Help for acute renal failure algorithm. Reasons for the development of acute renal failure

Renal failure refers to the system characteristic manifestations(symptoms) appearing due to chronic or acute functional disorder.

There are, respectively, two types of such symptoms: acute and chronic, and for each of them emergency pre-medical or medical for renal failure has its own specific characteristics.

Factors leading to acute renal failure are divided into:

Prerenal acute renal failure associated with impaired renal circulation and glomerular filtration, which are a consequence of massive blood loss in the body, strong, surgical interventions on, etc.
Parenchymal acute renal failure, due to the destruction of the parenchyma of an organ, which occurs due to a sudden disruption in its blood supply, parenchymal diseases or exposure to toxic substances
Obstructive (postrenal) acute renal failure associated with trauma or blockage of the ureters

Only ARF and the factors that caused it can be diagnosed!

For acute form The following symptoms are typical:

decreased hemoglobin level ()
increased heart rate ()
limbs (arms, legs)
increase pressure ()
drowsiness
general malaise
disturbance of urination and urination. may be released in small quantities or not at all
dysfunction of the digestive system

There are 4 phases (forms of acute renal failure) of acute renal failure syndrome:

Depends on the cause of the renal failure syndrome. During the first phase, urine output decreases, blood pressure and decreased heart rate
This phase is called oliguric. No urine comes out at all. The patient's condition worsens. All major body systems are affected
Polyuric phase. The amount of urine increases and even more than usual. However, this urine mainly consists of water and salts, and therefore there is still a threat to the patient’s life
The amount released is normalized. A few months later, after special treatment, kidney function is restored

Emergency resuscitation

Long-term, or chronic renal failure(CRF) will never occur “on its own”, as it is a complication for the majority serious illnesses kidney An important fact is that due to intense symptoms many patients start the disease and even bring it to terminal stage. U, diagnostics of this disease quite problematic.

Symptoms of chronic renal failure include:

paralysis
acidosis
nosebleeds
intestinal or stomach
due to impaired urine production - edema
high blood pressure (hypertension)
violation normal functioning respiratory system
manic state

The symptoms of chronic renal failure are different from the symptoms of acute renal failure - this significantly helps in making a diagnosis.

Treatment should be carried out under the supervision of specialists! Terminal conditions of chronic renal failure are unpredictable and pose a real threat to the patient’s life.

IN medical practice accepted standard methods help:

treatment of the disease that is the main
compliance with bed rest and prohibition of elevated physical activity
diet
adequate intake and control of its elimination
decline blood pressure
elimination of complications that have arisen, usually associated with ingestion of

Causes and treatment of elbow bursitis

This syndrome of any form requires the provision of strictly medical emergency care under the supervision of specialists. If symptoms indicating the onset of renal failure are detected, it is unacceptable to hesitate when calling a team!

Kidney failure is a set of symptoms that appear when kidney function gradually or suddenly declines. It can occur in acute and chronic forms, which will be characterized by their own symptoms and approaches to providing qualified medical treatment. medical care. Treatment of acute renal failure is a set of measures that should be carried out in a hospital setting.

Acute renal failure - emergency care and treatment

Acute renal failure, which is treated only in medical institution, characterized by pronounced symptoms:

violation of urine excretion - it can either be completely absent or be in small quantities;
disruption of the digestive system - nausea, vomiting, diarrhea (diarrhea), complete absence appetite;
swelling of the upper and lower extremities;
increased blood pressure;
tachycardia;
anemia;
drowsiness;

Therapeutic measures

Treatment of acute renal failure begins with determining the cause of development pathological condition- it never happens independent disease, but is a complication of existing diseases. To quickly get rid of the factors that provoke an attack of acute renal failure, doctors can carry out various events: eliminate blood loss, restore normal heart activity, infuse blood substitutes intravenously. If there are mechanical obstacles to the passage of urine, they are removed exclusively surgically– for example, they perform ureteric catheterization and nephrostomy.

