Dialysis acute renal failure

Bellomo R, Ronco C, Kellum JA, et al. Acute renal failure—definition, outcome measures, animal models, fluid therapy and information technology needs the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 2004 8 R204-R212. 

Osmotic diuretics such as mannitol act on the proximal tubule and, in particular, the descending limb of the Loop of Henle — portions of the tubule permeable to water. These drugs are freely filtered at the glomerulus, but not reabsorbed therefore, the drug remains in the tubular filtrate, increasing the osmolarity of this fluid. This increase in osmolarity keeps the water within the tubule, causing water diuresis. Because they primarily affect water and not sodium, the net effect is a reduction in total body water content more than cation content. Osmotic diuretics are poorly absorbed and must be administered intravenously. These drugs may be used to treat patients in acute renal failure and with dialysis disequilibrium syndrome. The latter disorder is caused by the excessively rapid removal of solutes from the extracellular fluid by hemodialysis. 

Gruberg L, Mehran R, Dangas G, et al. Acute renal failure requiring dialysis after percutaneous coronary interventions. Catheter Cardiovasc Interv 2001 52 409-416. 

This disorder shows a good prognosis, involving spontaneous recovery in most patients [4]. However, 29 (21.0%) of 138 patients required dialysis therapy owing to severe acute renal failure. No patient died in our series or in the literature consulted. 

Many patients have non-oliguric acute renal failure, with a good prognosis. However, some patients require dialysis. For treatment, hydration must be controlled, and nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided if possible. When oliguria is observed, dialysis therapy should be performed, as described for acute tubular necrosis. 

There is no actual treatment per se for acute renal failure. Just provide supportive measures, for example, renal replacement therapy (dialysis), treat the symptoms, and if possible, the underlying cause, and wait to see if renal function is recovered. 

Frankel MC, Weinstein AM, Stenzel KFI. Prognostic patterns in acute renal failure the New York Elospital, 1981-1982. Clin Exp Dialysis Apheresis 1983 7 1457. 

Occurrence of acute renal failure from p-lactam treatment may be prevented by early treatment of serious infections, together with maintenance of hemodynamic stability, renal perfusion, and urinary solute excretion. The (3-lactam induced renal failure has a time course comparable to acute tubular necrosis of other origins. While there is no firm evidence that dialysis will speed up renal recovery, clinical stabihty and good nutrition are likely to improve recovery, as it is also the case with other types of renal failure. 

Acute renal failure 4pg,4rbe,4gpr Hemodynamic disruption CHF, renal disease, hepatic disease, diuretic use, advanced age, dehydration, SEE, shock, sepsis, hyperreninemia, hyperaldosteronemia Discontinue NSAID, support with dialysis and steroids, if needed... 

Cortinarius orellanus, C. orellanoides, C. speciosissimus, C. splendens Psilocybe semilanceata ("Magic mushrooms") Orellanine Late onset of acute renal failure (3-17 days), dialysis may be required Chronic renal failure in 30-45% of cases [87]... 

Dialysis and renal replacement therapy (RRTx) are common treatments option for the treatment of acute renal failure in the hospital setting. Many... 

Shilliday I R, Quinn K J, Allison M E 1997 Loop diuretics in the management of acute renal failure a prospective, double-blind, placebo-controlled, randomized study. Nephrology, Dialysis and Transplantation 12 2592-2596... 

Kumar VA, Craig M, Depner TA, et al. Extended daily dialysis a new approach to renal replacement for acute renal failure in the intensive care unit. Am J Kidney Dis 2000 36 294-300. 

Subramanian S, Venkataraman R, Kellum JA Influence of dialysis membranes on outcomes in acute renal failure a meta-analysis. Kidney Int 2002 62 1819-1823. 

Acute renal failure due to cisplatin therapy is usually partially reversible with time and supportive care, including dialysis. Serummag-nesium concentrations should be monitored frequently and hypomagnesemia corrected (see Chap. 50). Hypocalcemia and hypokalemia may be difficult to reverse until hypomagnesemia is corrected. Progressive chronic kidney disease due to cumulative toxicity may not be reversible and in some cases may require chronic dialysis support. 

NSAID-induced acute renal failure is treated by discontinuation of therapy and supportive care. Renal failure may be severe, but recovery is usually rapid and dialysis is rarely necessary. Occasionally the hemodynamic insult is sufficiently severe to cause frank tubular necrosis, which can prolong recovery. The differential diagnosis of NSAID hemodynamically-mediated acute renal failure must include NSAID-induced acute interstitial nephritis, with or without the nephrotic syndrome, because steroid therapy may benefit this type of renal injury. 

Symptomatic polyuria and polydipsia can be reversed by discontinuation of lithium therapy or ameliorated with amiloride or NSAIDs during continued lithium therapy (see Chap. 49). Acute renal failure is usually reversible with supportive care, including dialysis to reduce toxic blood lithium concentrations. Progressive chronic interstitial nephritis is treated by discontinuation of lithium therapy, adequate hydration, and avoidance of other nephrotoxic agents. 

Maxvold NJ, et al. Amino acid loss and nitrogen balance in critically ill children with acute renal failure A prospective comparison between classic hemofiltration and hemofiltration with dialysis. Crit Care Med 2000 28 1161-1165. 

Clinicians rely mainly on blood urea nitrogen (BUN) and serum creatinine measurements to evaluate patients with renal failure. Yet the correlation between symptoms and blood levels is at best approximate. In acute renal failure the underlying disease and its associated complications often dominate the clinical picture and determine the prognosis, and it is unclear at what level of nitrogen retention symptoms may be attributed to uremia. Clinicians generally institute dialysis when the BUN exceeds 100 mg/dl or the serum creatinine exceeds 10 mg/dl, but sometimes earlier or later, and early dialysis has not been shown to confer distinct benefits. In chronic renal failure, patients may be quite asymptomatic despite very high BUN and serum creatinine levels. Many so called uremic symptoms may be more properly attributed to anemia, heart failure, nephrotic edema and hypoproteinemia, hypertension, malnutrition, or uncontrolled diabetes or its complications, such as gastroparesis, diarrhea, and neuropathy. 

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