Definition
Rapid decline of renal function in a short period
Etiology
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Blood loss due to bleeding, burn, or surgery
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Heart failure
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Shock
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Severe transfusion reactions, hemolysis
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Malignant hypertension
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Pyelonephritis, sepsis
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Nephrotoxins
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Acute nephritis
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Urinary tract obstruction
Clinical stages
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Oliguria phase: Decreased urine output (less than 400 ml/day) occurs and may persist for 1-4 weeks. It is not present in all acute renal failure.
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Diuretic phase: Due to some recovery of renal function in this phase, daily urine output increases. The volume is about 1-2 L/day or even up to 4-5 L/day. This phase persists for 1 to 2 weeks.
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Recovery phase: Renal function recovers gradually and returns to normal after 3-12 months. Mild to moderate renal injury may be left.
Symptoms
It maybe asymptomatic, but some patients may suffer from edema, decreased urine output, nausea, vomiting, fatigue, hypertension, dyspnea, lethargy, headache, irritability, agitation, or coma.
Treatment
The treatment includes obstruction relief, medical treatment (fluid supplement, diuretics), dialysis, and diet control. Removal of the etiology of renal failure is the most important.
Dialysis
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Hemodialysis: removal of uremic toxin, water and electrolytes by a dialysis machine to maintain homeostasis.
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Peritoneal dialysis: removal of uremic toxin, water and electrolytes by infusion and drainage of dialysate through an temporarily implanted catheter in the peritoneal cavity.
Attention after dialysis
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Mind the body weight changes and record the amount of intake and urine output every day.
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Keep the dialysis catheter (double lumen or peritoneal catheter) clean and do not twist or pull it.
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Take high biological value protein (animal protein) like pork, beef, fish and avoid plant protein like soybean protein.
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Restrict water, salt and high potassium food (e.g., fruits, vegetables, and rich soup) during oliguria phase and not as strict as the diuretic phase.
Acute renal failure is temporary renal failure. By prompt and specific treatment, renal function mayrecover and dialysis can be stopped. However, acute renal failure is a serious disease and bears high mortality. It can also cause permanent kidney injury that requires chronic dialysis therapy.
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