Acute Renal Failure(ARF/AKI)

Clinical Feature:

• 1)Decreased urine output, 
• 2)although occasionally urine output remains normal. 
• 3)Fluid retention, causing swelling in your legs, ankles or feet. 
• 4)Shortness of breath.

Investigations:

• 1)CBC with PBF
• 2)Serum Creatinine-raised
• 3)BUN-raised
• 4)serum electrolyte- high K+& Low HCO3-
• 5)uric acid-raised
• 6)usg of KUB-To see renal anatomy
• 7)urine RME-RBC,pus cell,crystal,cast
• 8)x-ray KUB
• 9)ECG-change due to electrolye imbalance
• 10)ASO titre,C3,C4,ANA-to find out causes
• 11) Renal biposy

Rx:

• Bed rest
  
• Diet-protein,salt and fruits restriction
  
• Fluid: previous day out put + 500ml
  

if Oliguria:

• catheterization
  
• inf.5%DA ([post id="511" title="Dextrose"])(2L) + inf.5%DNS([post id="510" title="DNS"]) (1L) I/V @30 D/M (correction  of hypovolumia) 
  
• inj.Sodi-Bicarb (25 ml) 1 amp I/V stat very slowly over 10-15 min.(mx metabolic acidosis)
  

if urine out put not increase within 6 hours

• inj.Lasix ([post id="478" title="Frusemide"])(20mg) 2 amp I/V with 100ml normal saline over 30 min
  

For electrolyte balance.

• inj.calcium gluconate (10ml) 1 amp I/v stat slowly(if hypocalemia)
  

if infection 

• Tab.ciprocin(500mg) 1+0+1….7 days 

if Hypertension:

• Tab.NifedipineSR ...1+0+1

If Seizure:

• inj.Diazepam... P/R or I/V slowly 

Advice : 

•  maintain out-input chart
•  Record vital sign
•  Dialysis -if needed

❤❤যদি মনে কর তুমি পারবে, কিংবা মনে কর তুমি পারবেনা, দুই ক্ষেত্রেই তোমার বিশ্বাস সঠিক। – হেনরি ফোড।❤❤

Indication for dialysis:

• persistent Serum k > 6 mmol / l no respond toRx 
  
• Serum creatinin > 600 µmg 
  
• serum urea 180 mg ( 30 mmol/L) 
  
• HCO3 level < 10 mg 
  
• ureamic pericarditis
  
• pulmonary edema 
  
• ureamic encephalopathy