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Acute Renal Failure with Oliguria


Presentation

  • METHODS: During a 10-year observation, a study of 11 older ( 65 years) and 7 younger patients ( 65 years), suffering from acute myocardial infarction and cardiogenic shock, is presented: clinical data and laboratory: diuresis, sodium in urine, creatinine[ncbi.nlm.nih.gov]
  • ARF due to other causes as partial obstruction may present as polyuria. ARF due to postrenal obstruction may present as anuria. Diagnosis Renal failure is manifested by the rise of serum creatinine.[doctorslounge.com]
  • ) Physical findings Asterixis and myoclonus Pericardial or pleural rub Peripheral edema (if volume overload is present) Pulmonary rales (if volume overload is present) Elevated right atrial pressure (if volume overload is present) TABLE 1 Key Symptoms[aafp.org]
  • A renal biopsy may reveal the specific underlying disease, but crescent formation in 50% of glomeruli is usually present.[unboundmedicine.com]
  • Consider, for example, a patient who presents with pneumonia and an abnormal creatinine level. Assume for this example that the patient’s baseline creatinine is 1.0 mg/dl and he presents with a creatinine of 1.3 mg/dl.[clinicaladvisor.com]
Inflammation
  • Acute glomerulonephritis or acute inflammation of renal interstitium (acute interstitial nephritis) (usually from allergic reactions to beta-lactam antibiotics, sulfonamides, rifampin, NSAIDs, cimetidine, phenytoin, allopurinol, thiazides, furosemide,[quizlet.com]
  • Exposure to nephrotoxic drugs and other toxins (consider muscle lysis â “ rhabdomyolysis ) Evidence for renal inflammation â “ urinary red cells, protein, or white cells in the absence of infection.[edrep.org]
  • Although abnormalities in coagulation are also associated with AKI, the link between inflammation and AKI severity is strongest. Sustained systemic inflammation seems to be associated with development of AKI as well as other organ failures.[clinicaladvisor.com]
  • ., glomerulonephritis); and white cell casts (D) imply renal parenchymal inflammation (e.g., acute interstitial nephritis, pyelonephritis).[foamcast.org]
  • These storage-induced modifications may induce a poor restoration of microcirculatory oxygenation associated with inflammation and changes in immune status.[anesthesiology.pubs.asahq.org]
Anemia
  • Clearly, however, the anemia is multifactorial, since in one-quarter of the patients it precedes onset of renal failure.[ncbi.nlm.nih.gov]
  • Anemia can also frequently occur and the prognosis depends on the underlying cause. Treatment for chronic renal failure generally includes restricting the patient’s water and protein intake and the usage of diuretics.[availclinical.com]
  • At the same time, patients also have high serum creatinine and blood urea nitrogen levels, anemia will be worsened and it usually indicates poor prognosis. Doctors will suggest preparation for dialysis and kidney transplant.[kidneyfailureweb.com]
  • ., diarrhea and vomiting) should be given intravenous fluid Complications Hyperkalemia Metabolic acidosis Uremic encephalopathy and platelet dysfunction Anemia Chronic kidney disease Please rate topic. Average 4.1 of 9 Ratings Thank you for rating![medbullets.com]
  • Decreased values may indicate hemodilution (hypervolemia) however, during prolonged failure, anemia frequently develops as a result of RBC loss. Other possible causes (active or occult hemorrhage) should also be evaluated. Serial chest x-ray s.[nurseslabs.com]
Falling
  • In oliguric ARF, urine production usually falls below 400ml/day . However, the aging kidney normally loses its concentrating ability, and renal function becomes more susceptible to insult.[sites.google.com]
  • A significant number of oliguric patients will not have urinary indices that fall within these guidelines.[annals.org]
  • For children the pRIFLE, stages 1 (risk), 2 (injury) and 3 (failure), are defined at specific falling levels of eGFR and falling urinary output [ 5 ].[patient.info]
  • In the control kidney, renal blood flow increased 32% 48 h after norepinephrine in association with a fall in the fractional distribution of flow to the outer cortex.[jci.org]
  • Compensatory mechanisms for preventing a fall in glomerular filtration rate (GFR) in the presence of prerenal failure Iatrogenic interference with renal autoregulation by administration of vasoconstrictors (eg, cyclosporine, tacrolimus), inhibitors of[emedicine.medscape.com]
Fever
  • A person who has developed this condition may also experience diarrhea, a high fever , vomiting , and being unable to get enough fluid intake to replace the fluid lost as a result.[medicalook.com]
  • End-stage kidney disease (Medical Encyclopedia) Glomerular filtration rate (Medical Encyclopedia) [ Read More ] Uncommon Infant and Newborn Problems It can be scary when your baby is sick, especially when it is not an everyday problem like a cold or a fever[icdlist.com]
  • Mortality in leptospirosis-associated AKI is around 22%. 4 Case presentation In October 2010 a 74-year-old Caucasian male was admitted because of fever, anuria and mialgia lasting for 2 days.[elsevier.es]
  • […] state in GFR which may be incorrect has the limitations of creatine measurement PLASMA CREATININE Advantages commonly used and available well validated Disadvantages more a marker of renal function rather than injury production may increase with trauma, fever[lifeinthefastlane.com]
Physician
  • Notify the physician B. Check client’s previous BUN and creatinine levels C. Document the result D.[empowern.com]
  • Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org[academic.oup.com]
