First aid for renal failure. The initial stage of OPN

There are 3 forms of acute kidney failure:

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

The 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 noted:

decline contractile function heart muscle.

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

Acute insufficiency of the vascular system.

Occurs due to various kinds 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 disorders and hypovolemia contribute to vasoconstriction of the kidneys, a decrease in blood flow in the renal tissue and its redistribution along alternative pathways. With further circulatory disorders in the kidneys, acute kidney failure prerenal form can progress to the renal.

renal capillaries

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

Toxic is ethylene glycol, heavy metal compounds, poisons that destroy blood cells.
Medicinal - aminoglycosides, polymyxins, cephalosporin antibiotics, Paracetamol, substances for X-ray diagnostics.

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

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

Division by stages

Acute renal failure has 4 phases:

Initial.

It is characterized by the primary manifestation background disease, septic condition, renal colic. In this phase, there is a collapse of blood vessels, a violation of the blood supply to the kidneys. To prevent the progression of the process, it is very important to start therapy during this period.

Oliguric.

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

Polyuric (recovery) phase.

It lasts an average of 7-10 days. It is characterized by a rapid increase in urine production and excretion. Sometimes polyuria can be very pronounced and reach 4 liters per day. Against this background, dehydration develops, sodium and potassium in the blood decrease.

recovery phase.

It is characterized by the elimination of the causes of acute renal failure, full recovery the movement of blood through the vessels and the functioning of the kidneys. In this phase, sanatorium-resort treatment is prescribed.

Diagnostics

doctor's examination

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

Careful collection of information about the disease.
Inspection and palpation of the patient.
Detailed and biochemical analysis of blood.
General urine analysis.
Detection of C-reactive protein.
Study of blood acidity and electrolyte levels.
definition of diuresis.
Monitoring blood pressure.
Electrocardiogram.
Ultrasound of the kidneys and other organs according to indications.
X-ray examination of the lungs with suspected edema.
Computed and magnetic resonance imaging of internal organs according to indications.
Consultations of narrow specialists.

Emergency care and intensive care for acute renal failure

Treatment of AKI should be started as early as possible. Emergency care is provided in a specialized department by resuscitation doctors. The choice of treatment tactics depends on the cause of development, the form and phase of the pathological process. The patient is necessarily hospitalized in the hospital department. A diet and strict bed rest are prescribed, 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 the causative factor and consists in the following treatment:

Infusion therapy is prescribed to replenish the volume of circulating blood, correct metabolic disorders, removing from a state of shock. Glucose-salt solutions, Reopoliglyukin, fresh frozen plasma are used required group, Hemodez, Albumin. Treatment with glucocorticosteroid hormones is prescribed - Prednisolone, Methylprednisolone.
Lavage of the stomach and intestines.
Removal of toxic substances from bloodstream. Plasmapheresis, exchange transfusion, hemosorption are carried out.
With a septic process, the appointment of antibacterial treatment in a combination of two antibiotics is indicated. The drugs of choice are drugs from the group of carbopenems (Tienam, Meronem), Vancomycin.
With an obstructive form, a surgical intervention is performed to restore the movement of urine. Urethral catheterization can be performed, in severe cases, according to vital indications, drainage of the kidney or removal of its capsule.

If the initial stage of acute renal failure has passed into oliguric, the following is added to the treatment:

Intravenous administration of Furosemide with Dopamine, Mannitol to increase diuresis. The therapy is carried out against the background of a protein-free diet, under strict control over the drunk and excreted liquid, monitoring of central venous pressure. It is necessary to monitor body weight and control the level of urea and electrolytes.
Peritoneal dialysis or hemodialysis. They are prescribed for the ineffectiveness of the therapy, when the level of potassium and urea increases according to the biochemical analysis.

In the polyuric stage of acute renal failure, treatment is aimed at correcting electrolyte disturbances and combating dehydration. Sodium and potassium losses are replenished with appropriate drugs. Rehydration is carried out with glucose-salt solutions intravenously or by ingestion. The diet is changing - the consumption of salt and water 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:

Develop pulmonary edema, pleurisy, pneumonia, respiratory failure.
There is a violation of the heart rhythm and conduction, cardiac and vascular insufficiency, cardiac tamponade.
Hyperhydration or dehydration.
Cerebral edema, encephalopathy.
Aseptic peritonitis.
Lethal outcome - in severe cases reaches 70%.

Acute renal failure requires urgent measures to eliminate violations of kidney function, hemodynamic disorders. Proper diagnosis and timely treatment reduces the risk serious complications and lethal outcome. If the slightest disturbance of the functions of the organs of the urinary system appears, it is very important to immediately contact a specialist or call an ambulance team.

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Acute renal failure emergency care

Acute renal failure in children. Urgent care

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

Depending on the cause, there are: prerenal, postrenal and renal forms of acute renal failure. The prerenal form of acute renal failure develops as a result of cessation or insufficient blood flow to the kidney and often occurs with intestinal toxicosis with exicosis, with polyuria, shock of any etiology, congestive heart failure, etc. Postrenal acute renal failure - in the presence of an obstacle to the outflow of urine from the kidneys (urolithiasis, volume process, scars, etc.), with neurogenic bladder dysfunction, etc.

Renal acute renal failure is caused by a pathological process in the kidney itself - glomerulonephritis, interstitial nephritis, microthromboembolism, acute tubular necrosis, etc.

