ACUTE RENAL FAILURE
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Chronic kidney disease
ACUTE RENAL FAILURE
ACUTE RENAL FAILUREAcute renal failure is a clinical syndrome in which sudden deterioration in renal function results in the inability of the kidneys to maintain fluid and electrolyte homeostasis. If treated within a proper time it is reversible.Criteria has been developed to characterize the pattern of acute kidney injury in critically ill children. The criteria were given the acronym of RIFLE. This criteria depend on glomerular filtrations rate.
CRITWRIAESTIMATED CClURINE OUTPUTRiskeCCl decreased by 25%150% rise in serum creatinine.-stage ll >200% rise in serum creatinine.-stage lll >300% rise in serum creatinine.Common causes of acute renal failure:ARF HAS BEEN CLASSIFIED IN TO 3 MAIN TYPES:1-Prerenal ARF:is characterized by diminished effective circulating arterial volume, which leads to inadequate renal perfusion and a decreased glomerular filtration rate. Common causes are:-Dehydration.-Hemorrhage.-Sepsis.-Hypoalbuminemia.-Heart failure.
2-Intrinsic ARF: characterized by renal parenchymal damage common causes are:-Post infectious glomerulonephritis.-Lupus nephritis.-Hemolytic uremic syndrome.-Henochschonline purpura.-Acute tubular necrosis.-Acute interstitial nephritis.-Tumor lysis syndrome.3-Post renal ARF: characterized by obstruction of urinary tract. Common causes are:-Posterior urethral valve.-Bilateral ureteropelvic junction obstruction.-Urolithiasis.-Tumor.-Hemorrhagic cystitis.-Neurogenic bladder.---Obstruction must be bilateral to cause ARF.Relife of the obstruction usually results in recovery of renal function except inpatients with associated renal dysplasia or prolonged obstruction.
CLINICAL MANIFESTATION-Clinical presentation depend on the underlying causes, in patient with prerenal causes there are features of volume depletion.-patient with renal parenchymal causes present with features of the underlying causes with volume overload,hypertention and edema.-patient with post renal causes present with volume overload and abdominal mass.LABORATORY FINDING-Elevated concentration of blood urea and creatinine.-There is hyperkalemia, hyper phosphatemia,increasd serum concentration of uric acid, hypocalcaemia,hyponatremia and metabolic acidosis.-there is anemia,leukopenia,thrombocytopenia.-Urine exam shows hematuria,proteinuria,RBC or WBC cast.-Renal ultrasonography may shows hydronephrosis hydro ureter or abdominal mass.-CXR may shows cardiomegaly pulmonary congestion.LABORATORY FINDINGUrine indices can differentiated between prerenal and renal causes of ARF.Patient with prerenal ARF urine indices shows:-elevated urine specific gravity >1.020.-elevated urine osmolality >500mOsm/kg.-Low urinary sodium concentration