0 Acute Renal Failure

Reactions: 


Acute renal failure ( better termed as Acute kidney injury )

Markers :

  1. NGAL ( Neutrophil gelatinase associated lipocalin )
  2. IL-18
  3. KIM-1 ( Kidney injury molecule - 1 )
Can be :


  • Pre-Renal
  • Renal
  • Post-Renal




 Pre-Renal
(can have hyaline cast)

Renal
(granular cast)


Urine Na

<20 meq/l (or < 10 mmol/l)


 >40 meq/l (or > 20 mmol/l)

 Urine Osmol. 


 >500

 <300

 Blood urea / creatinine


 >20:1

 < 20 : 1

 Fractional excretion of Na %


 <1

 >1


MC cause of ARF in 

  • Newborn : Birth Asphyxia
  • Children ( 1 - 3yr ) : 1. HUS ; 2. ATN


MC Complications ( and their management ) :

  1. Fluid overload ( so restric fluids to 400ml/m2 - dextrose)
  2. Hyperkalemia ( so - Nebulize beta 2 agonist , IV -Na Bicarb , IV Insulin with dextrose , Resins , Haemodylasis , Ca Gluconate for cardiac stabilization )
  3. Hyponatremia -dilutional ( manage same as 1 )
  4. Dilutional anaemia ( so transfuse RBC )
  5. Increase phosphate , decrease calcium ( so Restrict phosphate, use phosphate binders )
  6. Metabolic acidosis ( so use Na Bicarb )




MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

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