Acute renal failure

Acute renal failure is defined as a clinical syndrome characterized by a rapid, severe reduction of renal filtration, usually with a reduced excretion of urine.

Definition
Acute renal failure is defined as a clinical syndrome characterized by a rapid, severe reduction of renal filtration, usually with a reduced excretion of urine. It occurs due to ischemic or toxic lesions that operates in renal blood vessels, glomeruli and / or tubules causing a reduction in glomerular filtration rate and increase intratubularnog pressure.

Invasion of extracellular fluid causes the formation of islands, high blood pressure and chronic heart failure. Often the increase of potassium, sodium, and acidity of the cell can be fluid . Etiology of kidney problem can be prerenal, renal and postrenal  and potentially reversible if the disorder is diagnosed in time and treated.

The clinical picture
Symptoms related to loss of function and secretion depend on the level of renal dysfunction, the degree of renal damage, and the cause. In outpatients only clinical indication may be oliguria or anuria after use of contrast. In hospitalized patients, acute renal failure is usually associated with recent trauma, surgical, medical events, therefore, depend on it, and the signs and symptoms. Normal daily urine output was 1 to 2.4 liters per day. This could result in oliguria; anuria leads to mutual suspicion of renal artery occlusion, obstructive uropathy, acute cortical necrosis or rapid progressive

Forecast
Acute renal failure with immediate complications (eg hypervolaemia, metabolic acidosis, hyperkalemia, uremia, hemorrhagic diathesis) may be treated, but the percentage of survival remains about 60% despite aggressive nutrition  and dialysis therapy. Further improvement seems impossible because normally associated sepsis, pulmonary failure, coagulopathy, surgical complications.

Diagnostic evaluation
The diagnosis of acute renal failure is determined by a progressive increase in serum creatinine daily.Currently back prerenal and postrenal causes must first be excluded. Correction of the disturbances that reduce renal confirms prerenal causes. For postrenal causes, the possibility of recovery of renal function is often irreversible depending on the duration of obstruction. Early urinary and serum chemical analysis in the case of acute renal failure may facilitate the determination of the cause.Typical laboratory findings are progressive azotemia, acidosis, hyperkalemia, and hyponatremia.

Treatment
Acute renal failure can be prevented by proper maintenance of fluid balance in the body, blood volume and blood pressure during and after major surgery; appropriate isotonic fluid infusion in patients with severe burns, and the current blood transfusion in blood pressure due to bleeding. If you need a vasoconstrictive drug, dopamine 1 to 3 micrograms / kg / min intravenously may improve renal blood flow and urine output, but no clinical indicator to stop and acute. In the early stage of acute renal failure, furosemide with mannitol or dopamine can restore the normal flow of urine or reverse oliguric to nonoliguric acute renal failure, but there is little evidence that mortality thereby reduced. Dialysis improves the balance of fluids and electrolytes and provides an adequate supply. No single rule when to start dialysis, to what frequency is conducted, or whether improved recovery or survival. Acute renal failure without dialysis should be treated only if it is not possible or the development of renal uncomplicated and present less than 5 days. In postliguric stage, it is necessary to pay special attention to fluid and electrolyte balance in order to prevent potentially lethal disorder of the extracellular fluid volume, plasma osmolality, acid-base status and potassium levels.