With the timely elimination of prerenal and postrenal disorders, renal function can be fully restored, but if time is missed, a secondary organic lesion renal parenchyma. For example, acute tubular necrosis due to renal ischemia with uncorrected hypovolemia and arterial hypotension develops within 2-6 hours. For differential diagnosis functional and organic acute renal failure with hypovolemia and shock, a test with a water load is indicated (Tsybulkin E.K., 1998): a volume of fluid equal to 2% of body weight is administered intravenously for 30 minutes in the form of a glucose-salt solution (5 % glucose solution and isotonic sodium chloride solution in a ratio of 3:1 or 2:1), then lasix is administered 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 - the restoration of diuresis indicates functional renal failure and hypovolemia.

Clinical diagnostics

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

The initial stage of acute renal failure (pre-anuric - 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 300 ml / m2 of body surface area per day or less than 0.5 ml / kg per hour, or less than 1/3 of the age-related daily diuresis (see Appendix). Anuria - diuresis less than 60 ml / m2 per day or less than 50 ml / day. The exceptions are 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.

In the oligoanuric stage of acute renal failure, a threatening condition develops, primarily due to hyperhydration, disorders electrolyte balance and uremic toxicity. Hyperhydration can be extracellular (weight gain, peripheral and abdominal edema) and / or intracellular (cerebral, pulmonary edema). Cerebral edema (angiospastic encephalopathy) is manifested by an increase in headache, agitation, vomiting, hearing and vision loss, muscle twitches with increased tone and tendon reflexes, and subsequently coma and convulsions. Another real complication of hydremia that has arisen is acute heart failure of the left ventricular type up to pulmonary edema: sudden inspiratory dyspnea, diffuse rales in the lungs, muffled heart sounds, pulse is frequent, weak (for more details, see section "Pulmonary edema").

Electrolyte imbalances are expressed by hyperkalemia (with repeated vomiting and profuse diarrhea, on the contrary, hypokalemia is possible), hypermagnesemia and a decrease in the level of calcium and sodium. Of particular danger is the development of hyperkalemia, which is clinically manifested by paresthesia, muscle hypotension, hypo- or areflexia, fibrillar twitching of individual muscles, tonic convulsions, muffled heart tones, bradycardia, arrhythmia, etc .; on the ECG - high-amplitude T waves, expansion of the QRS complex and lengthening interval P-Q, in severe cases - the development of ventricular fibrillation and cardiac arrest (see Appendix). An increase in serum potassium to 6.5 mmol/l is considered critical.

Developing uremic intoxication can be indicated by: increasing adynamia, lethargy up to the development of coma, anorexia, dyspeptic manifestations, the addition of toxic stomatitis and gastroenteritis, Kussmaul respiration, in the blood serum - an increase in the content of urea and / or creatinine.

In the oligoanuric stage of acute renal failure, anemia and a decrease in hematocrit are noted in peripheral blood tests. The urinary syndrome is characterized by hypoisostenuria, proteinuria with hematuria, and leukocyturia. The main causes of deaths are: hyperhydration with the development of cerebral and pulmonary edema, hyperkalemia (cardiac arrest), decompensated acidosis (less often - alkalosis), intoxication, sepsis.

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

Treatment of a child with developed acute renal failure is carried out in a specialized hemodialysis unit or intensive care unit in a differentiated manner depending on the stage of the process and the etiological factor.

Urgent care

The initial stage of OPN

1. Treatment of the underlying disease. In case of hypovolemia and shock - restoration of BCC with solutions of rheopolyglucin (polyglucin), 10% glucose, 0.9% sodium chloride according to generally accepted principles under the control of CVP, blood pressure, diuresis.

2. In order to stimulate diuresis:

with hypovolemia, 15% mannitol solution at a dose of 0.2-0.4 g / kg (dry matter) intravenously; in the absence of an increase in diuresis after the introduction of half the dose, its further administration is contraindicated; mannitol is also contraindicated in heart failure and hypervolemia;
against the background of sufficient replenishment of the BCC, a 2% solution of Lasix at a dose of 2 mg/kg IV; if there is no response - after 2 hours, repeat the introduction in a double dose; in order to enhance the diuretic effect of lasix, simultaneous administration of intravenous titrated dopamine at a dose of 1-4.5 mcg/kg per minute is possible.

3. Appointment of drugs that improve renal blood flow:

2.4% solution of eufillin 1.0 ml/year of life per day i.v.;
2% solution of trental at a dose of 1-2 mg/kg IV or 0.5% solution of chimes at a dose of 3-5 mg/kg IV.

Oligoanuric stage of acute renal failure

I. Indications for emergency hemodialysis:

serum urea above 24 mmol / l, serum creatinine above 0.5 mmol / l, as well as a daily increase in plasma urea more than 5 mmol / l, creatinine - more than 0.18 mmol / l per day;
hyperkalemia above 6.0-6.5 mmol/l; hyponatremia less than 120 mmol/l;
acidosis with blood pH less than 7.2 and base deficiency (BE) more than 10 mmol/l;
daily increase in body weight by more than 5-7%; swelling of the lungs or brain;
lack of positive dynamics against the background of conservative treatment (anuria that persists for more than 2 days).

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

1. Amount of fluid per day = previous day's urine output + perspiration loss + extrarenal loss, where perspiration loss is 25 ml/kg per day or in ml/kg per hour:

in newborns -1.6 ml / kg hour;
up to 5 years - 1.0 ml / kg hour;
older than 5 years - 0.5 ml / kg hour.

Extrarenal losses:

unaccounted losses with stool and vomiting - 10-20 ml/kg per day;
for every 10 breaths above the age norm - 10 ml / kg per day;
for every degree of body temperature 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 - intravenously. Infusion therapy carried out with glucose-salt solutions (1/5 of the volume - reopoliglyukin).

