ACUTE RENAL FAILURE
A.L. Billson, A.V. Pearce, C. Tuffrey in Key Topics in Paediatrics, 1994
Acute renal failure occurs when a sudden decrease in renal function leads to loss of biochemical homeostasis. Oliguria or anuria leads to accumulation of nitrogenous waste products and disturbance of water and electrolyte balance. It may occur as a result of renal hypoperfusion (prerenal), parenchymal damage (renal) or obstruction of the renal tract (post-renal). If not corrected, renal hypoperfusion will lead to acute tubular necrosis and, if the insult is severe, cortical necrosis will follow. Acute on chronic renal failure may be precipitated by dehydration or an intercurrent infection.
Acute renal failure
Bobbee Terrill in Renal Nursing, 2002
Introduction Acute renal failure (ARF) develops in between 5% and 7% of hospitalised patients, but only a small number of these patients require renal replacement therapy. Of these, the mortality rate is approximately 50% and has not changed over the past several decades, despite the many technological advances in that time. If multiorgan failure is present, the mortality rate approaches 90%. The management of ARF, especially that requiring renal replacement therapy, presents a special challenge to renal nurses. Despite the current trend towards managing these patients in intensive care units, many present initially to the renal ward, or require post-acute management in renal areas. To provide appropriate care for these patients, renal nurses need to understand the differences between the pathophysiology of CRF and ARF, and appreciate the features that are shared by these two disease processes.
Renal function in the child
Bobbee Terrill in Renal Nursing, 2002
Introduction The successful management of children with renal failure can only be achieved if the practitioner has a thorough understanding of the development of normal renal function and the alterations that occur to metabolic balance during childhood. The kidney in the newborn is immature, buffering capacity is reduced and the ability to conserve and excrete sodium is limited. Even when quite severe renal disease is present, serum biochemistry can be normal at birth because the mother maintains fetal homeostasis. When a severely affected infant is born, especially when multiple defects are present, the ethical and moral implications of attempting renal replacement therapy can be considerable. A thorough working knowledge of the expected prognosis is required prior to commencing treatment because the mortality rate for both acute and chronic renal failure in infants remains high.
The Lack of Clinical Value of Laboratory Parameters in Predicting Outcome in Acute Renal Failure
Published in Renal Failure, 1989
Zijad Durakovic, Asaf Durakovic, Senadin Durakovic
In 55 patients with either the oliguric and nonoliguric form of acute renal failure, some laboratory parameters for the analysis of prerenal and intrinsic types of acute renal failure were examined. The parameters were analyzed within 7 days of the clinically known beginning of the illness. The parameters were analyzed as follows: sodium in urine, creatinine urine/plasma ratio, urine osmolality, osmolality urine/plasma ratio, renal failure index, and fractional excretion of filtered sodium. Hemodialysis was performed in 29 of the 55 patients. The oliguric form of acute renal failure was present in 49 of the 55 patients. In relation to renal failure index, prerenal acute renal failure was present in 7 patients and intrinsic acute renal failure in 48. It appears that in patients with a clinical diagnosis ofprerenal acute renal failure, the urinary parameters do not separate them from those with acute tubular necrosis. It also appears that in patients with laboratory diagnosis of prerenal acute renal failure (i.e., a RFT < 1.0), the response to treatment is unpredictable and in fact may have a worse prognosis than in those with a RFI > 1.0 (5/7 deaths vs 10/48 deaths).
Acute Renal Failure Due to Falciparum Malaria
Published in Renal Failure, 1990
Seventy-two patients with severe falciparum malaria are described. Twenty-four (33.3%) were complicated by acute renal failure. Comparing patients with renal failure and those without, statistically significant differences occurred regarding presence of cerebral malaria (83% vs 46%), jaundice (92% vs 33%), and death (54% vs 17%). A significantly higher number of patients with renal failure were nonimmune visitors to malaria endemic regions. Renal failure was oliguric in 45% of cases. Dialysis was indicated in 38%, 29% died in early renal failure, and 33% recovered spontaneously. It is concluded that falciparum malaria is frequently complicated by cerebral malaria and renal failure. As nonimmune individuals are prone to develop serious complications, malaria prophylaxis and vigorous treatment of cases is mandatory.
Renal Consequences of Long-Term, Low-Dose Intentional Ingestion of Ethylene Glycol
Published in Renal Failure, 2009
Malini B. DeSilva, Paul S. Mueller
Acute renal failure can result from a wide variety of causes. When the cause of acute renal failure is unclear, the history, physical examination, and laboratory findings are crucial to help establish the cause. However, the cause of acute renal failure may remain unclear even after gathering this information. In this report, we describe a case of acute chronic renal failure in which the cause of acute renal failure was not determined until a kidney biopsy was performed, which revealed calcium oxalate crystals in the renal parenchyma, a finding pathognomonic for ethylene glycol ingestion.
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