First aid for acute renal failure. Acute renal failure clinic

A group of disorders caused by dysfunction of the kidney(s) is called acute renal failure. This is a reversible process, which is characterized by a violation of the secretory, filtration, excretory functions, changes in water-electrolyte balance and increased content products of nitrogen metabolism in the blood.

Basic forms, their causes

There are three main forms of acute renal failure(table), helping to decide on taking measures to prevent similar complication and treatment of pathology:

Forms	Cause	The situation in which pathology develops
Prerenal	Appears outside the kidneys (caused by poor circulation)	heart failure; heart rhythm disturbance; accumulation of fluid near the heart; stool disorder; accumulation of fluid in the peritoneum; blood loss; burn; hypotension; blockage of blood vessels.
Renal	Kidney problem	destruction of cells by poisons; reception medicines; blood transfusion; injury; inflammatory process.
Postrenal	Disturbed urine flow	blockage of the renal duct; the presence of a neoplasm.

Pathogenesis

Functional kidney disorders lead to inflammatory processes in the organ.

Impaired functionality of the renal corpuscles in the cortical layer of the organ, which are an important part of the glomerular structures, determines the pathogenesis of the disease. Destructive influence functional disorder acts in several directions. First of all, the release of nitrogen end products from the blood is inhibited or completely stopped. With the liquid part of the blood they spread throughout the body, ending up in internal organs and vital systems. This leads to pollution and disrupts gas exchange in the body. The presence of oxygen in the body decreases, carbon dioxide increases. The glomerular structures of the kidneys suffer from this situation, and their partial or complete necrosis occurs. Restoration of the filtration function when the renal corpuscles die off is practically impossible. In the future, the process is complicated by inflammation, which leads to poisoning of tissues and blood with poisons.

Main criteria for surge arresters

RIFLE classification

In 2002, a rifle classification was developed and published in 2004, allowing one to identify and diagnose acute injury kidney IN English letters hidden definition of the phases of development of renal failure:

R - risk;
I - damage;
F - failure;
L - loss of function;
E - irreparable (terminal) degree of failure.

Acute kidney injury is diagnosed when two conditions occur:

time criterion;
functional criterion (weakening of organ functions, determined by the amount of urine excreted or the degree of creatinine in the blood).

RIFLE classification of the development of acute renal failure
Class	Glomerular filtration rate	Diuresis
R risk	Increase in Ccr by 1.5 times or decrease in GFR by 25%	< 0,5 мл/кг на протяжении ≥ 6 ч.
I damage	Increase in Ccr by 2 times or decrease in GFR by 50%	< 0,5 мл/кг на протяжении ≥ 12 ч.
F deficiency	Increase in Ccr by 3 times or decrease in GFR by 75%	< 0,3 мл/кг на протяжении ≥ 24 ч. или анурия ≥ 12 ч.
L loss of function	AKI for ≥ 4 weeks
E irreparable deficiency	ARF for ≥ 3 months
Ccr - creatinine level; GFR - glomerular filtration rate

AKIN classification

To improve diagnostics by increasing the control of minor deviations in the concentration of creatinine in the blood, the classification was improved in 2007 by a group of AKIN specialists. The emphasis is on the end product of the creatine phosphate reaction and the glomerular filtration rate (GFR) is excluded. Acute renal failure is characterized by the following criteria:

Symptoms and stages

The development of acute renal failure goes through 4 stages:

Acute failure during pregnancy

The disease in pregnant women is provoked inflammatory processes urinary system.

Acute kidney disease during pregnancy is a life-threatening complication. The danger is that kidney damage always appears quickly, within a few hours or days. Most often, the problem makes itself felt at the beginning of the third trimester, after childbirth. But there is a risk when acute renal failure develops with infectious diseases. The reasons for the development of pathology during pregnancy are as follows:

increased load on the kidneys due to more blood undergoing filtration;
chronic inflammatory processes of the urinary system;
exacerbation after abortion or after childbirth;
fetal death during pregnancy.

With timely attention to the signs of acute renal failure (back pain, decreased urination, thirst, and others), it is possible to restore the functionality of the organ and save the life of mother and child.