Protein preparations, solutions containing potassium (disol, trisol, acesol, Ringer's solution, potassium chloride, etc.) are contraindicated in anuria!

Body weight control after 12 hours: with adequate water load, body weight fluctuations do not exceed 0.5-1%.

2. Correction of metabolic acidosis:

gastric lavage with a 2% solution of sodium bicarbonate and the appointment of the same solution inside (0.12 g / kg per day of dry matter) fractionally in 4-6 doses;
under the control of KOS indicators 4% sodium bicarbonate solution IV drip per day in an amount (in ml) equal to: BE (mmol / l) x body weight (in kg) x 0.3.

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

10% calcium gluconate solution 20 mg/kg (0.2 ml/kg) IV slowly over 5 minutes, may be repeated twice;
20% glucose solution at a dose of 4-5 ml / kg with insulin (1 unit per 5 g of glucose administered);
4% solution of sodium bicarbonate at a dose of 1-2 meq/kg (2-4 ml/kg) IV drip for 20 minutes (do not use 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 - see the relevant sections.

5. For prophylactic purposes, the appointment of antibiotic therapy in short courses of 5 days at a half dose from the average therapeutic one, between courses there are breaks of 1-2 days; do not prescribe nephrotoxic antibiotics and those that are excreted mainly by the kidneys (aminoglycosides, tetracyclines, methicillin, cephalosporins of the first generation, etc.).

Polyuric stage of acute renal failure

In the polyuric stage of acute renal failure, it is necessary to correct the water-salt metabolism with the 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 the doctors of the hemodialysis unit. With renal anuria, hospitalization in a hospital where there is an “artificial kidney” apparatus, with obstructive anuria - in a surgical hospital. Anuria due to severe heart failure urgent hospitalization to the somatic department.

malyok.ru

Acute renal failure

Acute renal failure is a sharp sudden violation of all intrarenal processes: hemo- and hydrodynamics, glomerular filtration, tubular secretion and reabsorption, as a result of which homeostasis is disturbed and hyperazotemia develops, profound disturbances in water and electrolyte metabolism, acidosis, arterial hypertension, anemia. The most important condition Successful treatment of patients with acute renal failure is its early diagnosis, which is carried out taking into account the polyetiology of this disease. Conditionally allocate the following etiological factors acute renal failure:

prerenal (shock, prolonged crush syndrome, endogenous intoxication, massive loss of fluid and electrolytes, renal artery thromboembolism, kidney infarction);

renal (pephrotoxicosis in case of poisoning with salts of heavy metals, tetrachloride hydrocarbon, chloramine, some types of fungi, phosphorus; infections - pyelonephritis, hemorrhagic fever, leptospirosis, septic abortion, anaerobic infection, acute glomerulonephritis; toxic-allergic lesions;

subrenal (obstruction of the ureters with stones, ligation of the ureters during gynecological operations, germination of the tumor in the ureter, squeezing the ureters by tumors from the outside).

AT clinical course There are several stages of acute renal failure:

Stage I - initial (symptoms due to the direct influence of the etiological factor);

Stage II - oligoanuric (oliguria or complete anuria, hyperazotemia, metabolic acidosis, hyperkalemia, sharp changes in the acid-base state, manifested by toxic myocarditis and pleuropneumonia, often uremic pulmonary edema, erosive gastroenterocolitis, liver failure, polyserous lesions of bones and joints, CNS lesions) ;

Stage III - recovery:

phase of early diuresis - the clinic is the same as in stage II;
the phase of polyuria and restoration of the concentration ability of the kidneys - all hemorenal constants are normalized, the functions of the respiratory and cardiovascular systems, digestive canal, support and movement apparatus, central nervous system;

Stage IV - recovery - anatomical and functional restoration of renal activity to the original parameters.

Diagnosis of acute renal failure, starting from stage II, does not cause any difficulties and is based on clinical manifestations and data from laboratory, biochemical and radiological studies, allowing to assess the depth and dynamics renal disorders and damage to all organs and systems. The most important task clinicians of any profile - to diagnose stage I acute renal failure.

Traumatic and hemorrhagic shock are characterized by a classic clinic, described by N.I. Pirogov. With burn shock, patients scream in pain, massive plasma loss, blood clotting, and toxicosis are observed. Transfusion shock causes pain in the lumbar region, chills, subicteric sclera and skin, intravascular hemolysis develops.

Bacteremic (bacteriotoxic) shock is characterized by tremendous chills, hectic fever and profuse sweat, high leukocytosis.

At anaphylactic shock appear pruritus, rashes, coughing, bronchospasm, blood pressure decreases, eosinophilia is detected in the blood.

Massive loss of fluid and electrolytes causes dehydration, extracellular dehydration, hypokalemia, and seizures.

Nephrotoxicosis is manifested by profuse vomiting, abdominal pain, diarrhea, the appearance of a black border on the gums. The clinic of acute gastroenterocolitis is developing. In the urine, cells of dystrophically altered tubular epithelium are found.

Acute bilateral pyelonephritis is characterized by tremendous chills, high leukocytosis, hectic fever, intense aching pain in the lumbar region, dysuria, leukocyturia, bacteriuria.

In acute glomerulonephritis, pain occurs in the lumbar region, hematuria (leached erythrocytes), cylindruria, proteinuria and dysproteinuria are noted, hypertensive syndrome and edema develop.

The clinic of septic abortion is similar to that of bacteremic shock. In addition, there are cramping pain in the abdomen, signs of DIC, and there is distinguishing feature- skin vessels are affected (necrotic areas in the wings and back of the nose, lips, cheeks, earlobes, nail phalanges), most women develop uterine bleeding.

