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

Renal insufficiency refers to the system characteristic manifestations(symptoms) resulting from chronic or acute functional disorder.

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

Factors leading to ARF are divided into:

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

Diagnose acute renal failure and the factors due to which it occurred, can only!

For acute form the following symptoms are typical:

reduced hemoglobin level ()
cardiopalmus ()
limbs (arms, legs)
pressure increase ()
drowsiness
general malaise
violation of urination and urination. may be released in small amounts or not at all
dysfunction of the digestive system

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

Depends on the cause of the kidney failure syndrome. During the first phase, urine output decreases, a decrease blood pressure and decrease in heart rate
This phase is called oliguric. Urine is not excreted at all. The patient's condition is deteriorating. 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, in this regard, there is still a threat to the life of the patient.
The amount allocated is normalized. A few months later, after special treatment, kidney function is restored

emergency resuscitation

long, or chronic nature kidney failure(CKD) will never occur “on its own”, as it is a complication for most serious illnesses kidneys. Important is the fact that, due to intense symptoms many patients start the disease and even bring it to the terminal. Wu, diagnosis this disease problematic enough.

Symptoms of CKD 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 greatly helps in making a diagnosis.

Treatment should be under the supervision of specialists! Terminal states of CRF are unpredictable and pose a real threat to the patient's life.

IN medical practice accepted standard methods help:

treatment of a disease that is the main
bed rest and prohibition of high physical activity
diet
sufficient intake and control of its excretion
decline blood pressure
elimination of the complications that have arisen, as a rule, associated with ingestion

Causes and treatment of ulnar bursitis

This syndrome of any form requires the provision of purely medical emergency care under the supervision of specialists. If symptoms are found that indicate the onset of kidney failure, it is unacceptable to hesitate when calling the brigade!

Renal failure is a complex of symptoms that appear when the kidney function gradually or suddenly fails. It can occur in acute and chronic forms, which will be characterized by their own symptoms and approaches to providing qualified 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, is characterized by pronounced symptoms:

violation of urine output - it can either be completely absent, or be in small quantities;
violation 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 finding out the cause of the development pathological condition- it never happens independent disease, but is a complication of existing diseases. To quickly get rid of factors that provoke an attack of acute renal failure, doctors can conduct various events: eliminate blood loss, restore normal activity of the heart, infuse blood substitutes intravenously. If there are mechanical obstacles to the passage of urine, then they are removed exclusively surgically- for example, ureteral catheterization, nephrostomy is performed.

In 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 kidney 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 the elimination of 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 a large number sorbents, the use of antidotes. Also, doctors can perform hemodialysis or hemosorption on the patient - in most cases, these methods of emergency care are the patient's only chance for survival.

Acute renal failure in children and adults is a terminal states, that is, with a high chance lethal 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 health of the patient.

Chronic renal failure

This syndrome never occurs "on its own", it is a complication of almost all kidney diseases. With acute and chronic insufficiency clinic will vary. For example, for chronic form characterized by edema and pain syndrome with localization in lumbar region- the symptoms are not marked by intensity, so they are often ignored by patients. There is also a problem in diagnosing chronic renal failure in children - parents may not notice a decrease in urine and mild pain. These symptoms may be accompanied general weakness, increased fatigue, insomnia - these signs are nonspecific, therefore it is not possible to make a correct diagnosis only on their basis, a full examination will be required.

Chronic renal failure, the treatment of which must be carried out under the supervision of doctors, can also occur in the terminal stage. In this case, it 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;
violation of respiratory activity;
high blood pressure.

The treatment of chronic renal failure in the terminal stage is unpredictable, doctors do not give any predictions, because the life of such patients is calculated in hours.

Therapeutic measures

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

therapy for the underlying disease;
compliance with the regime of the day and therapeutic nutrition;
correction of water balance disorders;
treatment of arterial hypertension;
anemia treatment;
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 be in the hospital for treatment. The pathogenesis of chronic renal failure is such that it is unambiguous to answer the question of drug treatments impossible - everything is too individual. Everything will depend only on what kind of pathology provoked the development of the condition in question. With particularly severe renal failure, patients may undergo organ transplantation - sometimes this only chance on survival, patients after surgery live more than 10 years.

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

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

Clinical manifestations AKI is associated with life-threatening conditions in which functions are impaired important systems and organs. On initial stage pathology symptoms are practically absent, and its development is characterized by swiftness. Therefore, acute renal failure requires emergency care. medical personnel. Prior to 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, are engaged in cleaning the body, preventing it from penetrating into the body during intoxication. systemic circulation I will give. Thereby paired organ at healthy people water and chemical balance is maintained. They rid the body of excess water, dangerous toxins and leftovers medicines. The participation of the kidneys is necessary for 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 be filled with toxic human waste.

