Some brief acute renal insufficiency

First, the etiology and pathogenesis
( - ) Pre-renal azotemia
1 , decreased intravascular volume causes bleeding , gastrointestinal loss, dehydration , excessive diuresis .
2 , in the case of systemic vascular resistance sepsis , allergic reactions , anesthesia , reduce cardiac afterload drug use . Angiotensin- converting enzyme inhibitors, non-steroidal anti-inflammatory drugs , epinephrine , norepinephrine , narcotics and cyclosporine can cause , such as glomerular filtration rate decline.
3 , inadequate cardiac output resulting in lack of effective circulating volume cardiogenic shock , congestive heart failure , pulmonary embolism , cardiac tamponade caused by decreased renal perfusion .
(B ) post-renal azotemia
Include urethral obstruction , bladder dysfunction or obstruction, ureter or renal pelvis obstruction. An enlarged prostate , bladder , prostate or cervical cancer , retroperitoneal fibrosis or neurogenic bladder can lead to urinary tract obstruction .
Less common causes include bilateral ureteral calculi , urinary stones and renal papillary necrosis. In isolated human kidney , urinary tract obstruction can cause unilateral renal azotemia .
(C ) Renal ARF
1 , glomerular disease rapidly progressive glomerulonephritis , glomerulonephritis and severe infection after nephrotic syndrome with ARF.
2 , the pathological manifestations of acute interstitial nephritis interstitial inflammation with edema and renal tubular damage.
Mainly caused by drugs, and other causes include infectious diseases, autoimmune diseases or idiopathic .
3 , ischemic etiology of acute tubular necrosis and poisoning.
4 , renal vascular disease is rare
(D ) the occurrence of chronic renal insufficiency on the basis of ARF
Chronic renal disease with acute interstitial nephritis , diabetic nephropathy with contrast-induced nephropathy , glomerular disease after application of various ACE cause prerenal ARF
Second, the clinical manifestations
Were divided into oliguric and non- oliguric .
High resolution type ARF: tissue catabolism fast , blood urea nitrogen and serum creatinine were daily > 14.3mmol / L (40mg/dl) and > 170umol / L (2mg/dl) annually.
1 , prerenal azotemia , oliguria , elevated blood urea nitrogen
2 , post-renal azotemia suddenly interrupted urine or no urine without
3 , renal parenchymal involvement may be due to different parts were mixed .
(1) RPCN with rapidly progressive glomerulonephritis syndrome.
( 2 ) oliguric ATN typical oliguria , polyuria and recovery .
(3) AIN drug-induced more than a medication history, minorities have a history of allergies . Performance with interstitial tubular dysfunction , such as the decline in renal function is not parallel with anemia , low blood potassium , blood sugar normal and positive urine and acidosis .
( 4 ) ARF malignant renal vascular hypertension, one or both macrovascular (
Third, diagnosis and differential diagnosis of acute and chronic renal failure
1, ARF is composed of a variety of reasons so that the two rapid decline in renal excretory function in the short term , increasing the average daily serum creatinine ≥ 44.2umol / L.
2 , and further identified as oliguria , non- oliguric or high resolution type ?
3 , note the following points : ① the use of diuretics can increase urinary sodium excretion , so at this time can not rely on urinary sodium excretion and fractional excretion of sodium as a diagnosis ; ② who have diabetes and proteinuria or mannitol , dextran or contrast after the agent can make the urine specific gravity and urine osmolality , and should not be used as a diagnostic basis.
4 , should also be excluded chronic renal failure. Application B- measure kidney size and nail creatinine measurements help identify acute and chronic renal failure. B- kidneys is not small , thin renal parenchyma thickness not support acute renal failure. Nails represent the patient's serum creatinine serum creatinine level three months ago , so if the normal creatinine nails also supports the diagnosis of acute renal failure .
5 , renal biopsy is the gold standard for the diagnosis of early implementation of emergency biopsy to confirm the diagnosis .
Fourth, the rule boils and prognosis
1 , treatment of pre-renal azotemia should first find the cause .
2 suspected ARF caused by renal obstruction, the catheter should be placed in the bladder . Increase the capacity of the bladder residual urine , or export a lot due to obstruction of urine retention .
3 , renal parenchymal ARF
RPCN immunosuppressive therapy ; after severe acute streptococcal glomerulonephritis should be supported mainly symptomatic , if necessary, can be applied to dialysis ; nephrotic syndrome with ARF should actively steroid treatment of nephrotic syndrome , dialysis may be supplemented , if necessary therapy.
ATN treatment is the key to disable the allergenic drugs , corticosteroids required when necessary.
ATN light treatment to support , symptomatic conservative therapy.
Malignant hypertension should be gradually actively buck . Early renal artery or renal vein thrombosis or embolism kidney disease correspondingly large thrombolysis and anticoagulation therapy.