The first place in the treatment process is the restoration of urine production; for this, diuretics are used along with special solutions that are administered by infusion and in a strictly defined dosage. Treatment of renal failure in acute period also implies the use of drugs that can improve microcirculation in the kidneys, activate metabolism and restore their function.

Urgent Care

Acute renal failure, urgent Care in which it consists in eliminating acute phenomena, it can also be provoked by poisoning with poisons or certain medicines. In this case, it is important to quickly carry out detoxification measures - gastric lavage, introduction to digestive system large quantity sorbents, use of antidotes. Doctors can also perform hemodialysis or hemosorption on the patient - in most cases, these emergency treatment methods are the patient’s only chance of survival.

Acute renal failure in children and adults refers to terminal conditions, that is, with a high chance fatal outcome. Fortunately, both children and adults are treatable, acute renal failure is most often reversible, and every patient has a chance of survival. Timely treatment renal failure in the acute period is an indispensable condition for restoring the patient’s health.

Chronic renal failure

This syndrome never occurs “on its own”; it is a complication of almost all kidney diseases. For acute and chronic failure clinic will vary. For example, for chronic form swelling and pain syndrome with localization in lumbar region– symptoms are not marked by intensity, so they are often ignored by patients. There is also a problem when diagnosing chronic renal failure in children - parents may not notice a decrease in urine output and mild pain. These symptoms may be accompanied general weakness, increased fatigue, insomnia - these signs are nonspecific, so it is not possible to make a correct diagnosis based on them alone; a full examination will be required.

Chronic renal failure, the treatment of which must be carried out under medical supervision, can also occur in the terminal stage. In this case, the following may develop:

extensive swelling due to the fact that the kidneys stop producing urine;
nosebleeds;
stomach or intestinal bleeding;
high blood pressure;
damage to the nervous system;
depression;
acidosis;
respiratory impairment;
high blood pressure.

Treatment of end-stage chronic renal failure has an unpredictable outcome; doctors do not give any prognosis, because the life of such patients is calculated in hours.

Therapeutic measures

There is a clear algorithm for the treatment of chronic renal failure:

carrying out therapy for the underlying disease;
compliance with the daily routine and therapeutic nutrition;
correction of water balance disorders;
treatment of arterial hypertension;
treatment of anemia;
treatment of infectious complications.

The disease in question is considered dangerous, so patients are registered immediately after diagnosis - they will have to undergo regular examinations by specialists and periodically stay in the hospital for treatment. The pathogenesis of chronic renal failure is such that there is no clear answer to the question about drug treatments impossible - everything is too individual. Everything will depend only on what particular pathology provoked the development of the condition in question. In case of particularly severe renal failure, patients may undergo an organ transplant - sometimes this only chance on survival, patients live more than 10 years after surgery.

Kidney failure of any form is a condition that requires qualified medical care. Emergency care for acute renal failure and a course of treatment for the chronic form of the pathology should be carried out by specialists in a hospital setting - this increases the likelihood of restoring normal kidney function.

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 AKIs are associated with life-threatening conditions that impair function 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 poison. Thanks to this paired organ at healthy people water and chemical balance is maintained. They rid the body of excess water, dangerous toxins and leftovers medicines. 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 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 febrile 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 that caused 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 clinical manifestations of the disease are determined from the patient:

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;
Acidity study bloodstream and electrolyte concentrations;
Electrocardiogram;
Blood pressure readings over time;
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 biological fluid in the bladder. 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 during this period:

Eliminate violations 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 avoidance of physical activity and stress.

Acute renal failure(AKI) is an acutely developing, potentially reversible syndrome characterized by a sudden total disruption of renal function in ensuring homeostasis, which is manifested clinically by disturbances in water-electrolyte metabolism and the acid-base state of the blood, an increase in azotemia with the development of uremia, and damage to almost all systems and functions.

