Notes in the treatment of acute renal failure

The article is professionally consulted by Specialist Doctor I Nguyen Hong Phuc - Emergency Department - Vinmec Phu Quoc International General Hospital.

Acute kidney failure is a disease that many people suffer from today, the treatment of acute kidney failure needs to be done very urgently and aggressively in order to save the patient's life and preserve kidney function.

Acute renal failure is a condition in which the kidney function is impaired or lost temporarily. Acute renal failure is caused by many causes, the disease presents itself acutely within hours or days, the patient's glomerular filtration rate is decreased or stopped rapidly leading to oliguria or anuria, water-electrolyte and balance The acid-base status of the patient is disturbed, the blood nitrogen is elevated, the patient is edematous, and the blood pressure is elevated.
Acute kidney failure is a serious disease, patients can die during kidney failure. However, if detected early, medical treatments and dialysis can help correct the homeostasis, protecting the patient until renal function is restored.

2.1 Principles of treatment
Acute kidney failure is treated with the goal of saving the patient's life and restoring kidney function. The general principles of treatment are prompt removal of the cause, restoration of urine flow, and correction of circulatory and homeostatic disturbances caused by renal failure. Treat symptoms, pay attention to nutrition, balance water and electrolytes according to each stage of the disease. When necessary, extra-renal dialysis may be indicated.
2.2 Treatment of stage-specific acute renal failure
Treatment during the attack phase of pathogens The attack phase is counted from the time the pathogen affects the disease until the appearance of oliguria or anuria . This phase lasts from a few hours to a few days. The patient's symptoms in this stage are symptoms of the underlying disease. For example, if the ureter is blocked by a stone, the patient has renal colic, if the patient is poisoned with carp bile, there are symptoms of abdominal pain, diarrhea, nausea, and little urine.

Recognizing this stage has a very important role, if detected early and treated promptly, the disease will not progress to the severe stage. Anuria renal failure can turn into urine-preserving renal failure. , the treatment of acute renal failure will be much more favorable. The goal of treatment at this stage is to determine the cause of kidney failure and quickly treat to eliminate the cause:
Surgery to remove stones, tumors, .. to rule out the cause of urinary tract obstruction. Gastric lavage, use antitoxin to remove toxins, if there is intoxication. pulse (Dopamine). Use antibiotic groups that are less toxic to the kidneys to fight infections. Closely monitor the patient's oliguria and anuria. Treatment of acute renal failure with oliguria, anuria The stage of oliguria, anuria, also known as the full-blown phase, is counted from the time there is oliguria, anuria until the patient returns to urinating. This phase lasts from a few days to less than 1 month, the average time is 8-10 days. This is the stage when severe symptoms appear and complications can be fatal for the patient.
The treatment of acute renal failure in this period should be very aggressive and urgent, the patient's condition should be closely monitored. Treatment should pay special attention to:
Maintain water and electrolyte balance:
In patients with anuria or oliguria but with edema, it is necessary to ensure that the amount of water in the body is less than the amount of water out.
If the patient has pre-renal acute renal failure, it is necessary to compensate for the volume of the blood, if the volume is not compensated, the diuretic should not be used.
Induce diuresis with diuretics (Furosemide, Mannitol) when there are no signs of dehydration, systolic blood pressure above 90 mmHg, central venous pressure from 8-10cm H2O.
Prophylaxis and treatment of hyperkalemia:
Do not use fluids, food, drugs with high potassium. If gastrointestinal bleeding is present, prompt removal of the blood from the gastrointestinal tract is required. Remove the foci of necrosis, infection if any. If blood potassium is from 6-6.5 mmol/l, drugs must be used to reduce blood potassium. The drugs that can be used are calcium gluconate, calcium chloride, 20% glucose combined with insulin, sodium bicarbonate,... If blood potassium is over 6.5 mmol/l or causes heart rhythm changes, dialysis should be indicated by peritoneal dialysis or peritoneal dialysis. hemodialysis.
Limit the increase of Nitrogenphiprotein with a reduced protein diet and eliminate the foci of infection.
Treatment of electrolyte disorders, anti-acidemia, symptoms and complications such as hypertension, heart failure if any.

Treatment of acute renal failure with urinary retention stage The urinary incontinence phase lasts a few days, counting from the time the patient returns to urinating until the time when creatinine and blood urea begin to decrease. During this period, urine output gradually increased, 200-300ml/24 hours, then gradually increased 4-5 liters/24 hours, blood pressure returned to normal, edema decreased. However, the patient is still at risk of increasing blood urea and creatinine in the early stages of urinary return.
During this period, it is necessary to closely monitor blood electrolytes, accurately measure the patient's urine volume in 24 hours for timely adjustment:
If the urine volume is less than 3 liters in 24 hours and the patient has no electricity severe solution, give the patient Oresol solution to drink. If urine output is greater than 3 liters in 24 hours, rehydrate patient with fluids and electrolytes by intravenous infusion. Closely monitor the patient's urine status for appropriate fluid resuscitation. After about 5 days, the patient's kidneys have begun to recover the concentrated function, if the patient still urinates a lot, the infusion should also be limited. Treatment of kidney failure in the rehabilitation phase The rehabilitation phase usually lasts several weeks, counting from when creatinine and blood urea start to decrease until kidney function returns to normal.
During this period, the treatment of acute renal failure is mainly rehydration, electrolytes for the patient with isotonic solutions such as NaCl 0.9%, Glucose 5%, Ringer lactate. Prophylaxis of increased potassium and blood urea again by drugs and diet. Give the patient enough protein and vitamins when blood urea levels return to normal. Continue to treat primary acute renal failure and other complications if present.
Acute kidney failure is a serious disease, but if detected early and treated promptly and properly, kidney function can be completely or almost completely restored.
BSCK I Nguyen Hong Phuc has nearly 20 years of experience in Emergency Resuscitation. Before being an Emergency Medicine Doctor at Vinmec Phu Quoc International General Hospital, Dr. Phuc worked at hospitals: Bac Ninh Lung Hospital, Cu Chi Regional General Hospital - Ho Chi Minh City Bright.
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SEE ALSO:
Meaning of creatinine test index in diagnosing kidney failure Dialysis at Vinmec, comfortable at home Instructions on how to care & eat for people with kidney dysfunction