In acute urostasis (subrenal etiological factors of acute renal failure), the first and cardinal symptom is renal colic.

In the initial stage of acute renal failure, the following complex of urgent medical measures:

Antishock therapy.

Transfusion detoxification therapy (before exchange transfusions, administration of antidotes, intravenous drip injection concentrated glucose solutions).

Lavage of the stomach and intestines with 5% sodium bicarbonate solution for endogenous and exogenous intoxications and poisonings.

In septic conditions, if urinary tract urodynamics are preserved, at least two antibacterial drug in doses that take into account the degree of impaired renal function.

With obstructive anuria, catheterization of the ureters is indicated, and if attempts to implement it are unsuccessful, an urgent operation, according to vital indications, is drainage of the kidney and, according to indications, its decapsulation.

In all cases, cardio- and vasotonics, antispasmodics, diuretics, anabolic drugs are prescribed.

Early diagnosis of acute renal failure and adequate urgent measures, carried out in its initial stage, in 25 - 30% of cases suspend further development acute renal failure. If this cannot be achieved and acute renal failure progresses, the use of extrarenal blood purification methods is indicated.

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Acute renal failure: emergency care

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

Forms of kidney failure

Acute renal failure is an organ pathology in which there is a sharp and rapid decrease in kidney function.

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, a decrease in the volume of water in the body with intense vomiting, diarrhea, burns and other phenomena;
Renal, detected on the basis of acute glomerulonephritis, interstitial nephritis, toxicity with poisons, antibiotics, radiopaque preparations;
Postrenal, which is directly related to blockage of the tubules with urate, oxalate-type calculi, protein coagulants or blood clots.

The clinical picture looks like symptoms of the underlying disease that caused 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 OPN manifested itself, what should I do?

Emergency care is the only way to reverse the process of kidney destruction

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 the development of pathology. The patient must be hospitalized without fail, a strict regimen is prescribed and a diet of food and drink is introduced. In addition, it is necessary to monitor diuresis, blood pressure, respiratory rate, contraction of the heart muscle and temperature.

It is best to provide assistance 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, there are symptoms of acute renal failure, emergency care should be provided by those present. What should be done:

Put the patient horizontally, slightly to one side, slightly hanging his head so as not to impede the process of vomiting (if any);
Immediately call an ambulance team, explaining that there is a patient with acute renal failure;
Warm the patient outside with blankets, clothes;
Remove from a state of shock, hypovolemia by means of improvised means;
Measure blood pressure, with reduced blood pressure, give a drink that increases blood pressure: rosehip broth, strong tea with sugar and no alcohol;
Inject warm sterile saline intravenously;
To improve the circulation of blood flow in the kidneys, intravenously inject dopamine 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 heparin intravenously at once from 5 to 10 thousand units, then daily 40-60 units;
Enter furosemide (Lasix) intravenously.

Infusion therapy is prescribed to restore the volume of blood flow, remove toxins and normalize the post-shock state of the patient. Shown gastric lavage, intestines for better removal toxic waste from the bloodstream. If sepsis has begun, antibacterial therapy is carried out based on combined antibiotics, and the selection of drugs is made from the group of carbapenems. Catheterization is allowed to avoid stagnation of urine and the onset of necrosis.

Important! According to vital signs, surgical intervention is prescribed with opening the capsule of the kidney, draining or removing the organ.

Possible Complications

The severe course of the disease can lead to the most negative consequences, and from the side of all vital important organs

A severe course of the disease can lead to the most negative consequences, and from all vital organs:

On the part of the respiratory system, these are: pulmonary edema, pneumonia, pleurisy;
Cardiovascular system: heart rhythm failures, decreased conduction, insufficiency, tamponade;
Hyperhydration/dehydration;
Cerebral edema, encephalopathy;
Aseptic peritonitis.

Important! Failure to provide first aid may result in death. According to statistics, the mortality rate in the most severe cases reaches 70%. Acute renal failure is a pathology that requires emergency measures of assistance, immediate diagnosis and the use 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 of the urinary system are an occasion to consult a doctor, undergo an examination and take the necessary measures for treatment. OPN 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.

lecheniepochki.ru

Emergency care for acute renal failure

Acute renal failure (ARF) is a clinical condition characterized by sharp deterioration kidney function, which leads to excessive accumulation of nitrogenous slags in the patient's blood serum. Depending on the amount of urine excreted during the day, in acute renal failure, an oliguric form (less than 500 ml of urine) and a neoliguric form (more than 500 ml of urine) are distinguished. The causative factors of acute renal failure can be divided into three groups:

prerenal;
renal;
postrenal.

History and physical examination can provide important information regarding the etiology of acute renal failure. History of acute abdominal pain with nausea and vomiting may indicate a prerenal cause, while oliguria associated with discomfort in suprapubic region and an increase in the zone of dullness of percussion sound over bladder suggest obstructive uropathy.

Intravenous pyelography, renal angiography, and renal biopsy can provide additional diagnostic information, but these methods are invasive and can cause significant complications, so they should not be used routinely in the evaluation of acute renal failure. They should only be used in specific situations.

Treatment of acute renal failure is aimed at eliminating the causative factor. In patients with a postrenal cause of acute renal failure, adequate urine flow should be ensured. The procedure used can vary greatly depending on the level of obstruction. For example, insertion of a Foley catheter may be sufficient for obstruction due to benign hypertrophy. prostate, whereas percutaneous nephrostomy drainage is necessary for ureteral occlusion. Once the patient's condition improves, surgical correction of the obstructive lesion should be considered. In patients with suspected prerenal cause of acute renal failure every effort should be made to restore effective intravascular volume. To restore volume, rapid administration of isotonic fluids (isotonic sodium chloride solution, plasma, or Ringer's solution) is carried out.