Depending on the cause, there are: prerenal, postrenal and renal forms of acute renal failure. The prerenal form develops when there is cessation or insufficient blood flow to the kidney (intestinal toxicosis with exicosis, polyuria, shock of any etiology). Postrenal - when the outflow of urine from the kidneys is obstructed (ICD, volumetric process, scars); neurogenic dysfunction bladder. Renal - a pathological process in the kidney itself - (glomerulonephritis, interstitial nephritis).

With timely elimination of prerenal and postrenal disorders, renal function can be completely restored, but if time is lost, secondary organic damage to the renal parenchyma may develop. For example, acute tubular necrosis due to renal ischemia with uncorrectable hypovolemia and arterial hypotension develops within 2-6 hours. For diff. For the diagnosis of functional and organic acute renal failure in hypovolemia and shock, a water load test is indicated: a volume of fluid equal to 2% of body weight (5% glucose solution and saline solution in a ratio of 3:1 or 2:1), then Lasix at a dose of 2 mg/kg. Interpretation of the sample: within 2 hours after the load, the child must excrete at least 60% of its volume - restoration of diuresis indicates functional renal failure.

Clinical diagnosis.

The course of acute renal failure is staged, with initial period- from 3 hours to 3 days, oligoanuric - from 3 days to 3 weeks, polyuric - 1 - 6 weeks or more (up to 3 months), recovery stage - up to 2 years.

1. Initial stage AKI (preanuric - functional renal failure) is manifested by symptoms of the underlying disease and a decrease in diuresis, which has not yet reached stable oliguria. For early recognition of the transition to the oligoanuric stage of acute renal failure, it is necessary to take into account hourly diuresis.

Oliguria - diuresis less than 0.5 ml/kg per hour, or less than 1/3 of the age value daily diuresis. Anuria - diuresis less than 50 ml/day. The exception is newborns in the first 3-4 days of life, when diuresis may be absent even in healthy children, as well as newborns older than 7 days and children under 3 months, when oliguria is considered to be a decrease in diuresis of less than 1 ml/kg per hour.

2. Oligoanuric stage- a threatening condition develops due to overhydration, electrolyte imbalance and uremic intoxication. Overhydration can be extracellular in nature (increase in body weight, peripheral and cavitary edema) and/or intracellular (edema of the brain, lungs). Brain edema (angiospastic encephalopathy) is manifested by an increase in headache, agitation, vomiting, decreased hearing and vision, muscle twitching with increased tone and tendon reflexes, and subsequently coma and convulsions. Another complication of hydremia is acute heart failure up to pulmonary edema: sudden inspiratory shortness of breath, scattered wheezing; Heart sounds are muffled, pulse is frequent and weak.

Electrolyte imbalances are expressed by hyperkalemia (with repeated vomiting and profuse diarrhea, hypokalemia is possible), hypermagnesemia and a decrease in Ca and Na levels. A particular danger is the development of hyperkalemia, manifested by paresthesia, muscle hypotension, hypo- or areflexia, fibrillation of individual muscles, tonic convulsions, muffled heart sounds, bradycardia, arrhythmia; on the ECG - high-amplitude T waves, widening of the QRS complex and lengthening P-Q interval, in severe cases - the development of ventricular fibrillation and cardiac arrest. An increase in serum potassium to 6.5 mmol/l is considered critical.

Developing uremic intoxication is indicated by: increasing adynamia, lethargy up to the development of coma, anorexia, dyspeptic symptoms, the addition of toxic stomatitis and gastroenteritis, Kussmaul breathing, increased urea and/or creatinine levels.

In the oligoanuric stage of acute renal failure in the analyzes peripheral blood Anemia and decreased hematocrit are noted. Urinary syndrome characterized by hypoisosthenuria, proteinuria with hematuria and leukocyturia. The main causes of death: overhydration with cerebral and pulmonary edema, hyperkalemia (cardiac arrest), decompensated acidosis (less commonly, alkalosis), intoxication, sepsis.

