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Clinical details cause acute renal failure

Dec 30, 2016
Acute renal failure is refers to the various causes, oliguria or anuria acute renal parenchyma damage, cannot excrete metabolic product, the rapid emergence of nitrogen qualitative hematic disease, water electrolysis and acid-base balance disorders of each system function changes and produce a series of clinical syndrome.If a lot of urine, called non oliguria acute renal failure.
In general, BUN, Scr, rapid rise in the short term, the daily BUN rise by 3.57 millimoles/l o (1 mg/dl) and higher Scr 44, 2 micro mol/l (0.5 mg/dl) for acute renal failure should be considered.When elevated BUN and Scr of daily 10.7 millimoles/l (30 mg/dl), 88, 4 mol/l (1 mg/dl), should be suspected with high catabolism.Acute renal failure in its narrow sense refers to acute tubular necrosis.The cause of acute renal failure can be pided into before the kidney, kidney and kidney after three.
(1) before the kidney factors: refers to a variety of reasons cause blood volume caused by absolute or relative deficiency kidney severe ischemia, glomerular hypoperfusion, glomerular filtration rate is reduced, not in time to correct can lead to irreversible renal tissue necrosis.Common cause with cardiovascular disease such as acute myocardial infarction, arrhythmia, congestive heart failure, cardiac tamponade, etc;Infectious diseases such as bacterial sepsis and meningitis, je, epidemic hemorrhagic fever, leptospirosis, toxic bacillary dysentery, acute hepatitis or liver and kidney syndrome, acute suppurative gangrene or gallbladder cholangitis, acute pancreatitis, shock lung, etc.;Hemorrhagic shock, such as gastrointestinal bleeding, trauma, and surgical bleeding, postpartum hemorrhage, ectopic pregnancy bleeding, bleeding of placental abruption, etc.Drugs or serum allergic anaphylactic shock;A large number of dehydration cause shock, such as severe vomiting, diarrhea, paralytic ileus, heat stroke, such as diabetic ketoacidosis.
(2) renal factors: mainly for acute tubular necrosis, cause severe dehydration, blood loss and shock for a long time, drug misuse vasoconstriction caused by ischemic acute tubular necrosis;Drugs such as amino sugar glycosides (gentamicin, etc.), 2 amphotericin, mannitol, contrast agent, low molecular dextran and biological toxin (snake venom, mushroom poisoning, fish gall bladder poisoning) and the toxic heavy metals cause acute tubular necrosis, blood type unworthy, mechanical damage, severe acute nephritis, acute hemolytic disease like blackwater fever often produce a large number of hemoglobin, or crush syndrome of myoglobin, or multiple myeloma, oliguria of nephrotic syndrome, sulfanilamide and uric acid small stones in the kidney caused by renal tubular obstructive acute tubular necrosis.Primary glomerular diseases, such as the accelerated nephritis, severe acute nephritis, secondary glomerulonephritis, such as lupus kidney, allergic purpura nephritis, goodpasture's syndrome, acute interstitial nephritis, hemolytic uremic syndrome, renal vascular diseases such as renal artery infarction and renal vein thrombosis, malignant glomerular sclerosis, etc all can cause acute renal failure.
(3) after renal factors: mainly caused by urinary tract obstruction, there were stones, blood clots, reasons for the tumor oppression, mistakenly bilateral ureter, sulfanilamide and uric acid crystals, soluble protein (seen in multiple myeloma), etc.
Correct the difference between above three kinds of acute heart failure treatment of choice has important significance.Specific points as follows: (1) according to the history, a detailed analysis, specific content as described above.(2) the oliguria period shall be identified according to the urine change situation, plays an important role.(3) renal figure check: before the kidney is parabolic, but after infusion, can appear the discharge;Kidney is low graphics, after infusion without change;Renal sexual secretion after the period of rising, do not fall for 15 minutes, don't change after rehydration.(4) should be carefully distinguish between sex before renal ischemic acute renal failure and acute tubular necrosis, both tend to cause similar, there are insufficient blood volume, treatment sometimes on the contrary, such as the former should be rehydration to increase, while the latter should be limited water, sodium.Specific, besides the above method can make the following three tests: rehydration test: if add 1000 ml of liquids in 1 hour, urine volume increased to 40 ml/hour, for kidney before sex, if blood volume is correct, it doesn't increase of urine for renal tubular necrosis, should immediately stop infusion;Mannitol test: if not sure, the rehydration testing can be input in 5 ~ 15 minutes 62.5 ~ 125 ml of mannitol, 2 hours per hour of 40 ml of urine for kidney before sex, otherwise for renal tubular necrosis, should be stopped;Furosemide test: after blood volume correction, urine volume is not increased, can static note 200 mg furosemide, urine volume increased to 2 hours before kidney, or not to increase again in 100 ml of 5% glucose to add 500 mg furosemide and 10 mg of dopamine, 1 hours to upload, urine volume increased renal before sex, otherwise for renal tubular necrosis, should be discontinued.Three test shall prudently used above, the former should prevent water intoxication, excessive expansion, caused by left heart failure, the latter two will accelerate renal tubular necrosis, once found no reaction, should immediately stop using.The above three methods or prevent kidney before sex acute renal failure for the development of ischemic renal tubular necrosis, the method of visible difference between the two, is of great significance.Relates to the success or failure of rescue.

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