Avoid introducing hypotonic solutions such as 5% dextrose in water (D5W). If cardiac decompensation contributes to prerenal azotemia, then intravascular volume should be reduced to facilitate cardiac work. Surgery for the underlying pathology (eg, peritoneal venous shunting for massive ascites, valve replacement for heart disease, pericardiectomy for pericarditis) is recommended when the patient is stable.

Acute tubular necrosis due to ischemic injury or exposure to a nephrotoxic agent is the most common cause true renal failure. Renal parenchyma damage in acute glomerulonephritis or allergic interstitial nephritis rarely causes true acute renal failure. History, physical examination, and simple laboratory tests can provide the necessary information to distinguish one form of true kidney disease from another. For example, in a young patient with prolonged crush syndrome, who has elevated level urea in the blood, but no erythrocytes are found in the urine on microscopy, the diagnosis of acute myoglobinuric tubular necrosis should be made.

The acute onset of oliguria, hypertension, pulmonary edema, and the appearance of erythrocytes, leukocytes, and protein in the urine sediment suggest acute glomerulonephritis as the primary causative factor in acute renal failure. In such situations, the physician should avoid the use of nephrotoxic drugs, certain antibiotics, and non-steroidal anti-inflammatory drugs. Until recovery, kidney function is maintained with dialysis.

The diet should be high in calories (3000-4000 calories), with low content protein (40-60 g), sodium (2-3 g) and potassium (60-80 mEq). Limit fluid intake (500 ml + urine output).

Patients who cannot eat have adequate intake high-calorie food provided with a probe. In situations where the gastrointestinal tract is not functioning, preference is given to intravenous administration of mixtures for parenteral nutrition. Providing adequate calories prevents further tissue destruction in the body and minimizes the daily rise in serum urea nitrogen levels.

The role of diuretics (eg, furosemide, ethacrynic acid, mannitol) in the treatment of established acute renal failure is limited, although in rare cases they can increase diuresis, thus converting oliguric to neoliguric AKI.

The administration of hypertonic solutions (eg, mannitol) can cause an acute increase in circulating blood volume in a patient with oliguria and lead to massive pulmonary edema. Rapid infusion large doses furosemide may cause ototoxicity. In patients with true renal insufficiency, these drugs should be used with extreme caution.

Both hemodialysis and peritoneal dialysis are effective methods of maintaining patient homeostasis until renal ischemia is relieved and toxemia is eliminated. The choice of dialysis method is carried out on the basis of an individual approach, taking into account the available equipment, the state of hemodynamics and the condition of the patient's abdominal cavity. AT last years in patients with unstable hemodynamics due to cardiogenic or septic shock, slow and long haemofiltration is used.

Intermittent dialysis facilitates the removal of not only nitrogenous wastes, but also excess fluid volume, which improves hemodynamics. It also helps to correct metabolic acidosis and hyperkalemia, which, if left untreated, can lead to heart failure and death. Most patients with acute renal failure require 4-hour hemodialysis every other day.

Dopamine at low concentrations (1-3 mcg/kg per minute) improves blood flow in the renal cortex and is often used in the early stages of acute renal failure. At a dose of 4-6 mcg/kg per minute, dopamine exhibits a beta-adrenergic effect, increasing cardiac muscle contractility and increasing cardiac output.

Other drugs that are excreted by the kidneys (eg, digoxin, magnesium compounds, sedatives) should be used with caution. Usual therapeutic doses can cause serious side effects, since with an excessive concentration of the drug, it accumulates.

If possible, procedures that violate the patient's protective barriers (skin and mucous membranes) should be avoided, which reduces the risk of developing a microbial infection. The duration of use of bladder catheters and intravenous infusion lines should be kept to a minimum to avoid or minimize the incidence of bacteremia. It should be borne in mind that other frequent extrarenal complications that develop against the background of acute renal failure, such as sepsis, gastrointestinal bleeding and pericardial tamponade, which require quick treatment. The prognosis depends on the causative factor of acute renal failure. In most cases of prerenal and postrenal AKI, recovery can be expected. In patients with true renal insufficiency, most of whom have AKI caused by toxins (aminoglycosides, radiopaque agents, myoglobinuria), renal function normalizes.

Poor prognosis in patients with posttraumatic or postoperative acute tubular necrosis. Elderly patients with involvement in pathological process many organs and systems have a poor prognosis compared with young patients who were healthy before the onset of AKI. In most patients, after acute stroke kidney function is restored within 2-3 weeks, although rare cases normalization of renal function after 6 months.

Even now, the mortality of patients due to acute renal failure is very significant. Therefore, every effort should be made to prevent the development of renal failure. Measures to be taken include patient identification high risk, refraining from prescribing nephrotoxic drugs and ensuring adequate hydration with intravenous fluids prior to angiography. Use of crystalloid or colloid solutions before, during, and after extensive surgical intervention reduced the incidence of acute ischemic tubular necrosis in the perioperative period. K. Venkateswara Rao

Acute renal failure (ARF) is a complex of symptoms caused by a sudden violation of the functions of the kidneys or a single kidney and is associated with damage to the tubular apparatus of the organ. Very diverse causes and the complete absence early symptoms diseases make it very dangerous for the patient.

Kidney Functions

It is possible to describe the mechanisms of action of the kidneys on the organs and systems of the human body for a long time. Or you can simply say that it is they who have the "honor" of maintaining the chemical balance in the body. Thanks to the kidneys, the lion's share of poisons, medicines, and metabolic products that have got into it are washed out of the blood. It is they who save us from excess water, participate in metabolism and even synthesize hormones. And that is why a person cannot live without kidneys if his blood is not purified by other methods.

