis or cardiogenic shock. Pressor agents that restore
systemic blood pressure while maintaining renal blood flow and renal function are most useful. However, the previously touted benefits of renally dosed dopamine (1–5 ?g/kg/min) have not been proven. A more promising agent might be fenoldopam, a direct dopamine A-1 receptor agonist.


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