Problem #1 A man presents to the clinic with complaints of asthenia, malaise, headache, weight gain, and a decrease in urination. A tentative diagnosis of acute renal failure is made.
Acute renal failure is a steady and fast deterioration of the functioning of the kidneys. This happens when there is a high level of the waste from the kidneys is left unattended. Acute renal failure occurs when the kidney fails to push out the waste or the everyday toxins out of the body in the form of urine. Simply put the kidneys have stopped working, they have lost their ability to filter water and waste from the blood. The kidneys remove the waste products help balance salt, water, and other minerals in our blood. With acute renal failure the kidneys lose the ability to remove waste and concentrate urine without losing electrolytes.
Acute renal failure is classified as: Pre Renal this occurs as a result of renal hypo perfusion, or as a result from a condition that diminishes blood flow to the kidneys. Intra Renal results from damage to the kidneys, usually from acute tubular necrosis. Post Renal (obstructive) is a result from bilateral obstruction of urine flow. The most common cause of obstructive uropathy in men is prostate.
There are several diagnostic test or evaluations done to prognosis acute renal failure. These are:
1. Arterial blood gases (ABG) analysis, which shows metabolic acidosis.
2. Urine, Pre Renal has decreased PH, urine sodium, oliguria, increased specific gravity, normal creatinine and sediment. Renal has decreased specific gravity, increased urine sodium and creatinine, sediment contains cast. Post Renal has normal specific gravity, urine sodium and creatinine, sediment normal or hematuria possible.
3. Blood chemistry shows increased potassium, phosphorus, magnesium, blood urea nitrogen (BUN) creatinine, and uric acid levels. Also will show a decrease of calcium, carbon dioxide. Sodium normal or decreased hemoglobin and hematocrit increased with dehydration and decreased with hypervolemia, decreased adhesiveness of platelets.
4. Ultrasound or CT scan shows kidneys may be enlarged.
5. Renal scan or IV urogram to visualize obstruction, tumors, or masses.
6. Excretory urography shows decreased renal perfusion and function.
7. Glomerular filtration rate (GFR)
A. 20-40 ml/min. (renal insufficiency)
B. 10-20ml/min. (renal failure)
C. < then 10ml/min. (end-stage renal disease)
Some symptoms of acute renal failure include, decreased urine production or oliguria, Anuria absence of urine excretion, swelling of body parts. There are problems with concentration, and confusion. The patient may feel tired and fatigued, the patient maybe lethargic. There is feelings of nausea and vomiting, the...