Causes of acute renal failure

All causes of renal failure can be divided into three groups, depending on where they are located relative to the renal structures:

Prerenal - these are diseases in which the blood supply to the kidneys worsens;
renal, in which the pathology is located in the kidneys themselves and affects their structures (glomeruli and tubules);
postrenal, which occur due to violations of the outflow of urine:

due to blockage or compression of the ureters;
damage to the bladder, losing the ability to eject urine;
narrowing of the urethra.

Prerenal causes include shock and similar conditions in which the blood supply to the kidneys drops sharply. because of oxygen starvation and the deterioration of the nutrition of the organ in it, the tubules begin to be damaged, through which urine is excreted.

Renal causes are infections, poisoning with various poisons, side effects of certain drugs.

Acute renal failure, which develops as a result of an anomaly of development - the absence of both kidneys in a newborn, stands apart. Such children, unfortunately, are not viable and die in the first days of life. This can also include acute renal failure due to the removal of a single kidney or its traumatic destruction.

Read more about the causes of kidney failure in the video review:

Clinical diagnosis of acute renal failure

According to the standard algorithm for examining any patient, first of all, the doctor must find out the history of the disease, especially focusing on:

concomitant chronic diseases;
recent acute pathologies;
taken in recent times medicines;
possible contact with toxic substances.

After that, the subjective signs of acute renal failure are clarified, that is, what the patient himself feels or notices:

Decrease in the amount of urine excreted or its complete absence;
appearance;
signs of intoxication:

loss of appetite, especially for protein foods;
sleep disturbances, weakness,;
nausea, vomiting, diarrhea, flatulence.

The examination reveals pain on palpation of the kidneys, swelling, pallor of the skin and visible mucous membranes. Arterial - a frequent companion of acute renal failure, and if it existed before, then its course is sharply aggravated, sometimes leading to the development of acute heart failure with an extremely unfavorable prognosis for life.

In general, OPN in its course goes through several stages:

Initial, in which there are only symptoms of the underlying disease or signs of intoxication with the corresponding poison.
The oligoanuria stage is the stage during which urine output progressively decreases down to zero. It is at this stage that ARF is most pronounced.
The stage of recovery of diuresis, when the symptoms gradually subside, urine begins to separate, its amount gradually increases.
The stage of recovery with the disappearance of all signs of the disease.

The symptoms and methods for diagnosing acute renal failure are described in the video clip:

Laboratory and instrumental diagnostics of acute renal failure

The main criterion for the diagnosis of acute renal failure is the absence of urine in the bladder. This is determined very simply - by catheterization of the organ. If there is no urine, then the patient has acute renal failure, if there is, then it is just a delay in urination.

Insertion of the catheter before renal pelvis allows you to determine if there is an obstruction in the ureter that causes the development of acute renal failure.

An important diagnostic method is the study of urine, if it is available at least in a minimal amount:

the presence of hemoglobin in it indicates hemolysis (destruction of red blood cells);
an admixture of myoglobin indicates a crash syndrome (prolonged crush syndrome);
crystals of sulfonamides - about damage to the kidneys by drugs of the corresponding group.

Instrumental studies such as kidney x-ray with a contrast agent, ultrasound, computed tomography allow to reveal the expansion of the pelvicalyceal system of the kidneys, determine the position of the organs, their size, as well as identify tumors and stones that cover the lumen of the ureters.

Mandatory laboratory method is to identify the levels of urea, creatinine, blood plasma electrolytes and determine its acid-base state. Based on these data, a decision is made on the appointment of hemosorption, plasmapheresis, hemodialysis.

Treatment of acute renal failure

Some cases of acute renal failure respond well to treatment, although mortality in it ranges from 26 to 50%. However, the earlier the disease is detected, the greater the chance for the patient to recover, sometimes even without consequences.

Considering that OPN is never independent disease, but only complicates the existing pathology, its treatment should begin with the elimination of the cause. To do this, anti-shock measures are taken, the activity of the heart is restored, blood loss is eliminated, blood substitutes are injected intravenously, which improves the blood supply to the kidneys.

With existing mechanical obstacles, they are removed surgically methods of catheterization of the ureters, nephrostomy.

In case of poisoning with poisons or drugs, it is important early start detoxification measures with gastric lavage, the introduction of large amounts of sorbents into digestive system using antidotes. Depending on the type of poison, hemosorption and hemodialysis can be used. The latter method in some cases becomes the patient's only chance for survival.

In terms of the treatment of acute renal failure itself, the first place is the restoration of diuresis (urine production). For this purpose, apply intravenous infusions strictly measured doses of solutions in combination with diuretics.

After the elimination of acute phenomena and the restoration of urine output, doctors switch to the use of drugs that improve microcirculation in the kidneys, activate metabolism in them, and restore their function.

Acute renal failure is classified as terminal states, that is, diseases in which the risk of death is high. Fortunately, in many cases it is reversible, and therefore every patient has a chance of survival. Timely treatment of concomitant diseases, constant monitoring of people with kidney diseases by a urologist, greatly reduces the risk of developing acute renal failure.

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, a change in the water-electrolyte balance and an increased content of nitrogen metabolism products in the blood.

