Eng / Emergency situation

Prerenal form of acute renal failure

with a deep disorder of blood circulation and perfusion of the kidneys with

infectious-toxic

dehydration or

anaphylactic shock

and a decrease in blood pressure below 70 mm Hg.

Prolonged (more than 8 hours) hypotension leads to hypoxia, acidosis and irreversible changes in the kidneys.

Renal form of acute renal failure

is a consequence of the

primary lesion of nephrons the endothelium of the renal tubules in leptospirosis and hemorrhagic fever with renal syndrome.

DIC plays an important role in pathogenesis.

As a result of hypoxia, nephronecrosis occurs, the excretory function of the kidneys decreases or stops

content of urea and creatinine increases in the blood.

Azotemia leads to a dysfunction of the central nervous system - encephalopathy.

Metabolic acidosis, hyperkalemia, decreased urine output contribute to overhydration of the body with the threat of pulmonary edema, cerebral edema, or acute heart failure.

Subrenal (postrenal) form of acute renal failure

develops with occlusion of the urinary tract a

can turn into renal due to increased intratubular pressure and impaired renal microcirculation

Stages of acute renal failure

Initial (pre-oliguric)

at the height of the disease, against the background of shock, the content of creatinine and urea, sodium and potassium in the blood increases;

Oliguric - daily diuresis below 500 ml, anuria - diuresis less than 50 ml / day (clinically - signs of hyperhydration, uremic syndrome: signs of damage to the central nervous system, gastrointestinal tract, progressive anemia, polyserositis), badycardia up to asystole

Polyuric increase in diuresis up to 4 l / day, there may be severe waterelectoral disorders, hypokalemia. Normalization of urea and creatinine levels are observed by the 15th day of the polyuric stage

Long-term convalescence from 3 to 12 months

Treatment

Diuresis control

Restriction of protein products

Exclusion of antibiotics with nephrotoxic action

Determination of sodium, potassium in the blood

determination of urea, creatinine in blood and urine

Urinary Syndrome Assessment

Improving systemic hemodynamics, combating hyperhydration, azotemia, electrolyte disorders, acid-base status

Dopamine in doses from 3 to 10 mcg / (kg * min)

Mannitol 1 g/kg in 20% solution

Glucocorticosteroids

Heparin 5 thousand units every 4-6 hours

Fresh frozen plasma

Indications for renal replacement therapy (Extracorporeal detoxification)

Hyperkalemia (more than 7 mmol / l, ECG signs of hyperkalemia)

Urea more than 33.3 mmol/l

creatinine more than 884 µmol/l

The threat of pulmonary edema and cerebral edema

Decompensated metabolic acidosis (deficiency of buffer bases of 15 mmol or more)

Сonvulsive syndrome

Convulsive syndrome is a universal reaction of the body to various influences, which is characterized by attacks of involuntary contractions of striated muscles of various nature.

Causes of the convulsive syndrome (tetanus, rabies cholera)

Paralysis of intercalary neurons with impaired inhibition of motor neurons with the development of tonic convulsions and the periodic occurrence of tetanic convulsions (tetanus, rabies)

fluid and electrolyte disorders (cholera)