  • The physician’s understanding of AKI and urine output also plays a role; some physicians consider urine output less significant than other assessment findings.[americannursetoday.com]
  • […] for employment; Received contract payment from American Physician Institute for Advanced Professional Studies, LLC for independent contractor; Received contract payment from Healthcare Quality Strategies, Inc for independent cont.[emedicine.medscape.com]
  • Using a step-by-step approach, physicians can determine the cause of acute renal failure in most patients ( Figure 1 ).[aafp.org]
Oliguria
  • Abstract A 39-year-old man, a known case of paroxysmal nocturnal hemoglobinuria (PNH), developed severe acute renal failure, prolonged oliguria, and grossly bloody urine.[ncbi.nlm.nih.gov]
  • This study confirms the presence of anemia in 91% of patients with acute renal failure and shows it to be related to rise in urea and presence of oliguria.[ncbi.nlm.nih.gov]
  • OBJECTIVES: Reports indicate some differences in the outcome of prolonged arterial hypotension due to cardiogenic shock: acute renal failure in older and more often functional oliguria in younger patients.[ncbi.nlm.nih.gov]
  • Abstract Perioperative oliguria is common but rarely implies acute renal failure. We should interpret oliguria as a sign of intravascular hypovolemia and treat it as prerenal until proven otherwise.[ncbi.nlm.nih.gov]
  • OLIGURIA SIGNS AND SYMPTOMS Oliguria is categorized based on the factors that cause it.[medicalook.com]
Kidney Failure
  • Acute kidney failure is most common in people who are already hospitalized, particularly in critically ill people who need intensive care. Acute kidney failure can be fatal and requires intensive treatment.[mayoclinic.org]
  • failure N17.0 Acute kidney failure with tubular necrosis N17.1 Acute kidney failure with acute cortical necrosis N17.2 Acute kidney failure with medullary necrosis N17.8 Other acute kidney failure N17.9 Acute kidney failure, unspecified N18 Chronic kidney[icd10data.com]
  • Postrenal Kidney Failure Postrenal kidney failure is the deterioration of renal function due to inadequate drainage of urine.[urology-textbook.com]
  • Oliguria And Acute Kidney Failure Acute kidney failure, as the name implies, is a severe breakdown in renal functioning that occurs suddenly.[kidneypedia.net]
  • But with the help of health care providers, family, and friends, most people with kidney failure can lead full and active lives.[icdlist.com]
Renal Insufficiency
  • […] non oliguric renal insufficiency Do anyone know the DX for non oliguric renal insufficiency? I know that non oliguric means 500ml or more urine output and oliguric means less than 500ml.[aapc.com]
  • insufficiency (acute) Type 1 Excludes chronic renal insufficiency ( N18.9 ) unspecified nephritic syndrome ( N05.- ) analgesic N14.0 ICD-10-CM Diagnosis Code N14.0 Analgesic nephropathy 2016 2017 2018 2019 Billable/Specific Code with medullary necrosis[icd10data.com]
  • Acute renal insufficiency due to lower nephron nephrosis. N Engl J Med 239: 693, 1948. PubMed CrossRef Google Scholar 5. Vertel RM, Knochel JP. Nonoliguric acute renal failure. JAMA 200: 118–122, 1967. CrossRef Google Scholar 6.[link.springer.com]
  • This form of oliguria and renal insufficiency usually responds to the release of the obstruction.[emedicine.medscape.com]
  • You are here: Urology Textbook Kidneys Renal insufficiency Acute renal injury Acute kidney injury – acute renal failure (1/2): causes, pathophysiology and symptoms Acute kidney injury – acute renal failure (2/2): Diagnosis and treatment Review literature[urology-textbook.com]
Uremia
  • ( N18.9 ) extrarenal uremia ( R39.2 ) prerenal uremia ( R39.2 ) renal insufficiency (acute) ( N28.9 ) uremia of newborn ( P96.0 ) acute N17.9 ICD-10-CM Diagnosis Code N17.9 Acute kidney failure, unspecified 2016 2017 2018 2019 Billable/Specific Code[icd10data.com]
  • With significant uremia, coagulation may be impaired, and pericarditis may develop. Urine output varies with the type and cause of AKI. Resources In This Article Acute Kidney Injury Acute Kidney Injury (AKI)[msdmanuals.com]
  • Signs and Symptoms of Acute Kidney Injury Uremia resulting from acute renal failure causes non-specific complaints. The underlying disease for the acute kidney injury is crucial for most of the symptoms.[urology-textbook.com]
  • Indications for dialysis include acidosis or electrolyte disturbances that do not respond to pharmacologic therapy, fluid overload that does not respond to diuretics, and uremia.[aafp.org]
  • I- Intoxication with dialyzable toxins (ethylene glycol) O- Overloaded with volume U- Uremia Generously Donated Rosh Review Questions Question 1. A 72-year-old man is brought to the ED from a nursing home for evaluation of oliguria.[foamcast.org]
Renal Impairment
  • The good news is, many forms of acute renal impairment are reversible after the underlying cause has been identified.[availclinical.com]
  • Renal impairment is a frequent complication in patients with severe form of leptospirosis, mainly characterized by an association of interstitial and tubular damage.[elsevier.es]
  • The study concluded that low-dose intravenous furosemide appeared to offer no advantage over placebo in an unselected group of patients with moderate postoperative renal impairment.[austinpublishinggroup.com]
  • It is more likely in the presence of pre-existing renal impairment, and in the elderly, and usually occurs in the context of other severe illnesses.[edrep.org]
  • impairment: CrCl 50 ml/min, 1 g every 8 h; CrCl 30–49 ml/min, 1 g every 12 h; CrCl 10–29 ml/min, 1 g every 24 h and CrCl 10 ml/min, 0.5 g every 24 h; thus, the Cockcroft–Gault equation, the traditional method of estimating CrCl, might not be appropriate[academic.oup.com]