If measures are not taken in a timely manner, the disease goes through all periods of acute renal failure, new signs are added (blood in the stool, numbness in the limbs) and there is a high probability of death for both the woman and the fetus. At acute course diseases future mom You should definitely consult not only a urologist, but also a gynecologist.

Complications and consequences

Acute kidney diseases do not go smoothly, and significant pathological outcomes often occur:

Diagnosis of acute renal failure

If you suspect the development acute failure The doctor takes into account the history of symptoms and the examination of the patient. Further clinical guidelines supported by the results of cfo and laboratory tests:

Diagnostic methods using mechanical instruments allow you to examine the organ and assess the difficulties of the process (chronic or acute), determine the presence of blockage of the ducts:

Ultrasound of the peritoneum;
CT (computed tomography);
X-ray of the peritoneum determines the presence of stones in the kidneys or ducts.

If the cause of the acute condition is blockage of the ducts, you may need additional types research:

MRI, which allows you to assess the degree of change in the structure of the organ.
Kidney pyelography. Through catheterization of the ureter, contrast is introduced for a detailed anatomical study of the organs of the urinary system.
Renal scintigraphy. Evaluates functional state organ.

What treatment is needed?

The manifestation of symptoms indicating the development of an acute form of the disease indicates the need to deliver medical assistance to the patient as soon as possible. Until the doctor arrives, people nearby will need self-control to assess the situation and provide the necessary first aid.

Urgent Care

The first step is to restore blood volume.

The necessary assistance in the first phase of the development of the disease will be of a more preventive nature, aimed at eliminating the causes that caused acute condition, and elimination of violations that have occurred. To begin with, the patient is provided with bed rest, rest and warmth. To restore blood movement through the vessels, drip therapy is carried out using solutions of albumin, glucose, mannitol, plasma and others. After blood volume is restored, diuretics are used. Vascular spasms are relieved with novocaine mixtures.

Emergency care for acute renal failure during the development of the second phase is aimed at eliminating symptoms, since the situation is complicated by anuria or oliguria. Treatment of acute renal failure is concentrated on eliminating the consequences of poisoning of the body. All conditions are prevented and eliminated, life threatening to the patient. Are used hypertonic solutions, vitamin preparations, anticonvulsants and antibiotics.