Basic forms, their causes

There are three main forms of acute renal failure (table) that help determine how to take measures to prevent similar complication and treatment of pathology:

Forms	Cause	The situation in which the pathology develops
prerenal	Manifested outside the kidneys (caused by impaired circulation)	heart failure; violation of the heart rhythm; accumulation of fluid in 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; taking medications; blood transfusion; injury; inflammatory process.
Postrenal	Impaired urine flow	blockage of the renal duct; the presence of a neoplasm.

Pathogenesis

Functional disorders of the kidneys lead to inflammatory processes in the organ.

Violation of the 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. The destructive influence of functional disorder acts in several directions. First of all, inhibition or complete suspension of the release of end products of nitrogen from the blood occurs. With the liquid part of the blood, they are carried throughout the body, getting into the internal organs and vitally. important systems. This leads to pollution, disrupted 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, their partial or complete necrosis occurs. Restoration of the filtration function during the death of the renal corpuscles is practically excluded. In the future, the process is complicated by inflammation, which leads to poisoning of tissues and blood with poisons.

The main criteria for acute renal failure

RIFLE classification

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

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

Acute kidney damage diagnosed under a combination of two conditions:

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 AKI
Class	filtration rate in the glomerulus	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	2-fold increase in Ccr or decrease in GFR by 50%	< 0,5 мл/кг на протяжении ≥ 12 ч.
F failure	A 3-fold increase in Ccr or a 75% decrease in GFR	< 0,3 мл/кг на протяжении ≥ 24 ч. или анурия ≥ 12 ч.
L loss of function	AKI for ≥ 4 weeks
E irreparable insufficiency	AKI for ≥ 3 months
Ccr - creatinine level; GFR - glomerular filtration rate

AKIN classification

To improve diagnosis by improving the control of minor deviations in the concentration of creatinine in the blood, the classification was improved in 2007 by the AKIN group of specialists. Emphasis is placed on the end product of the creatine phosphate reaction, 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 lies in the fact that kidney damage always manifests itself quickly, in 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 in infectious diseases. The reasons for the development of pathology during pregnancy are as follows:

increased load on the kidneys due to more blood being filtered;
chronic inflammatory processes of the urinary system;
exacerbation after an 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 the mother and child.

If measures are not taken in time, the disease goes through all periods of acute renal failure, new signs are added (blood in the feces, limbs go numb) and there is a high probability of death for both the woman and the fetus. In the acute course of the disease, the expectant mother must necessarily consult not only a urologist, but also a gynecologist.

Complications and consequences

Acute kidney disease does not go smoothly, and significant pathological outcomes often occur:

Diagnosis of acute renal failure

If you suspect the development of acute insufficiency, the doctor takes into account the history of the manifestation of symptoms and examination of the patient. Further clinical recommendations are supported by the results of CFA and laboratory tests:

Diagnostic methods using mechanical devices 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, it may be necessary additional types research:

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

What treatment is needed?

The manifestation of symptoms indicating the development acute form disease, indicates the need to deliver medical care 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 the volume of blood.

The necessary assistance in the first phase of the development of the disease will be more preventive in nature, aimed at eliminating the causes that caused the acute condition and eliminating the violations that have occurred. To begin with, the patient is provided with bed rest, peace and warmth. To restore the movement of blood through the vessels, drip therapy is carried out using solutions of albumin, glucose, mannitol, plasma and others. After the resumption of blood volume, diuretics are used. Vascular spasms are stopped 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 focused on eliminating the consequences of poisoning the body. Warn and clear all conditions life threatening sick. Hypertonic solutions, vitamin preparations, anticonvulsants and antibiotics are used.

Acute kidney failure is a condition characterized by a decrease in the ability of the kidneys to form urine (filter fluid). At the same time, the kidneys also lose their function to free the body from by-products and excess metabolic products and toxins, which leads to its poisoning (intoxication).

Acute kidney failure can occur for a variety of reasons. For convenience, they are divided into three main groups. The first group includes factors that affect the body as a whole, for example. With a large loss of blood, the supply of blood to all organs, including the kidneys, drops sharply. Too low blood pressure in the vessels of the kidneys does not allow them to filter fluid effectively.

Acute renal failure also develops in all types, with electric shock, bacterial infection of the blood, severe infections with dehydration, extensive burns and other conditions in which there is an excessive drop in blood pressure. Sometimes too active use of diuretics can lead to kidney failure, causing significant fluid loss, as well as blood diseases in which there is a decrease in the level of hemoglobin that carries oxygen in it.

The second group of causes combines factors that act directly from the kidneys. Thus, acute glomerulonephritis, a disease in which antibodies are formed against the components of the kidney capillaries, can become a potential cause of acute renal failure. In addition, a decrease in kidney function can occur with many diseases from the rheumatic group - systemic lupus erythematosus, scleroderma, Goodpasture's syndrome, etc. All of them are united by the fact that the immune system begins to perceive kidney tissues as foreign and secrete special substances that destroy them.

Damage to the renal tissue causes severe arterial hypertension with sharp drops and a strong increase in arterial pressure - in such cases it is also called malignant. Often the cause of such hypertension lies in the kidneys themselves and occurs, for example, with abnormalities in the structure of the renal vessels or tumors of the adrenal gland. Acute renal failure can also develop from various toxic effects on the body.

Substances such as mercury, copper salts, some fungi, act on the kidneys and inhibit their work. Acetic acid and some of the substances contained in fertilizers for plants have a similar effect. There are also drugs that, in case of an overdose, have an effect on these organs. similar action. it antimicrobials(aminoglycosides, sulfonamides) and cancer treatments (methotrexate, azathioprine, etc.).