Workup

Potassium Increased
  • Hyperkalemia Potassium increases 0.5 mmol/l/day during anuria. Hyperkalemia is particularly serious with additional cell disintegration (tumor lysis, hemolysis, rhabdomyolysis).[urology-textbook.com]
Base Deficit
  • Acidosis May be corrected with sodium bicarbonate (mmol base deficit x weight (kg) x 1/3) over 4 hr should be avoided if: Patient is hypocalcaemic (HCO3 may lower Ca2 and cause convulsions) Accompanying Na load likely to cause fluid overload (hypertension[rch.org.au]
Myocardial Fibrosis
  • All had myocardial fibrosis and scars, apart from recent myocardial infarction and coronary atherosclerosis. In 2 older, acute tubular necrosis was found while in 2 no renal changes were found.[ncbi.nlm.nih.gov]

Treatment

  • Treatment Of Oliguria Oliguria does not have a single treatment recommendation. Being a symptom rather than a disease, it calls for treatment appropriate to whatever is causing it.[kidneypedia.net]
  • If your kidneys fail, you need treatment to replace the work they normally do. The treatment options are dialysis or a kidney transplant. Each treatment has benefits and drawbacks.[icdlist.com]
  • Removal of nephrotoxins, rapid treatment of the triggering factors, and attention to cardiac output and mean arterial pressure remain the cornerstones of the prevention and treatment of AKI in ICU.[oxfordmedicine.com]
  • Treatment Treatment of acute renal failure usually should be conservative and largely supportive. It requires careful and precise management. All patients will require close monitoring, many of them within intensive care settings.[doctorslounge.com]
  • Patients with sepsis, or with a severe heart insufficiency, often require intensive care treatments.[lecturio.com]

Prognosis

  • Prognosis The prognosis for those suffering from oliguria depends on what is causing the symptom but in most cases is quite good, provided the acute condition is promptly and properly treated.[kidneypedia.net]
  • CONCLUSIONS: Lactate is an objective parameter that can predict prognosis and contributes to a better management of acute kidney injury in hemodialysis patients.[ncbi.nlm.nih.gov]
  • Indicators of poor prognosis include older age, multiple organ failure, oliguria, hypotension, number of transfusions and acute on chronic kidney disease. Prognosis is closely related to the underlying cause.[patient.info]
  • Prognosis AKI which results from nephrotoxic injury, interstitial nephritis and neonatal asphyxia is frequently of the non-oliguric type. It is related to a less severe renal injury and has a better prognosis.[patient.info]
  • Anemia can also frequently occur and the prognosis depends on the underlying cause. Treatment for chronic renal failure generally includes restricting the patient’s water and protein intake and the usage of diuretics.[availclinical.com]

