Acute Renal Failure – April 10, 2002

Acute Renal Failure – April 10, 2002

Prerenal causes: trauma, infection, shock, massive blood loss, poisoning, etc.; intrinsic renal causes: renal tumors, nephritis, kidney stones, renal tuberculosis; postrenal causes: prostate, tumors, and other factors can all lead to acute renal failure. The typical clinical course consists of oliguria phase, polyuria phase, and recovery phase. Oliguria is defined as urine output <400 mL in 24 hours; polyuria is defined as urine output >1500 mL. Initial symptoms include nausea, vomiting, loss of appetite, abdominal distension, and loose stools, followed by headache, dizziness, irritability, and even coma. Anemia and pancytopenia may also occur, along with infections in various organs throughout the body. During the oliguria phase, there is hyperkalemia, hypermagnesemia, hyperphosphatemia, hyponatremia, and hypocalcemia; during the polyuria phase, there is hyponatremia, hypophosphatemia, hypokalemia, and hyponatremia. However, whether in the oliguria or polyuria phase, both blood urea nitrogen and serum creatinine levels rise, while CO2-P decreases, indicating acidosis. Urine specific gravity remains valuable for diagnosis: a specific gravity <0.012 confirms the diagnosis, and elevated urinary sodium levels >30 mmol/L, coupled with decreased urinary urea nitrogen and creatinine levels, further supports the diagnosis.

[Urinary sodium mmol/L]{.underline} Urinary creatinine / Serum creatinine