Acute renal failure

Sudden impairment of filtration, secretory and excretory function of kidneys, or single working
kidney due to the influence of different endogenous and exogenous factors on it’s parenchyma. All
nephrones can be affected or glomerular apparatus or all part of the renal tubules.

Causes: Prerenal, Renal, Postrenal, Arenal .

Pre-renal factors:

 Decreasing of blood pressure – decreasing of blood flow in renal parenchyma – reduction of

glomerular filtration (blood loss, sepsis, shock)

 Decreasing of blood pressure – influence of toxic products on renal parenchyma – necrosis of

tubular epithelium (transfusion of incompatible blood, crush-syndrome, big burns, bacterial
shock, allergic shock)

 Loss of water and electrolytes – decrease of blood volume – decrease of glomerular filtration
rate (non-stop vomiting, diarrhea, inappropriate use of diuretics)

Renal Factors:

 Immunoalergic affection of kidneys – precipitation of ummune complex at the glomerulas

( acute nephritis, lupus, Goodpasture syndrome, acute interstitial nephritis, haemolutico-uremic
syndrome)

 Influence of nephrotoxic factors –necrobyotic changes in epythelial cells of tubules with tearing
them off from the basic membrane (salts of mercury, urane, copper, poisonous mashrooms,
medicines – sulfanilamides, aminoglycosides, uric acid etc.

Post Renal Factors:

 Obstruction of upper urinary tract (bilateral or unilateral in case of one functioning kidney)

 Occlusion by stone of blood clot

 Compression by a tumor

Arenal Factors:

 Bilateral nephrectomy (very rarely)

Stages: Initial, Oliguric, Poliuric, Convalescence

Initial stage:

 Depends on the cause

 Circulatory collapse

 Hyperhydration

Huperasotemia
 Oliguric stage:

 Lasts for 2-12 days

 The main and the most dangeruos stage

 Urine volume is less than 500 ml, urine has dark color, content of protein and cylindersis is
elevated, density is 1003-1010, osmolarity 350-360 mosmol/l

 Na is less than 50 mmol/l

 Anorexia, nausea, diarrhea,drowse

 Hyperasotemia – urea 32-50 mmol/l, creatinine 0,5-0,9 mmol/l.

 Hypernatriemia, hyperkaliemia, phosphatemia 4-5 mmol/l.

 Metabolic acidosis

 Tahypnoe, fluid lung

 ECG – elevation of T, widening of QRS, depression of S_T

 Intestinal bleeding

 Anaemia

 Pain at lumbal area, enlargement of renal contour at plain X-Ray

Diuric stage:

 Lasts 9-11 days

 Has two phases

 Early diuretic phase

 Phase of poliuria

Convalescence stage:

 Lasts 6-12 month

 Duration depends on severity of the disease

 Criterium of reconvalescence – recovery of renal concentrational capability

Diagnosis:

 Anamnesis

 Catheterization of vesical bladder

 Radioisotope renography

 Utlrasound
  CT

 Retrograde pyelography

 Roentgenography of lungs

 ECG

 Blood serum analysis

 Urinalysis

Treatment:

 Removal of the cause

 Elimination of haemodynamic changes: (infusion of colloid solutions: plasm, albumine, dextrane)

 Detoxication (plasmapheresis, dialysis, infusion of Na hydrocarbonate)

 Stimulation of diuresis (Lasix 2.0 mg)

 Corticosteroids (prednisolone 180-210 mg than 60-90mg each 6-8 hours during 2-3 days)

 Enchancement of renal bloodflow dophamine 4% -5.0 on glucose solution, euphyllini 2.4 % 10,0
iv

 O2

 Antibyotics

 Nephrostomy if necessary

Chronic renal failure

Chronic renal failure is a slowly worsening loss of the ability of the kidneys to remove wastes,
concentrate urine, and conserve electrolytes

 Primary affection of a glomerular apparate (chronic glomerulonephritis, glomerulosclerosis)

 Primary affection of tubule apparate (chronic hypercalcyaemia, inborn oxaluria, chronic

impoisonment by salts of heavy metals)

 Secondary affection of tubules (chronic pyelonephritis)

 Bilateral anomalia of kidneys and ureters (hypoplasia of lidney, policystic kidney, neuromuscular
displasia of ureters)

 Obstructive diseases of upper and lower urinary tract

 System collagenous diseases

Stages: Latent, Compensated, Intermittent, Terminal

Clinics: Fatigue, loss of appetite, headache, edema of face and extremities, limited mobility

Symptoms:

 Skin of pale yellow color, dry, non-elastic, iching.

 Subcutaneous cellular tissue and muscles athpophic

 Fluid lung

 Arterial hypertension, hypertrophy and than dystrophy of heart muscle

 Nausea, vomiting, loss of appetitis uremic gastroenterocolitis.

 Hiccup, mental disorders, muscular jerking

Diagnosis:

 Blood test

 Blood serum analysis

 Urinalysis

 Ultrasound

 Plain X-Ray

 CT

 Radioisotope methods.