Acute renal failure treatment

Acute renal failure treatment takes place on nephrology ward / ICU. It´s important to insure and monitor basic life functions, liquid bilance by precise collecting of urine and observing the state of hydratation.

Postrenal ARF: resumption of drainage of urine mechanically can take place the natural path (stent, urinary catheter) or outside of the natural path (percutaneous epicystostomy, puncture nephrostomy), then remove the obstruction in right time.

Prerenal ARF: resumption of renal perfusion pressure → mean arterial pressure (MAP) 75–80 mm Hg: - renewal of circulating volume in real hypovelmia according to the character of the loss (elektrolytes, plasma, blood), improvement of effective plasma volume in false hypovolaemia (plasmaexpanders, albumin, plasma or blood); MAP < 70 mm Hg: adjustment of volume, vassopresor drugs.

Other cases + renal ARF: therapy by cause

restoration diuresis in oligouria:
 * ensuring normovolemia – furosemide in max. dosage up to 500 mg i.v. in 30 min,
 * 20% mannitol 100–250 ml in crush syndromein + myoglobinuria,
 * continuous administration of dopamineu 1,5–2,5 μg/kg/min → vasodilation in kidneys.

 Hyperkalemia: restriction of potassiumu intake → in acute threat:
 * acute hemodialysis (most effective),
 * 10% calcium gluconicum 10–30 ml i.v. / NaCl 10–30 ml i.v. (inhibition of the membrane effect of K),
 * 40% Glc 250 ml + 24 IU Ins / 8,4% NaHCO3> 100 ml in 30 min infusion (supporst of utilisation K in the cell),
 * ion exchanger Resonium A / Calcium Resonium 1–2 measuring cup after 2–4 p.o. with lactulose / in rectal enema.

 Hypokalemia (threatens in poluuric phase of ARF, onset of anabolism and treatment MAC): supplementation of K (kalium chlorid).

 Medical nutrition: daily energy intake 160–200 kJ/kg; proteins 0,8–1,2 g/kg, carbohydrates 6–8 g/kg, fats to 1 g/kg.

Compensation of renal function extracorporeal cleaning methods, among which we include hemodialysis + hemodiafiltraation / continuous hemofiltration + hemodiafiltration).

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