Acute renal failure is a syndrome caused by a critical decrease in the excretory function of the kidneys, most often due to ischemic or toxic damage renal parenchyma with retention in the blood of products that are normally removed in the urine. Acute renal failure (ARF) is divided into prerenal, caused by disorders of the general circulation (shock of various etiologies, profuse diarrhea, prolonged vomiting); renal, caused by damage to the renal parenchyma of various etiologies; and postrenal, caused by impaired urination (obstruction and compression urinary tract).
Symptoms. The following phases of acute renal failure are distinguished: initial, lasting up to 2 days (signs of the pathological process that caused acute renal failure are dominant - shock, infection, sepsis, hemolysis, exo- and endointoxication, disseminated intravascular coagulation);
oligoanuric duration up to 2-3 weeks (symptoms of uremia: patients are lethargic, drowsy, lack of appetite, headache, nausea increases, a puffy face with yellowness, peripheral edema, petechiae and ecchymosis on the skin, “uremic tan” and “uremic powder”, the smell of urea can be detected; usually hyperkalemia and hypermagnesemia focal lesions central nervous system, sometimes delirium, renal eclampsia develops epileptic seizures, coma);
phase of early polyuria (a decrease in the level of potassium sodium magnesium chloride ions is noted);
phase of renal function recovery.
Diagnosis. Not always clear, should be differentiated from comas and others various disorders central nervous system; When establishing a diagnosis of acute renal failure, it is necessary to identify its form.
Complications: bronchitis, pneumonia, pleurisy, pericarditis, cardiac tamponade, hypertensive crisis, arrhythmias, respiratory and heart failure, pulmonary edema, encephalopathy, delirium, aseptic peritonitis, disorders water-salt metabolism, Various types overhydration and dehydration Hyperkalemia is characterized by the appearance of first-degree AV block on the ECG, widening of the QRS complex, the ST segment begins below the isoline, shortening of the QT interval, and the appearance of a pointed narrow G wave; for hypokalemia - QT prolongation, ST segment depression, flattening up to G wave inversion, appearance of U wave.
Typical for acidosis are Kussmaul breathing (in severe acidosis - Cheyne-Stokes), myoclonus, myoplegia, confusion. Alkalosis is characterized by rare shallow breathing, carpo-pedal spasm, thoracic constriction, tetanic convulsions and disorders of consciousness (stupor, coma).
With hypertonic overhydration, thirst, dry mucous membranes, anasarca, hypertension are observed (furosemide, 5% glucose solution is used), and with hypotonic overhydration - aversion to water, vomiting, headache, anxiety, mental disorders, focal neurological symptoms (renal eclampsia), respiratory disorders coma (introduction of saline, if there is no oligoanuria, 10 ml of Panangin IV). Isotonic dehydration is characterized by: weight loss, acrocyanosis, weakness, hypotension, hoarseness, obstruction. respiratory tract and esophagus (5% glucose solution, saline). With extracellular dehydration, the skin and mucous membranes are dry, there is little or no thirst, muscle weakness, headache, hypotension, vomiting, convulsions, coma are possible (hypertonic or isotonic sodium chloride solution, in their absence, 40% glucose solution can help for a short time). With cellular dehydration, loss of body weight occurs, the skin is moist, facial features become sharpened, eyes are sunken, there is a lack of saliva and tear fluid, unquenchable thirst, apathy, muscle twitching, hallucinations, delirium, hypertension, breathing problems, coma (5% glucose solution, 0.45% or physiological sodium chloride solution).
Urgenthelp. Psycho-emotional peace, elimination causative factor(removal from shock, detoxification, etc.), to improve renal blood flow - 1-3 mcg/kg/min of dopamine. at peripheral edema- up to 300-500 mg of furosemide IV (if the urinary tract is obstructed). For renal eclampsia, up to 30 ml of 40% glucose and up to 20-25 ml of 25% magnesium sulfate are administered intravenously or intramuscularly.
Arterial hypertension adjusted with sodium nitroprusside - up to 10 mcg/kg/min (50 mg/amp., 50 mg/250 ml, 200 mcg/ml, 10 mcg/drop., initial infusion rate 05 mcg/kg/min), or labetalol (100 mg/amp.) 20-40 mg over a minute, can be repeated every 15 minutes until the effect occurs or a dose of 300 mg is reached. Convulsive syndrome stops with sibazon (diazepam) - 10-30 mg IV slowly over 5-10 minutes (10 mg/amp.). Hypertension can also be relieved with diazoxide - 75 mg over 10-30 s IV, if necessary, repeat every 5 minutes up to 300 mg, or hydralazine (20 mg/amp.) - 10-20 mg IV, repeat after 30 minutes ( IM 10-50 mg), or phenigidine (nifedipine) up to 1 mg IV. Phenigidine can be given sublingually up to 20 mg. In case of pulmonary edema with systolic pressure above 160 mm Hg. Art. - up to 10 mcg/kg/min sodium nitroprusside or up to 50 mg pentamine IV slowly. If the pressure is low - up to 500 mg of furosemide, with anuria - bloodletting up to 300-400 ml, extremely careful administration of 03-05 ml of 0.025% strophanthin solution or 0.25-05 mg of digoxin IV.
When treating arrhythmias, doses should be halved, and the phase of acute renal failure (hyper- or hypokalemia) should be taken into account. For asystole or ventricular fibrillation, additional calcium supplements are used (2-4 mg/kg calcium chloride at 10-minute intervals) and sodium bicarbonate (2 ml of 4.2% solution per 1 kg of body weight) or trisamine (1 ml/kg) intravenously.
Hospitalization: on a stretcher to the specialized department of the hospital for extracorporeal dialysis.

Acute renal failure is a symptomatic, potentially reversible complex that is caused by abrupt cessation of functionality organs. The occurrence of pathology is associated with a malfunction renal tubule, although there are much more factors that provoke the disease.

Clinical manifestations of acute renal failure are associated with life-threatening conditions, during which the functions of important systems and organs. On initial stage pathology, symptoms are practically absent, and its development is characterized by rapidity. Therefore, acute renal failure requires emergency care. medical personnel. Before their arrival, measures are taken to fix and maintain work in the kidneys and other systems and organs.

