Treatment of acute renal failure
Treatment of acute kidney failure takes place in the nephrology department / ICU. During treatment, it is important to ensure and monitor basic vital functions; fluid balancing with accurate urine collection and hydration status monitoring.
Postrenal ASL: recovery of urine drainage mechanically can take place naturally (urinary catheter, stent) or outside of natural pathways (percutaneous epicystostomy, puncture nephrostomy); then remove your own obstacle at the appropriate time.
Prerenal ASL: restoration of renal perfusion pressure → mean arterial pressure (MAP) 75–80 mm Hg: replenishment of circulating volume in true hypovolemia according to the nature of losses (electrolyte solutions , plasma, blood), improvement of the effective plasma volume in false hypovolemia (plasma expanders, albumin, plasma or blood); MAP < 70 mm Hg: volume adjustment + vasopressor drugs.
Other cases + renal ASL: treatment according to the cause.
Restoration of diuresis in oligoanuria:
- ensuring normovolemia – furosemide in a maximum dose of up to 500 mg i.v. within 30 min,
- 20% mannitol 100–250 ml for crush syndrome + myoglobinuria,
- continuous administration of dopamine at 1.5–2.5 μg/kg/min → vasodilation in the kidneys.
Hyperkalemia: restriction of potassium intake → in case of acute threat:
- acute hemodialysis (most effective),
- 10% calcium gluconicum 10–30 ml i.v. / NaCl 10–30 ml i.v. (inhibition of membrane effect K),
- 40% Glc 250 ml + 24 IU Ins / 8.4% NaHCO3> 100 ml in 30 min infusion (support of K utilization in the cell),
- ion exchangers Resonium A / Calcium Resonium 1–2 scoops after 2–4 p.o. with lactulose / in a rectal enema.
Hypokalemia (threatened in the polyuric phase of ASL, the onset of anabolism and adjustment MAC): K supplementation (potassium chloride).
Therapeutic nutrition: daily energy intake 160–200 kJ/kg; proteins 0.8–1.2 g/kg, carbohydrates 6–8 g/kg, fats up to 1 g/kg.
Renal function is replaced by extracorporeal purification methods, including intermittent hemodialysis + hemodiafiltration / continuous hemofiltration + hemodiafiltration).
Links[edit | edit source]
References[edit | edit source]
- DÍTĚ, P.. Vnitřní lékařství. 2. edition. 2007. ISBN 978-80-7262-496-6.
