Acute impairment of renal function
Causes
- Compromised renal perfusion e.g. dehydration, heart failure, shock (acute)
- Obstructed urinary flow
- Damage to renal tissue by infectious and inflammatory dieases (e.g. glomerulonephritis), intoxications,
nephrotoxic drugs
Clinical features
- Oliguria (urine flow <1 ml/kg/hour)
- Generalised oedema
- Hypertension, heart failure, dyspnoea
- Nausea and vomiting, anorexia
- Lethargy, convulsions
Differential diagnosis
- Other renal disorders
- Biventricular heart failure
Investigations
- Urine analysis: for blood, proteins, leucocytes, casts
- Urea, creatinine and electrolytes
Management
Management of acute kidney condition can be started at hospital level but the patient should be referred at higher
level for more appropriate management:
- Treat underlying conditions e.g. dehydration
- Monitor fluid input and output
- Daily fluid requirements = 10 ml/kg + total of losses through urine, vomitus and diarrhoea
- Monitor BP twice daily
- Daily weighing
- Restrict salt intake (<2 g or half teaspoonful daily)
- Restrict potassium intake e.g. oranges, bananas, vegetables, meat, fizzy drinks
- Moderate protein intake
- Ensure adequate calories in diet
- Check urine and electrolytes frequently
- Treat any complications (e.g. infections, hypertension, convulsions), adjusting drug dosages according to the clinical response where appropriate
- If oliguria, furosemide IV according to response (high doses may be necessary)
If no response to above general measures, worsening kidney function or anuria (urine output
less than 100 ml/24 hours)
- Refer for specialist management including possible dialysis as soon as possible and before
the patient’s condition becomes critical
Caution
- Do not give any drugs which may make kidney damage worse e.g. use gentamicin with caution