Reasons for the development of acute renal failure

The kidneys, along with the liver, cleanse the body, preventing intoxication from penetrating into the body. systemic blood flow I will give. Thereby paired organ at healthy people water and chemical balance is maintained. They rid the body of excess water, dangerous toxins and drug residues. The participation of the kidneys is necessary in metabolism and the production of certain hormones. A decrease in the capabilities of an organ will lead to the loss of its functions. This will cause the inevitable death of the victim: the blood will fill with toxic waste of human activity.

All causes of acute renal failure, manifested by impaired renal functionality, are divided into 3 large groups:

Prerenal. Diseases caused by disturbances in blood flow in a paired organ.
Renal. Damage to the kidney structure: glomeruli and tubules.
Postrenal. Pathology is associated.

This happens for 3 reasons:

The ureters are blocked or pinched;
The bladder is damaged, so the organ cannot “push” urine out;
The urethra has become very narrow.

Let us list which diseases contribute to the development of acute renal failure.

The prerenal form of acute renal failure is caused by pathologies associated with a state of shock. He provokes a sharp decline volume of blood flow. Loss of water electrolyte balance cause gastrointestinal diseases, and accompanied by diarrhea. This category includes the following malfunctions in the body:

Operational disruptions;
failure;
All types of burns;
Septicemia.

Renal forms are caused by the following factors:

Nephritis;
Acute glomerulonephritis;
Intoxication (poisons, drugs);
Ischemia;
Acute damage to the renal tubules.

Postrenal lesions are caused by blockage of the kidney tubules by blood clots or protein particles. The following disorders contribute to their appearance:

Symptoms and treatment depend on the course of the disease that caused AKI.

Symptomatic features

Severe progression of the listed diseases can lead to acute renal failure at any time. Dangerous condition goes through 4 stages of its development, each of which has characteristic symptoms.

Initial phase

The specificity of this period is the vivid manifestation of the background disease, the state of sepsis and. The duration of the phase is from 3 hours to 3 days. Begins intense violation blood supply to the kidneys. It is extremely important to provide emergency care for acute renal failure at this time. This way you can stop the development of pathology.

Oligoanuric phase

The period can last up to 3 weeks. His characteristic feature– rapid development of oliguria (diuresis less than 300 ml/m2 per day) or anuria (lack of urine). Laboratory research They will detect the presence of proteins and red blood cells in the urine, and an increased amount of sodium. The concentration capabilities of the kidneys are rapidly declining. Blood pressure is higher than normal. Biochemical analysis will show increased concentrations of urea, phosphate and creatinine.

Observed brightly severe symptoms intoxication:

Weakness;
Slow reaction;
Vomit;
Diarrhea;
Drowsiness.

The development of the septic process is accompanied by chills and feverish state. General records anemia and extremely low level platelets against the background of pronounced leukocytosis.

Without necessary assistance swelling of the brain and lungs will occur.

Polyuric phase

The stage is called recovery. Its duration can reach 3 months. There is a gradual, persistent increase in urine production and excretion. Sometimes highlighting biological fluid reaches 4 liters per day. Consequence quick loss fluid becomes dehydrated, the concentration of potassium and sodium decreases.

Recovery phase

Lasts longer than all other stages - up to 2 years.

Systemic blood flow and kidney function are gradually restored. The causes of acute renal failure are completely eliminated. This time is dedicated rehabilitation therapy and sanatorium-resort treatment.

Diagnostic methods

Diagnosis of acute renal failure is carried out according to standard provisions. It begins in the doctor's office with a history taking. The doctor is interested in the following information:

The presence or absence of chronic pathologies;
Medicines taken in the last month;
Possibility of contact with poisons or toxins;
Pathologies suffered during the last 2 months.

Then the patient is asked clinical manifestations diseases:

How pronounced is the decrease in the total amount of urine;
Is there swelling?
Does intoxication manifest itself?
Characteristics of appetite, sleep quality, general well-being;
Are there any signs of gastrointestinal dysfunction?

Then the doctor palpates the kidneys, finds out the presence of edema and its severity, the condition of the skin and mucous membranes.

Based on medical history and visual inspection The doctor determines the necessary laboratory and instrumental tests for the patient.