3. Polyuric stage ARF (diuresis recovery stage) is characterized by a gradual increase in diuresis followed by a decrease in azotemia. Due to polyuria, due to the failure of the tubules, electrolyte disturbances (hypokalemia, hypocalcemia, etc.), dangerous dehydration with loss of body weight may occur, and therefore this stage is called critical. Clinical manifestations of hypokalemia: lethargy, lethargy, muscle hypotonia, hyporeflexia, possible paresis, cardiac disorders (bradycardia, conduction disturbances); on the ECG - flattening and inversion of the T wave, deflection of the ST segment. In the polyuric stage, death is possible from cardiac arrest (hypokalemia) or from a septic process.

Treatment is carried out in a specialized hemodialysis department or intensive care unit, differentiation depending on the stage of the process and the etiological factor.

Urgent Care.

1. Initial stage of acute renal failure:

1. Treatment of the underlying disease. In case of hypovolemia and shock - restoration of bcc with rheopolyglucin, 10% glucose, 0.9% sodium chloride according to generally accepted principles under the control of central venous pressure, blood pressure, and diuresis.

2. To stimulate diuresis:

For hypovolemia, a 15% mannitol solution at a dose of 0.2-0.4 g/kg (by dry matter) intravenously; if there is no increase in diuresis after administration of 1/2 dose, its further administration is contraindicated; mannitol is also contraindicated in heart failure and hypervolemia;

Against the background of sufficient replenishment of blood volume, a 2% Lasix solution at a dose of 2 mg/kg IV; if there is no response, repeat the administration after 2 hours in a double dose; In order to enhance the diuretic effect of Lasix, simultaneous administration of titrated dopamine intravenously at a dose of 1-4.5 mcg/kg per minute is possible.

3. Prescription of drugs that improve renal blood flow: 2.4% aminophylline solution 1.0 ml/year per day intravenously; 2% solution of trental at a dose of 1-2 mg/kg IV or 0.5% solution of chirantil at a dose of 3-5 mg/kg IV.

2. Oligoanuric stage of acute renal failure:

I. Indications for emergency hemodialysis:

Serum urea > 24 mmol/l, creatinine > 0.5 mmol/l, as well as a daily increase in plasma urea more than 5 mmol/l, creatinine > 0.18 mmol/l;

Hyperkalemia above 6.0-6.5 mmol/l; hyponatremia less than 120 mmol/l; acidosis with blood pH less than 7.2;

Daily increase in body weight by more than 5-7%; pulmonary or cerebral edema;

Absence of “+” dynamics during conservative treatment (anuria persisting for more than 2 days).

II. Conservative treatment in the absence of indications for hemodialysis:

1. Amount of fluid per day = diuresis of the previous day + perspiration losses + extrarenal losses, where perspiration losses are 25 ml/kg per day or calculated in ml/kg per hour: in newborns - 1.5 ml/kg per hour; up to 5 years -1.0 ml/kg hour; over 5 years - 0.5 ml/kg hour.

Extrarenal losses: unaccounted losses through stool and vomiting - 10-20 ml/kg per day; for every 10 breaths over age norm- 10 ml/kg per day; for each degree above 37° C - 10 ml/kg per day.

In the absence of vomiting, 60-70% of the daily volume of fluid is given orally, the rest is given intravenously. Infusion therapy is carried out with glucose-saline solutions (1/5 of the volume - reopolyglucin).

Protein, potassium-containing solutions (di-, trisol, acesol, Ringer's) are contraindicated for anuria.

Body weight control h/w 12 hours: with adequate water load, weight fluctuations do not exceed 1%.

2. Correction of metabolic acidosis:

Gastric lavage with a 2% sodium bicarbonate solution and administration of the same solution orally (0.12 g/kg per day of dry matter) in 4-6 divided doses;

Under the control of CBS indicators, 4% sodium bicarbonate solution is administered intravenously.

3. In case of threatened hyperkalemia (rapidly increasing or above 6 mmol/l), administer:

10% calcium gluconate solution 0.2 ml/kg IV slowly over 5 minutes;

20% glucose solution at a dose of 4-5 ml/kg with insulin;

4% sodium bicarbonate solution at a dose of 2-4 ml/kg IV drip for 20 minutes (do not use together with calcium gluconate to avoid precipitation in the syringe);

Oral administration of an osmotic laxative (sorbitol, xylitol).

