Yeungnam Univ J Med.  1984 Dec;1(1):13-23. 10.12701/yujm.1984.1.1.13.

Diagnosis and Management of Acute Renal Failure in Surgical Patient

• Kwun KB

• KMID: 2372973
• DOI: http://doi.org/10.12701/yujm.1984.1.1.13

Abstract

Acute renal failure refers to a rapid reduction in renal function that usually occurs in an individual with no known previous renal disease. Development of a complication of acue renal failure in critically ill surgical patients is not unusual, and it causes high morbidity and mortality. Acute renal failure can be divided as Pre-renal (functional), Renal (organic), and Postrenal (obstructive) azotemia according to their etiologies. Early recognition and proper correction of pre-renal conditions are utter most important to prevent an organic damage of kidney. These measures include correction of dehydration, treatment of sepsis, and institution of shock therapy. Prolonged exposure to ischemia or nephrotoxin may lead a kidney to permanent parenchymal damage. A differential diagnosis between functional and organic acute renal failure may not be simple in many clinical settings. Renal functional parameters, such as FENa+ or renal failure index, are may be of help in these situations for the differential diagnosis. Provocative test utilizing mannitol, loop diuretics and renovascular dilators after restoration of renal circulation will give further benefits for diagnosis or for prevention of functional failure from leading to organic renal failure. Converting enzyme blocker, dopamine, calcium channel blocker, and propranolol are also reported to have some degree of renal protection from bioenergetic renal insults. Once diagnosis of acute tubular necrosis has been made, all measures should be utilized to maintain the patient until renal tubular regeneration occurs. Careful regulation of fluid, electrolyte, and acid-base balance is primary goal. Hyperkalemia over 6.5 mEq/l is a medical emergency and it should be corrected immediately. Various dosing schedules for medicines excreting through kidney have been suggested but none was proved safe and accurate. Therefore blood level of specific medicines better be checked before each dose, especially digoxin and Aminoglycosides. Indication for application of ultrafiltration hemofilter or dialysis may be made by individual base.

MeSH Terms

Acid-Base Equilibrium
Acute Kidney Injury*
Aminoglycosides
Appointments and Schedules
Azotemia
Calcium Channels
Convulsive Therapy
Critical Illness
Dehydration
Diagnosis*
Diagnosis, Differential
Dialysis
Digoxin
Dopamine
Emergencies
Energy Metabolism
Humans
Hyperkalemia
Ischemia
Kidney
Mannitol
Mortality
Necrosis
Propranolol
Regeneration
Renal Circulation
Renal Insufficiency
Sepsis
Sodium Potassium Chloride Symporter Inhibitors
Ultrafiltration
Aminoglycosides
Calcium Channels
Digoxin
Dopamine
Mannitol
Propranolol
Sodium Potassium Chloride Symporter Inhibitors