Blood – general and biochemical examination;
Urine - general analysis;
Study of bloodstream acidity and electrolyte concentrations;
Electrocardiogram;
Indications blood pressure in dynamics;
Specifics of diuresis;
Diagnosis of the presence of C-reactive protein;
Ultrasound of the kidneys;
If there are suspicions of complications such as, an x-ray examination is prescribed;
A consultation is scheduled according to indications. narrow specialists, CT and MRI.

An important part diagnostic measures is to check the presence or absence of bladder biological fluid. This indicator is determined by catheterization. The same method allows you to determine the presence or absence of an obstruction in the ureter.

Specifics of emergency care

Acute renal failure requires emergency medical care using large group medications that are administered intravenously.

In case of acute renal failure, immediate hospitalization of the patient is necessary. poses a danger only if the patient is in a state of shock. In this case, first aid is provided on the spot.

Each stage of the “emergency” has its own characteristics.

initial stage

During this period, it is important to eliminate state of shock, restoration of BCC (circulating blood volume). Since at this time a violation also occurs heart rate, are taking measures to restore it. Stabilizes renal hemodynamics and microcirculation, water balance.

Therapy is carried out in conditions medical institution. It begins with the prescription of the following medications:

Ringer's solution;
Albumen;
Sodium chloride and glucose;
Mannitol.

After the BCC has been restored, diuretics are prescribed: Furosemide, Eufillin and others.

To restore the filtration capabilities of the kidneys, forced diuresis is performed. To speed up detoxification and recovery acid balance appoint intravenous administration sodium chloride and glucose or use Ringer's solution.

For prophylactic purposes, subcutaneous administration of Heparin is prescribed, which will prevent thrombosis of the renal tubules.

Oligoanuric stage

Task urgent action in this period:

Eliminate disturbances in water-salt metabolism;
Eliminate azotemia;
Stop ;
Correct acid imbalance.

To achieve this goal, limit the patient's fluid intake. The following medications are prescribed:

Glucose with insulin - help potassium move into cells, working as a detoxifier;
Salt-containing blood substitutes, sodium chloride solution - eliminate vomiting and diarrhea;
Glycerin, sorbitol, ion exchange resins rectally - relieve the growth of hyperhydration and hyperkalemia;
“Kontrikal”, “Gordox”, “Retabolil” - reduce the breakdown of proteins;
"Lespenefril", glutamic acid, "Arginine" - reduce azotemia.

Polyuric stage

At the recovery stage, the leading principle of therapy is to correct the water and electrolyte balance. Therefore, all restrictions related to drinking, salt intake and certain products food are removed. However, the entire stage takes place under the control of the patient’s body weight, diuresis, blood pressure, respiration, heart function and body temperature.

At the healing stage, the patient is prescribed a strict diet, symptomatic therapy and exception physical activity and stress.

Kidneys are one of the the most important organs our body. These organs are part of the urinary system; they organize and cleanse the body of metabolic products. The kidneys react very quickly to any disturbances in the functioning of organs and systems, and when serious violations in the functioning of the cardiovascular system or in response to particularly aggressive substances entering the body, may fail. As a result of such pathological effects, acute renal failure may develop, the symptoms of which we will consider, we will also clarify what emergency care is needed for a patient with such a diagnosis, and we will consider how acute renal failure is diagnosed.

Acute renal failure refers to the rapid (developing over several hours, days or weeks) cessation of kidney function, which is explained by severe damage to most of the kidney tissue.

Symptoms of acute renal failure

At the first stage of development of acute liver failure only the initial effect appears pathological factor(shock, sepsis, poisoning, etc.). The patient exhibits manifestations of the underlying disease. Nonspecific symptoms also occur, including drowsiness, nausea, lack of appetite and weakness. initial stage Acute liver failure can last from several hours or last several days.

After pathological processes lead to a significant decrease daily diuresis– it is no more than five hundred milliliters. In this case, the urine is colored dark color, it contains quite a lot of protein.

The volume of nitrogen in the patient’s blood increases (azotemia occurs), and the amount of potassium, phosphates and sodium in the blood also increases significantly. Metabolic acidosis develops, in other words, the acid-base balance body.

The patient is bothered by diarrhea, severe nausea, turning into vomiting. Overhydration occurs, which leads to pulmonary edema, causing patients to suffer from shortness of breath and moist rales. Patients become lethargic, experience excessive drowsiness, and may even develop coma. A significant decrease in immunity can lead to accession various infections.