4. Treatment of complications: pulmonary edema, cerebral edema.

5. For preventive purposes - AB therapy in short courses of 5 days at 1/2 the average therapeutic dose, with breaks of 1-2 days between courses; except for nephrotoxic ABs and those that are excreted primarily by the kidneys (aminoglycosides, tetracyclines, cephalosporins I).

3. Polyuric stage of acute renal failure:

Correction of water-salt metabolism with replenishment of fluid and electrolytes according to losses.

Hospitalization of patients with oligoanuria in a state of shock in the intensive care unit, joint management with doctors of the hemodialysis department. For renal anuria, hospitalization in a hospital where there is a device “ artificial kidney", with obstructive anuria - to a surgical hospital. For anuria caused by severe heart failure, urgent hospitalization to the somatic department.

There are 3 forms of flow acute failure kidney:

Prerenal (secondary) – caused by disorders in other organs and systems.
Renal (parenchymal) – develops against the background of damage renal tissue.
Postrenal (obstructive) - occurs due to blockage or compression of the urinary ducts.

Reasons

Various pathological processes in the human body can lead to the development of acute renal dysfunction. There are 3 main groups of factors that cause a certain form of acute renal failure:

Among the causes of the prerenal stage are:

Decline contractile function heart muscle.

May be due to severe violations heart rhythm, heart failure, cardiogenic shock.

Acute insufficiency of the vascular system.

Occurs due to various types shock - blood transfusion (after blood transfusion), septic (against the background of infection), traumatic, anaphylactic (allergic).

A sharp decrease in blood volume in the bloodstream.

It can be observed with dehydration, massive burns, peritonitis (inflammation of the peritoneum), preeclampsia.

These hemodynamic disturbances and hypovolemia contribute to renal vasoconstriction, reducing blood flow in the renal tissue and its redistribution along alternative pathways. With further impairment of blood circulation in the kidneys, acute renal failure of the prerenal form can progress to renal failure.

Renal capillaries

The renal form of acute renal failure is often caused by acute necrosis renal tubules under the influence of the following substances:

Toxic is ethylene glycol, a compound heavy metals, poisons that destroy blood cells.
Medicinal - aminoglycosides, polymyxins, cephalosporin antibiotics, Paracetamol, substances for x-ray diagnostics.

Infrequent causes of the renal form may be death of renal tissue, uric acid blockade of renal tubules, tubulointerstitial nephritis, acute glomerulonephritis.

The postrenal form is caused by bilateral blockage or compression of the ureters by stones or a tumor. In this case, emergency surgical treatment is prescribed.

Division by stages

Acute renal failure has 4 phases:

Initial.

It's typical for her primary manifestation background disease, septic condition, renal colic. During this phase, blood vessels collapse and the blood supply to the kidneys is disrupted. To prevent progression of the process, it is very important to begin therapy during this period.

Oliguric.

This stage of acute renal failure is characterized by a decrease in urine volume (oliguria) or its complete absence (anuria). A urine test determines shaped elements blood (erythrocytes), proteins, cylinders. The concentrating ability of the kidneys is sharply reduced. Increased sodium excretion in urine. Blood pressure is more common in normal values. In the biochemistry analysis, an increase in urea and creatinine, phosphates, and hyperkalemia is observed. In severe cases, metabolic decompensated acidosis develops, which is characterized by noisy breathing. Symptoms of general intoxication are clearly expressed: weakness, lethargy, lethargy, drowsiness. During the septic process, fever and chills are noted. Appears dyspeptic syndrome, manifested by nausea, vomiting, diarrhea, and hemorrhagic (skin and gastrointestinal manifestations). At the same time, in general analysis blood, anemia, severe leukocytosis, and a decrease in platelet levels are determined. Overhydration subsequently develops, which can lead to edema of the brain, lungs, and pericarditis.