All causes of acute renal failure, manifested by a violation of the functionality of the kidneys, are divided into 3 large groups:

Prerenal. Diseases caused by disorders of blood flow in a paired organ.
Renal. Damage to the structure of the kidneys: glomeruli and tubules.
Postrenal. Pathology related.

This happens for 3 reasons:

Blockage or blockage of the ureters;
The bladder is damaged, so the organ cannot "push out" urine;
The urethra was severely narrowed.

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

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

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

Renal forms cause the following factors:

Nephritis;
Acute glomerulonephritis;
Intoxication (poisons, drugs);
Ischemia;
Acute renal tubular injury.

Postrenal lesions are caused by blockage of the renal tubules by blood clots or protein particles. Their appearance is facilitated by such violations:

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

Symptomatic features

Severe course of these diseases at any time can lead to acute renal failure. Dangerous state goes through 4 stages of its development, each of which has a characteristic symptomatology.

Initial phase

The specificity of this period is the bright 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. So you can stop the development of pathology.

Oligoanuric phase

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

Observed brightly severe symptoms intoxication:

Weakness;
Inhibited reaction;
Vomit;
Diarrhea;
Drowsiness.

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

Without necessary assistance there will be swelling of the brain and lungs.

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 highlight biological fluid reaches 4 liters per day. Consequence rapid loss liquid becomes dehydrated, the concentration of potassium and sodium decreases.

recovery phase

It lasts longer than all other stages - up to 2 years.

Systemic blood flow and kidney function are gradually restored. The causes that caused OPN are completely eliminated. This time is devoted rehabilitation therapy and spa treatment.

Diagnostic methods

Diagnosis of acute renal failure is carried out according to standard provisions. It begins in the doctor's office with an anamnesis. Doctors are interested in the following information:

The presence or absence of chronic pathologies;
Medications taken in the last month;
Possibility of contact with poisons or toxins;
Past pathologies within the last 2 months.

Then the patient finds out the clinical manifestations of the disease:

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

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

Based on the history and visual inspection the patient's doctor determines the necessary laboratory and instrumental studies.

Blood - general and biochemical research;
Urine - general analysis;
Acidity study bloodstream and concentration of electrolytes;
Electrocardiogram;
Indications of arterial pressure in dynamics;
The specifics of diuresis;
Diagnosis of the presence of C-reactive protein;
Ultrasound of the kidneys;
If there are suspicions of complications in the form, an x-ray examination is prescribed;
According to the indications, a consultation is appointed 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 find out the presence or absence of an obstruction in the ureter.

Specifics of emergency care

Acute renal failure requires emergency medical attention using large group medicines administered intravenously.

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

Each stage of the "ambulance" has its own characteristics.

initial stage

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

The therapy is carried out under conditions medical institution. It begins with the appointment of such drugs:

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

After the bcc is restored, diuretic drugs are prescribed: Furosemide, Eufillin and others.

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

For prophylactic purposes, the introduction of subcutaneous "Heparin" is supposed, which will not allow thrombosis of the renal tubules.

Oligoanuric stage

Task urgent action in this period:

Eliminate violations water-salt metabolism;
Eliminate azotemia;
Stop ;
Correct acid imbalances.

To achieve this goal, limit the intake of fluid taken by the patient. Prescribe the introduction of such medicines:

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;
"Kontrykal", "Gordoks", "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 stage of cure, the patient is shown a strict diet, symptomatic therapy and exclusion of physical activity and stress.

Acute renal failure(ARF) is an acutely developing potentially reversible syndrome characterized by a sudden total impairment of kidney function in ensuring homeostasis, which is clinically manifested by disturbances in water and 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 the blood flow to the kidney is stopped or insufficient (intestinal toxicosis with exsicosis, polyuria, shock of any etiology). Postrenal - with obstruction of the outflow of urine from the kidneys (ICD, volumetric process, scars); neurogenic dysfunction Bladder. Renal - a pathological process in the kidney itself - (glomerulonephritis, interstitial nephritis).

With the timely elimination of prerenal and postrenal disorders, renal function can be fully restored, but if time is missed, then secondary organic damage to the renal parenchyma may develop. For example, acute tubular necrosis due to renal ischemia with uncorrected hypovolemia and arterial hypotension develops within 2-6 hours. For diff. diagnosis of functional and organic acute renal failure with hypovolemia and shock, a test with a water load is indicated: the patient is injected intravenously for 30 minutes with a volume of fluid equal to 2% of body weight (5% glucose solution and saline 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 allocate at least 60% of its volume - the restoration of diuresis indicates functional renal failure.

