ACUTE RENAL FAILURE

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