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Acute Renal Failure - Coggle Diagram

- - - - rapid loss of water and electrolytes
        
        dehydration, hyponatremia, hypokalemia
- - - - Can give rise to intrinsic damage
      - Urea:Cr, >100:1
      - Causes
        
        All forms of shock
        
        Blood vessels = renovascular obstruction
        
        Bilateral renal artery stenosis
        
        Hepatorenal syndrome
        
        Acute hepatic failure
        
        Cirrhosis
      - more readily treatable!
    - - Urea:Cr, 40-100:1
      - Causes
        
        Bladder outlet obstruction - tumors
        
        Kids = vesicoureteral reflux = rising urea, creatinine
        
        Bilateral-ureteric obstruction - kidney stones, tumours, blood clots
    - - Urea:Cr, <40:1
      - Causes
        
        Free hemoglobin and myoglobin = toxic
        
        Crush injury > muscle injury > free myoglobin > nephrotoxic
        
        Acute kidney injury
        
        toxins - NSAIDs, ACE inhibitors, aminoglycosides (directly nephrotoxic)
        
        prolonged pre- and post-renal azotemia (ischemia)
        
        Interstitial nephritis (inflammation)
        
        Acute glomerulonephritis
        
        Acute tubular obstruction
        
        Drugs = NSAIDs
- - - - Intravascular volume low = restore with isotonic
      - Be careful to overflow
      - 500ml/day
    - - Na+
        
        Oliguric = restrict Na+
        
        diuretic phase = give Na+
      - K+
        
        Oliguric = restrict
        
        Diuretic phase = give if hypokalemic
        
        Hyperkalemia = death
        
        Diagnosis: ECG
        
        PR segment = prolongs
        
        ST elevation
        
        Peak T waves
        
        Wide QRS complex = severe! = atrial fibrillation/asystole = act quick!
        
        Management
        
        Ca gluconate
        
        Shift K+ into cells
        
        use insulin and glucose
        
        Salbutamol
        
        NaHCO3
      - H+
        
        Acidotic = give HCO3-
    - - Hemodialysis
      - Peritoneal dialysis
- - - - Recovery can occur if patient not die
        
        Resolve to normal tubular function
        
        Polyuric phase
- - - - CRP
      - WCC
      - Pro-calcitonin (PCT)
        
        Decreases = good sign in patients with sepsis
        
        increases = act quickly
    - - Neutrophil gelatinase associated lipocalin (NGAL) = inflammatory marker