Clinical diagnostics.

The course of acute renal failure is staged, while 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 OPN (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 0.5 ml / kg per hour, or less than 1/3 of the age 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 hyperhydration, electrolyte imbalance and uremic intoxication. 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 complication of hydremia is acute heart failure up to pulmonary edema: sudden inspiratory dyspnea, scattered wheezing; heart sounds are muffled, the pulse is frequent, weak.

Electrolyte imbalances are expressed by hyperkalemia (with repeated vomiting and profuse diarrhea, hypokalemia is possible), hypermagnesemia and a decrease in the level of Ca and Na. A particular danger is the development of hyperkalemia, manifested by paresthesia, muscle hypotension, hypo- or areflexia, fibrillations of individual muscles, tonic convulsions, muffled heart tones, bradycardia, arrhythmia; 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. 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 manifestations, the addition of toxic stomatitis and gastroenteritis, Kussmaul respiration, an increase in the content of urea and / or creatinine.

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

3. Polyuric stage AKI (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 weight loss may occur, and therefore this stage is called critical. Clinical manifestations of hypokalemia: lethargy, lethargy, muscular hypotension, 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 unit or intensive care unit, differentiation depending on the stage of the process and the etiological factor.

Urgent Care.

1. The initial stage of acute renal failure:

1. Treatment of the underlying disease. With hypovolemia and shock - recovery of BCC with rheopolyglucin, 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, a 15% solution of mannitol at a dose of 0.2-0.4 g / kg (dry matter) in / in drip; in the absence of an increase in diuresis after the introduction 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 the BCC, a 2% solution of Lasix at a dose of 2 mg/kg IV; if there is no answer - 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 aminofillin 1.0 ml/year 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.

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%; swelling of the lungs or brain;

The absence of "+" 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. The amount of fluid per day = diuresis of the previous day + perspiration loss + extrarenal loss, where perspiration loss is 25 ml / kg per day or based on ml / kg per hour: in newborns - 1.5 ml / kg per 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 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 - intravenously. Infusion therapy is carried out with glucose-salt solutions (1/5 of the volume - reopoliglyukin).

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

Body weight control within 12 hours: with adequate water load, weight fluctuations do not exceed 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 indicators of KOS 4% solution of sodium bicarbonate in / in drip.

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

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% solution of sodium bicarbonate at a dose of 2-4 ml / kg IV drip for 20 minutes (do not use together with calcium gluconate so that there is no precipitation in the syringe);

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

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

5. With a prophylactic purpose - AB therapy in short courses of 5 days in 1/2 dose of the average therapeutic dose, between courses there are breaks of 1-2 days; except for nephrotoxic antibiotics and those that are excreted mainly by the kidneys (aminoglycosides, tetracyclines, cephalosporins I pok).

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 the doctors of the hemodialysis unit. With renal anuria, hospitalization in a hospital, where there is a device " artificial kidney”, with obstructive anuria - in a surgical hospital. Anuria due to severe heart failure urgent hospitalization to the somatic department.

There are 3 forms of flow acute insufficiency kidney:

Prerenal (secondary) - due to 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.

Causes

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 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 impairment of blood circulation in the kidneys, acute renal failure of the prerenal form can progress to the renal form.

renal capillaries

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

Toxic is ethylene glycol, compounds 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 the death of the 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 typical for her 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. Appears dyspeptic syndrome manifested by nausea, vomiting, diarrhea, and hemorrhagic (skin and gastrointestinal manifestations). At the same time, in general analysis blood is determined by anemia, severe leukocytosis, a decrease in the level of platelets. 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.
deployed and biochemical analysis blood.
General urine analysis.
Detection of C-reactive protein.
Study of blood acidity and electrolyte levels.
definition of diuresis.
Blood pressure monitoring.
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 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, form and phase pathological process. Sick in without fail are admitted to the hospital department. A diet is prescribed 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, 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 toxic substances from the bloodstream. Plasmapheresis, exchange transfusion, hemosorption are carried out.
In the septic process, the appointment is shown antibacterial treatment in a combination of two antibiotics. The drugs of choice are drugs from the group of carbopenems (Tienam, Meronem), Vancomycin.
With an obstructive form, surgical intervention aimed at restoring 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 initial stage OPN 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 protein-free diet, under strict control of 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. changing diet food– Not limited to salt and water intake. 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, heart 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.