Acute renal failure – state and urinalysis

Acute renal failure (UNP) It is characterized by rapidly progressive violation of water-electrolyte metabolism and acid-base balance.

Among the reasons, causing acute renal failure, distinguish prerenal, Renal and postrenal. Prerenal causes include acute blood loss, traumatic shock and operational, Some acute severe infection (sepsis, typhus, cholera and others.), in obstetric practice (especially after unsafe abortions, complicated by sepsis and hemorrhage) – transfusion of incompatible blood group; to renal - heavy metal poisoning (mercury, lead, vysmutom, gold), Mushrooms, antibiotics, etc..

Postrenal causes include pressure and blockage of the urinary tract with nephrolithiasis, prostatic hypertrophy, pelvic tumors.

Enlarged kidneys, naʙuxşie, edematous. The pale gray cortex sharply demarcated from dark red renal pyramids, in the inner zone of the brain substance often found bleeding. Morphologically, in the early stages of the disease in the kidneys observed various changes, which will eventually lead to the development express varying degrees of focal nephrosclerosis.

The clinical course of acute renal failure can be divided into four periods:

• initial action factor (shock, sepsis, sharp otravlelenie);
• oligoanurii;
• restoration (having two phases - an initial diuresis and polyuria);
• recovery.

In the first period observed symptoms, cause acute kidney failure. This marked and signs of severe kidney damage, in particular, decreased urine output.

In the second period the UNP main symptom is severe oliguria (300-400 Ml per day) up to anuria. In severe oliguria occurs from the first day of the disease, with a light - on the second or third day. Duration oliguria up 10 days or more should be considered a poor prognostic sign.

Urine ED patient looks soapy water, its low relative density. Proteinuria in most cases mild.

Microscopic examination often found many white blood cells, a different number of red blood cells, until gross hematuria. The latter can be detected and unmodified erythrocytes. There gemosiderinuriya with deposits grains hemosiderin in the cellular elements of urine. Kidney epithelial cells of large size, fatty degenerated, as if dilapidated core can not see them, border cells are often blurred.

There is a wide cylinders - hyaline, grainy, buropigmentirovannye, hyaline droplets, etc.. Epithelial cylinders destroyed epithelial cells recognize hard.

In makrogematurii fibrin burookrashennыy, Klochko.

Acute renal failure develops suddenly vomiting, weakness, hypothermia etc.. The content of nitrogen products of protein metabolism increases rapidly and can reach large numbers (83,3-166.5 Mmol / l urea). There is a delay and potassium in the body (to 7,7- 10,2 mmol / l at normal 4,1- 5,6 mmol / l), which is especially dangerous and leads to severe nerve damage (until limb paralysis).

The recovery period diuresis lasts about two weeks. Despite increasing urine output, Kidney function has significantly disrupted, which manifests their lack of concentration ability (the relative density of urine remains low). Can grow azotemia.

Then, renal function gradually recovered, and biochemical parameters of blood and urine sediment microscopy normalized.