Finally, the third group of factors combines those causes that act on the part of the structures located below the kidneys, that is, the urinary tract. They are comparatively rarer. The so-called subrenal causes of acute renal failure include all those that cause a violation of the outflow of urine to different levels. It can be a stone wedged into the ureter, neoplasms in the abdominal cavity or small pelvis, squeezing the ureter or urethra, a blood clot formed after an injury to the urinary tract. For example, after surgery.

The reason for the violation of the outflow of urine and acute renal failure can be the germination of a tumor in the urinary tract. If an obstruction to the outflow of urine occurs at the level of the ureter, only one kidney suffers. Violation of the discharge of fluid leads to an increase in pressure in the overlying sections of the urinary system, stretching of the structures of the kidney occurs. If the kidney pelvis is not released in time, the kidney tissue dies and the organ loses its ability to filter fluid and form urine forever.

In cases where the block for the outflow of urine occurs at a lower level (bladder, urethra), both kidneys are affected simultaneously. It is much more dangerous for the forecast. In addition to the main causes, there are other risk factors for acute renal failure. People who have them are more prone to this pathology than others.

So, the risk factors for the development of acute renal failure include the presence of serious kidney and heart diseases in a person, a strong increase in blood pressure, age over 60 years, diabetes. The development of acute renal failure is facilitated by any processes that lead to a deficiency of fluid in the body (diarrhea, repeated severe vomiting, etc.).

Acute kidney failure should be suspected if the person has recently started taking a new kidney-toxic drug or is drinking heavily, or has signs of drug use (injection marks on the hands). It is impossible to exclude the development of acute renal failure if the patient has recently undergone some kind of surgical operation, he has urolithiasis or neoplasms of the urinary tract.

Symptoms of acute renal failure.

Acute kidney failure - not so fast developing state like a stroke, myocardial or convulsive attack. It usually takes up to several hours before the full deployment of symptoms. The difficulty lies in the fact that it is sometimes quite difficult to make a diagnosis of acute renal failure at first glance. Its manifestations at different stages are very similar to poisoning, shock or other emergency conditions.

In some cases, the patient does not feel the disease at all, the only symptom of which is the absence of urine output. This often happens in people with cardiac problems, for example, those who are being treated after a myocardial infarction. Classic symptoms acute renal failure are fatigue, weakness, decrease and decrease in volume, and then the cessation of urine output, lack of urge to urinate. Those small portions of urine that are excreted when acute renal failure develops are darker than usual.

With an increase in signs of poisoning the body with metabolic by-products, symptoms such as aversion to food, nausea, vomiting, and sometimes abdominal pain appear. Patients complain of an unpleasant taste in the mouth, as the body, which loses the kidneys as an excretory organ, begins to remove harmful substances through other organs: skin, mucous membranes, lungs. That is why sometimes, being near such a patient, you can feel an unpleasant "urinary" smell from his skin and in the air he exhales.

In acute renal failure, electrolyte disturbances quickly develop, which sometimes causes muscle twitching or even convulsions. Patients gradually lose consciousness. They stop talking, it becomes difficult to get in touch with them - questions are answered with a delay, in monosyllables, sometimes incorrectly. Then, in the absence of proper treatment, consciousness is oppressed and the person falls into.

Much easier in terms of diagnosis are those cases when the condition is caused by subrenal causes, i.e., obstructions to the outflow of urine. In such situations, there is a very important diagnostic sign- pain. Under the pressure of accumulating urine, the urinary tract, calyces and pelvis of the kidneys are stretched, swelling of the kidney tissue is increasing. All this together gives severe pain in the lower back. On one or both sides, depending on whether one or both kidneys are affected.

The pain tends to spread down along the way urinary tract- in the groin, genitals, on the inner surface of the thigh. When pressing on the skin on both sides of the navel or above the pubis, the pain intensifies. Whatever the cause of acute kidney injury, the key symptom is the lack of urine output. It is always necessary to ask about its quantity in a patient with suspicion of this pathology and in any other emergency conditions. Most of them, whether they are classified in the branches of cardiology, neurology or toxicology, can occur with symptoms of renal failure.

First emergency medical aid for acute renal failure.

If this condition is suspected, first of all, care must be taken to ensure that specialized medical care arrives at the patient as soon as possible. If the patient is being transported to the hospital, the transport position is selected according to the patient's condition. With severe weakness, convulsions, loss of consciousness, a person is transported lying down. If general well-being not yet very badly damaged, transportation in a sitting position is possible.

Before the patient falls into the hands of doctors, the caregiver is required mainly general care measures. For example, help with vomiting. If a person continues to bleed, efforts should be made to stop it. Apply a tourniquet, pinch an artery, etc. In case of a strong one, give the patient a drink of water. In the same situation, if a person is unconscious and has lost a lot of blood, it is permissible before the arrival of doctors to introduce intravenous drip replacement drugs - 0.9% sodium chloride solution or 5% glucose solution in an amount of not more than 400 ml.

If acute renal failure is caused by a blockage in the urinary tract, bladder catheterization may be attempted if skills are available to perform the procedure. In the same situation, we accept the use of available painkillers. True, it should be remembered that they will not help to relieve pain completely, but as a measure for some relief of the patient's condition, they are quite suitable.

Within first aid it is necessary to constantly monitor the patient's breathing and heartbeat. To reduce intoxication of the body, you can perform a gastric lavage and a cleansing enema with cool water. The intestines have an extensive circulatory network, and during these procedures, some of the toxins are excreted from the body with water.

For the same purpose, the patient is given enterosorbents ( Activated carbon, polyphepan). This will somewhat improve the patient's condition before admission to a specialized hospital, where there are opportunities for instrumental blood purification and treatment of acute renal failure.

Based on the book "Quick help in emergency situations."
Kashin S.P.