prerenal renal failure
Introduction
Introduction to prerenal renal failure Prerenal renal failure refers to "prerenality" which indicates renal failure caused by insufficient renal vascular content and insufficient renal blood flow. In the case of dehydration, prerenal oliguria is mainly caused by the loss of fluid. At this time, rapid fluid replacement should be performed. Insufficient fluid can further deteriorate renal hemodynamics and eventually lead to tubular degeneration (acute tubular necrosis). basic knowledge The proportion of illness: 0.005% Susceptible people: no special people Mode of infection: non-infectious Complications: hemolytic anemia
Cause
Causes of prerenal renal failure
Common causes of acute prerenal renal failure are renal or extrarenal dehydration caused by diarrhea, vomiting, and extensive use of diuretics; rare causes include septic shock, acute pancreatitis, and high-dose antihypertensive drugs, which cause blood Relative or absolute lack of capacity, heart failure, heart failure, and insufficient renal blood flow, careful clinical assessment can help identify the primary disease of acute renal failure.
Liver cirrhosis (hepatorenal syndrome), cyclosporin, non-steroidal anti-inflammatory drugs and angiotensin-converting enzyme inhibitors can also cause a decrease in glomerular filtration rate, which seems to pass prostaglandins and kidneys. Angiotensin regulates renal physiological changes and causes glomerular capillary function to suddenly fail. Urine analysis results are similar to prerenal renal failure, but clinical evaluation does not necessarily confirm the existence of true prerenal renal failure. After the above drugs are discontinued and the liver disease or liver transplantation is actively treated, the glomerular filtration rate can often be improved.
Prevention
Prerenal renal failure prevention
Actively prevent cirrhosis caused by various causes (especially schistosomiasis cirrhosis). Chronic infections such as malaria, tuberculosis, malignancies such as lymphoma, chronic lymphocytic leukemia, myelofibrosis, and chronic hemolytic anemia and rare reticuloendotheliosis.
Complication
Prerenal renal failure complications Complications hemolytic anemia
Complications: Severe anemia, especially hemolytic anemia, can occur.
Symptom
Symptoms of prerenal renal failure Common symptoms Venous collapse, pulse, rapid mouth, thirst, unbearable water loss, weight loss, dizziness, dehydration
(1) In addition to a small number of patients with prerenal renal failure caused by heart failure, other patients usually have symptoms such as thirst, erect dizziness, and a history of fluid loss. Sudden weight loss often reflects the extent of dehydration.
(2) Physical examination showed poor skin elasticity, venous collapse, mucosa and axillary dryness. The most important signs were erect or orthostatic blood pressure and pulse speed.
Examine
Examination of prerenal renal failure
(1) urine test: urine output is usually reduced, indwelling catheter can accurately determine the amount of urine per hour, while also eliminating lower urinary tract obstruction, urine specific gravity and urine osmotic pressure increased (>1.025,>600mosm/kg, respectively) Urine routines generally have little value.
(2) urine, blood chemical analysis: the ratio of normal blood urea nitrogen to creatinine is 10:1, the ratio of patients with prerenal renal failure is increased, mannitol and other diuretics can disturb the renal tubules on urea, sodium and creatinine Excretion and reabsorption, so these drugs will affect the evaluation of the results.
(3) central venous pressure: central venous pressure reduction often indicates insufficient blood volume, can be caused by blood loss or dehydration, but if the main cause of prerenal renal failure is severe heart failure, cardiac output is reduced and central venous pressure is increased high.
(4) Liquid load test: The liquid load test has diagnostic and therapeutic value for prerenal renal failure. If the amount of urine increases after careful rehydration, it can be considered as prerenal renal failure. The test starts rapid intravenous input of normal saline 300. ~500ml work 20% mannitol 125ml, after 1 to 3 hours, the urine volume is measured. If the urine volume exceeds 50ml per hour, the treatment is effective, and the intravenous saline is continued to expand the blood volume and correct the dehydration, such as the urine volume is not increased. The blood, urine biochemical analysis results should be carefully reviewed, the patient's body fluid status should be re-evaluated and a physical examination performed again to determine if the fluid load test needs to be performed again (with or without furosemide).
Diagnosis
Diagnosis and diagnosis of prerenal renal failure
Diagnosis can be based on medical history, clinical symptoms, and laboratory findings.