Acute renal failure is accompanied by loss of appetite. The patient may experience muscle twitching, heart rhythm disturbances and an increase in blood pressure. Pathological processes may cause painful sensations in the abdomen and an increase in the size of the liver.

The third stage of renal failure is accompanied by a significant increase in the volume of urine excreted - its daily volume can reach two to five liters. At the same time, the body loses significant amount potassium, which is fraught with the development of hypotension, decreased muscle tone, and in some cases paresis skeletal muscles, and heart rhythm disturbances also occur.

Urine at this stage of the disease is characterized by low density, the amount of creatinine and urea in it decreases, but after a week, with favorable course illness, hyperazothermia disappears and electrolyte balance is restored.

Vigorous treatment with a favorable course of the disease allows you to restore kidney function within three months to six months.

How is acute renal failure detected, what diagnostics are needed for this?

For staging correct diagnosis in acute renal failure, doctors evaluate the characteristic clinical picture. In addition, doctors determine the level of creatinine, urea, and potassium in the blood, and monitor the volume of urine excreted. If necessary, an ultrasound is performed and radionuclide and radiographic diagnostic methods are used.

Acute renal failure - emergency care

If the development of acute liver failure is suspected, the patient is immediately hospitalized in the intensive care unit. If a vascular accident or injury occurs, the victims are usually immediately taken to the hospital, but, unfortunately, many people believe that the ambulance health care in case of poisoning, it is not needed, which can lead to serious problems if kidney function is impaired.

Emergency care for acute liver failure involves organizing bed rest and warming the victim's body. Needs to be eliminated as quickly as possible causative factor– bring the patient out of the state of hypovolemia and neutralize shock. Doctors carry out immediate jet injection warm (38-40C) sterile Trisol saline solution. Implemented intensive therapy sepsis, etc.

How is acute renal failure corrected, what is its effective treatment?

Therapy involves eliminating the factors that provoked acute liver failure - medications are stopped, they are treated infectious diseases, take measures to remove poison, etc.

Patients with this diagnosis are prescribed furosemide (a diuretic) in an amount of 100-400 mg, which is administered intravenously. If the medicine gives the desired effect, it is administered in an amount of 2-3 mg per kilogram of weight intravenously in combination with mannitol ( osmotic diuretic) in a volume of 0.5-1 mg per kilogram of body weight. Mannitol is administered through a separate catheter.

Dopamine is administered, a dopamine receptor agonist that has hypertensive, cardiotonic and diuretic properties. This drug effectively improves renal blood flow and glomerular filtration, and also accelerates diuresis and activates the excretion of sodium ions. Dopamine is administered in a volume of 2-3 micrograms per kilogram of weight per minute. If the medicine doesn't work desired effect or if the increase in creatinine continues, its use is discontinued after six to twelve hours.

Quite often they practice intravenous administration of heparin - 5-10 thousand units for the first administration, after which it is injected drip into the daily dosage no more than 40-60 units.

Patients with acute renal failure are advised to undergo infusion therapy glucose-salt solutions. Doctors also correct anemia by transfusing red blood cells. In addition, plasmapheresis is performed - the removed plasma is replaced with fresh frozen plasma, as well as an albumin solution.

If necessary, doctors can perform hemosorption - blood purification outside the body using a special device. Hemodialysis or peritoneal dialysis can also be performed; it is carried out when urea in the blood plasma increases to 24 mmol/l or more, as well as when uremic intoxication and potassium increase to 7 mmol/l or more.

Patients are shown dietary food with limited protein intake.

Correct treatment allows achieving renal recovery in 90% of patients with uncomplicated acute renal failure.

Additional Information

In some cases, acute renal failure leads to the development chronic form of this disease. With such a diagnosis, funds will be useful traditional medicine- bird cherry plant and shepherd's purse.

This way you can prepare the fruits of bird cherry (a tablespoon of crushed ones). Brew them with one glass of boiling water and boil for twenty minutes. Strain the strained broth and drink a quarter glass, cooled, three times a day, without reference to the time of the meal.

Also, for chronic renal failure, the shepherd's purse plant can be used. Brew three tablespoons of chopped plant material with half a liter of boiling water. Leave in a thermos for three to four hours, then strain. Drink the prepared infusion a day before - it is best to take half a glass immediately before a meal.

