Summary sheet in arf

506 views

Published on

FOR LIBYA

Published in: Health & Medicine
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
506
On SlideShare
0
From Embeds
0
Number of Embeds
16
Actions
Shares
0
Downloads
19
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

Summary sheet in arf

  1. 1. 1 DR MAGDI AWAD SASI 2014 ARF SUMMARY SHEET SUMMARY SHEET OF ACUTE SENA FAILUR ((ARF)) CRITERIA OF ARF DIAGNOSIS: I. Raising plasma urea and creatinine concentration. II. Rising plasma potassium ,sulphate & falling calcium and bicarbonate III. A fall in urine volume to 400ml/day( 25% non oliguric) AETIOLOGY OF ARF: 1.PRE-RENAL ----------–HYPOPERFUSION-----75% 2.RENAL -------------------RENAL PARENCHYMA DAMAGE OR DYSFUNCTION -10-20% 3.POST-RENAL------------ACUTE OBSTRUCTION OF THE URINE FLOW ---2-15% WHAT ARE THE PRE-RENA CAUSES? 1. Hypovolemia 2. Decreased cardiac out put 3. Septicemic shock 4. Renal artery occlusion 5. Drugs causing reduction in renal blood flow WHAT ARE THE RENAL CAUSES? 1. Vascular—HHS,TTP,DIC , vasculitis ,scleroderma ,malignant HTN ,eclampsia 2. Glomerular ---rapidly progressive glomerulonephritis 3. Acute interstitial nephritis— A. Drugs B. Infections –bacterial interstitial nephritis -----streptococal ,leptospiral ,EB virus, Mycoplasma pneumonias ,legionella pneumophilia pneumonia 4. ATN------ A. Ischemia---prolonged pre-renal insult B.Toxins-------myoglobinuria ,haemoglobinuria ,bens jones myeloma WHAT ARE THE CAUSES OF POST-RENAL ARF? A. Prostate hyperatrophy, urinary bladder tumor, pelvic tumor B. Drugs and crystals
  2. 2. 2 DR MAGDI AWAD SASI 2014 ARF SUMMARY SHEET NATURAL HISTORY OF ARF: 1. Incidence: 50 cases annually / million population(UK) 1% OF all population 2—5% major surgery 5—15% intensive care units 2. Three phases: A. Initiating phase=precipitating factors ˂ 24 hours B. Established oliguric phase (ATN) Few days 60 days C. Recovery =diuretic phase 1.Gradual increase in GFT and urine volume 2.Gradual increase in tubular concentration ability 3.Follow up of ARF cases (RFT never return to normal as before ) 4.Increased mortality rate=50% (up to 90% of patients with severe trauma ,sepsis ,multiple organ failure). Only 105 die as a result of ARF due to HYPERKALEMIA HISTORY AND EXAMINATION OF A PATIENT WITH ARF: 1. ARF/CRF---- ARF AND stigma of CRF e.g.: I. Pigmentation and anemia II. Pruritis and hypocalcemia III. Bone diseases 2. ARF due to 3 main causes: I. Pre –renal : compatable history 1. Check input/output 2. Signs of dehydration----decreased CVP is the most important sign 3. Body weight---- over loaded or dehydrated
  3. 3. 3 DR MAGDI AWAD SASI 2014 ARF SUMMARY SHEET 4. Change in the urine characters which differentiate it from established ATN 5. Effect of fluid challenge and diuretic : A. Diuresis---prerenal B. Pulmonary oedema-----ATN II. Renal(ATN) History of precipitating factors Clinical S&S of precipitating cause and acute uremia Complication of ARF III. Post –renal: History of renal symptoms---renal colic ,haematuria Anurea (˂50 ml/day) Full urinary bladder (abdomen palpation and USS adomen) Palpable kidney’s tumor CLINICAL POINTS TO BE REMMEBERED: 1. ATN is the commonest histology in ARF secondary to pre-renal causes or nephrotoxic drugs. 2. A urine output ˂25-30ml/hour in adult should be investigated and urgently corrected. If oliguria persists ˃2-3 hour, it may be irreversible 3. The simplest screening test for RF in ICU patients are : I. Hourly urine output ( at least 0.5ml/kg/hour) II. Accurate I/O fluid chart III. Daily serum creatinine assessment 4.Rhabdomyolysis-----myoglobinuria---it is a cause of hypercatabolic ARF and hypocalcemia and hyperphosphatemia ( hypercalcemia occur in recovery phase). SUMMARY OF ARF MANAGEMENT Initial assessment Resuscitation Management of emergencies
  4. 4. 4 DR MAGDI AWAD SASI 2014 ARF SUMMARY SHEET Exclude prerenal element Renal ultrasound Dilated pelvicalyceal system normal sized kidneys small kidneys /PCKD OBSTRUCTION HISTORY COMPATIBLE ATN H/O NOT COMBATIPLE ATN ACUTE ON CRF OR HISTORY AND EXAMINATION SUGGESTIVE OF 1RY PARENCHYMAL DISEASE SURGERY RENAL BIOPSY MANAGEMENT OF ESTABLISHED ACUTE RENAL FAILURE RECOVERY---MANAGEMENT OF RECOVERY PHASE NON RECOVERY IN 3—4WEEKS FURTHER INVESTIGATIONS INCLUDING RENAL BIOPSY TO EXCLUDE OTHER DX

×