Etiology

  • (look at etiology) Prognosis lower rates of recovery in patients 65 years of age increased risk of end-stage renal disease, chronic kidney disease, and mortality Presentation Symptoms may be asymptomatic oliguria anuria polyuria confusion Physical exam[medbullets.com]
  • Principal causes of oliguric acute kidney injury in neonates The etiology of oliguria varies with age, and the common causes in neonates and children are listed separately.[emedicine.medscape.com]
  • While they may help in the diagnosis and management of very specific etiologies like hepatorenal syndrome, most of the time a fluid challenge or diuresis will be the diagnostic and therapeutic tests of choice. JAMA. 1976 Aug 9;236(6):579-81.[medicine-matters.blogs.hopkinsmedicine.org]
  • The principal etiologies of acute kidney injury while in hemodialysis were sepsis (39.2%), and severe dehydration (10.8%).[ncbi.nlm.nih.gov]
  • Etiology – many causes of AKI are reversible or amenable to treatment. Prerenal – this is one of the most common causes of acute kidney injury and basically is caused by decreased blood flow to the kidney.[foamcast.org]

Epidemiology

  • In this article we highlight the epidemiology, general causes, and evaluation of acute renal failure in adults.[nejm.org]
  • Methods Statistics Trigonometry Medical & Nursing Anatomy Anesthesiology Audiology Bacteriology Biochemistry Bioethics Biomedical Science Cardiology Cardiovascular Childbirth Chiropractic Dentistry Dermatology Diagnostic Imaging Drugs Endocrinology Epidemiology[brainscape.com]
  • Epidemiology/Prognosis Numerous studies have indicated that AKI is common, is increasing in incidence and is associated with considerable morbidity and mortality.[clinicaladvisor.com]
  • In 2013, Rhone et al 62 evaluated the epidemiology and impact of nephrotoxic medication exposure in 107 very low birth weight (VLBW) infants.[pediatrics.aappublications.org]
  • Acute kidney injury: epidemiology and diagnostic criteria. Curr Opin Crit Care. 2006; 12: 531-537. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG. Acute Kidney Injury Network.[austinpublishinggroup.com]
Sex distribution
Age distribution

Pathophysiology

  • In the past five decades, several important causes of acute renal failure and the pathophysiologic mechanisms that underlie renal dysfunction have come to be understood.[nejm.org]
  • Etiology and Pathophysiology of Acute Renal Insult Causes of Acute Renal Insult Because of various pathophysiologic processes, kidney function can diminish rapidly.[lecturio.com]
  • The most common trigger in ICU patients is sepsis—the pathophysiology of septic AKI is poorly understood and probably involves intrarenal haemodynamic and inflammatory processes.[oxfordmedicine.com]
  • You are here: Urology Textbook Kidneys Renal insufficiency Acute renal injury Acute kidney injury – acute renal failure (1/2): causes, pathophysiology and symptoms Acute kidney injury – acute renal failure (2/2): Diagnosis and treatment Review literature[urology-textbook.com]
  • When oliguria results from acute kidney disease, diagnosis to indicate the pathophysiology of the problem is necessary, as prerenal or postrenal acute kidney failure will be treated differently from renal failure properly so called.[kidneypedia.net]

Prevention

  • Meticulous attention must be paid to preventing or treating complications of AKI.[renalandurologynews.com]
  • Dialysis is a great treatment for 1 and 2 and prevents 4. Careful conservative management can prevent 1-3 and delay 4, allowing recovery to occur.[edrep.org]
  • Preventing Acute Kidney Disease. RenalGuard. Available at . Accessed: November 1, 2016. Zarbock A, Schmidt C, Van Aken H, Wempe C, Martens S, Zahn PK, et al.[emedicine.medscape.com]
  • Prevention of contrast nephropathy by furosemide with matched hydration: the MYTHOS(induced diuresis with matched hydration compared to standard hydration for contrast induced nephropathy prevention) trial. JACC Cardiovasc Interv. 2012; 5: 90-97.[austinpublishinggroup.com]
  • We reviewed current available evidence on prevention and treatment of SAKI with focus on some recent advances and developments. Prevention of SAKI starts with early and ample fluid resuscitation preferentially with crystalloid solutions.[annalsofintensivecare.springeropen.com]

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