If you suspect the development of acute renal failure, you should immediately call an ambulance.

Acute renal failure is a pathology of organs in which sudden and rapid decline kidney function. The phenomenon is most often associated with organ ischemia, toxic damage, immune destruction and tubular dysfunction with decreased urine osmolarity. The pathology is aggravated by an instantly increasing level of residual nitrogen, potassium, the development of uremia with an increasing creatinine level in the blood serum. Reversible pathology has lightning-fast development and therefore emergency care is necessary for acute renal failure. But we will tell you how to provide the patient with the necessary auxiliary actions.

Forms of kidney failure

Pathology is divided into several forms:

Prerenal, caused by all types of shock with a decrease in the speed and volume of blood circulation: bleeding, decrease in the volume of water in the body with intense vomiting, diarrhea, burns and other phenomena;
Renal, detected on the basis acute glomerulonephritis, interstitial nephritis, toxicity with poisons, antibiotics, X-ray contrast agents;
Postrenal, which is directly related to tubule blockage with urate, oxalate type stones, protein coagulants or blood clots.

The clinical picture looks like symptoms of the underlying disease that caused the NDE: shock, chills, heat, vomiting, diarrhea. If there is a decrease in urine volume, drowsiness and lethargy, the diagnosis is confirmed.

Important! Acute PN is often complicated respiratory failure, gastrointestinal bleeding, arrhythmias and liver failure.

If acute renal failure occurs, what should you do?

Emergency care is the only way to reverse the process of kidney destruction. The choice of therapy depends on the cause, form and intensity of development of the pathology. Patient in mandatory must be hospitalized, a strict regime is prescribed and a diet of food and drink is introduced. In addition, it is necessary to monitor diuresis, blood pressure, respiratory rate, cardiac muscle contraction and temperature indicators.

It is best to provide care in a hospital or intensive care unit through intensive care doctors, but this is not always possible. Therefore, if the patient is at home or at work and has symptoms of acute renal failure, emergency care should be provided by those present. What should be done:

Lay the patient horizontally, slightly to one side, with his head hanging slightly, so as not to impede the process of vomiting (if any);
Immediately call an ambulance, explaining that there is a patient with acute renal failure;
Warm the patient outside with blankets and clothes;
Remove from a state of shock, hypovolemia using improvised means;
Measure blood pressure, if it is low, give a drink that increases blood pressure: rosehip decoction, strong tea with sugar and no alcohol;
Insert warm sterile saline solution intravenously;
To improve blood circulation in the kidneys, administer dopamine intravenously using the system: drops at a frequency of 5-10 units per minute, a solution of 0.05% in a 5% glucose solution;
Give the patient intravenous heparin immediately from 5 to 10 thousand units, then 40-60 units daily;
Inject Furosemide (Lasix) intravenously.

Infusion therapy is prescribed to restore blood flow volume, remove toxins and normalize the patient's post-shock condition. Gastric and intestinal lavage is indicated for better removal toxic waste from the bloodstream. If sepsis begins, it is carried out antibacterial therapy based on combination antibiotics, and the selection of drugs is made from the group of carbopenems. Catheterization is allowed to avoid stagnation of urine and the onset of necrosis.

Important! Based on vital signs, surgical intervention is prescribed to open the kidney capsule, drainage or remove the organ.

Possible complications

From the outside respiratory system these are: pulmonary edema, pneumonia, pleurisy;
Cardiovascular system: heart rhythm disturbances, decreased conductivity, failure, tamponade;
Hyperhydration/dehydration;
Cerebral edema, encephalopathy;
Peritonitis of aseptic type.

Important! If first aid is not provided, it is possible death. According to statistics, the mortality rate in the most severe cases reaches 70%. Acute renal failure is a pathology that requires emergency measures assistance, immediate diagnosis and application of the necessary therapy. You should not refuse hospitalization if “everything has already passed” - the disease must be treated, otherwise necrosis of the kidney tissue will begin and the organ will die.

The slightest negative manifestations from the urinary system - this is a reason to consult a doctor, undergo an examination and take the necessary measures for treatment. Acute renal failure is a reversible process, but only as long as the patient takes care of his health, otherwise, death is a matter of time, and not as long as many people think.