Polyuric (recovery) phase.

Lasts on average 7–10 days. It is characterized by a rapid increase in urine production and excretion. Sometimes polyuria can be severe and reach 4 liters per day. Against this background, dehydration develops, and sodium and potassium in the blood decrease.

Recovery phase.

Characterized by eliminating the causes of acute renal failure, full restoration blood movement through blood vessels and kidney function. During this phase, sanatorium-resort treatment is prescribed.

Diagnostics

examination by a doctor

Acute renal failure should be diagnosed as early as possible. Diagnostics is based on the following data:

Careful collection of information about the disease.
Examination and palpation examination of the patient.
Expanded and biochemical analysis blood.
General urine analysis.
Detection of C-reactive protein.
Study of blood acidity and electrolyte levels.
Determination of diuresis.
Blood pressure monitoring.
Electrocardiogram.
Ultrasound of the kidneys and other organs as indicated.
X-ray examination of the lungs if edema is suspected.
Computed and magnetic resonance imaging internal organs according to indications.
Consultations of narrow specialists.

Emergency care and intensive care for acute renal failure

Treatment of acute renal failure should be started as early as possible. Emergency care is provided in a specialized department by resuscitators. The choice of treatment tactics depends on the cause of development, form and phase pathological process. patient in mandatory hospitalized in the hospital department. A diet and strict bed rest, control of diuresis, blood pressure, monitoring of respiratory rate, heart rate, pulse, saturation, body temperature.

Emergency care in the initial stage of acute renal failure is aimed at eliminating causative factor and consists of the following treatment:

Appointed infusion therapy in order to replenish the volume of circulating blood, correct metabolic disorders, removal from a state of shock. Glucose-saline solutions, Reopoliglucin, fresh frozen plasma are used required group, Hemodez, Albumin. Treatment with glucocorticosteroid hormones – Prednisolone, Methylprednisolone – is prescribed.
Washing the stomach and intestines.
Removal toxic substances from the bloodstream. Plasmapheresis, replacement blood transfusion, and hemosorption are performed.
In case of septic process, the appointment is indicated antibacterial treatment in a combination of two antibiotics. The drugs of choice are drugs from the carbopenem group (Tienam, Meronem), Vancomycin.
In case of obstructive form, it is carried out surgery, aimed at restoring urine flow. Catheterization of the ureters can be performed; in severe cases, for health reasons, drainage of the kidney or removal of its capsule can be performed.

If initial stage The acute renal failure has become oliguric, and the following is added to the treatment:

Intravenous administration of Furosemide with Dopamine, Mannitol to increase diuresis. Therapy is carried out against the background protein-free diet, under strict control over the fluid drunk and excreted, monitoring of central venous pressure. It is necessary to monitor body weight and monitor urea and electrolyte levels.
Peritoneal dialysis or hemodialysis. Prescribed when the therapy is ineffective, when the level of potassium and urea increases according to biochemical analysis.

In the polyuric stage of acute renal failure, treatment is aimed at correcting electrolyte disturbances and combating dehydration. The losses of sodium and potassium are replenished with appropriate medications. Rehydration is carried out with glucose-saline solutions intravenously or taken orally. Changes dietary food– salt and water consumption is not limited. The diet includes foods rich in potassium. As diuresis normalizes, the amount of rehydration solutions decreases.

Possible complications

Severe acute renal failure can lead to adverse consequences:

Pulmonary edema, pleurisy, pneumonia, and respiratory failure may develop.
Impaired heart rhythm and conduction, cardiac and vascular failure, cardiac tamponade may occur.
Overhydration or dehydration.
Cerebral edema, encephalopathy.
Aseptic peritonitis.
Lethal outcome – in severe cases reaches 70%.

Acute renal failure requires emergency measures to eliminate renal dysfunction and hemodynamic disorders. Competent diagnosis and timely treatment reduce the risk serious complications and death. If the slightest dysfunction of the urinary system organs appears, it is very important to immediately consult a specialist or call an emergency medical team.