postrenal renal failure
Introduction
Introduction This disease is caused by a variety of pathogenic factors leading to the damage of the kidney's intrinsic cells, releasing a series of nephrotoxic inflammatory cytokines and growth factors, which ultimately promotes the accumulation and accumulation of a large number of extracellular matrix in the kidney tissue, regulating the detoxification function. Sexual decline, toxins such as creatinine, urea nitrogen, uric acid and other abnormal accumulation in the body.
Cause
Cause
The main causes of post-renal renal failure are urinary tract obstruction and urinary reflux.
Acute renal failure (ARF) can be divided into pre-renal, post-renal and renal. The disease and damage of the kidney itself is called renal renal failure. Prerenal renal failure is often caused by decreased blood pressure and renal hypoperfusion due to heart failure or other causes. The main causes of post-renal renal failure are urinary tract obstruction and urinary reflux.
Prerenal and post-renal, if diagnosed early, may be reversed. Some renal causes of acute glomerular vascular and tubulointerstitial nephropathy, such as malignant hypertension, glomerulonephritis, vasculitis, bacterial infections, drug reactions, and metabolic disorders (such as hypercalcemia, hyperuricemia) Hemorrhage) is also treatable.
It refers to urinary tract obstruction or dysuria below the kidney level.
1. Ureteral calculi: bilateral ureteral stones or contralateral sputum on one side of the stone.
2. Urethral obstruction: seen in stones, stenosis, posterior urethral valve.
3. Bladder neck obstruction.
4. Prostatic hyperplasia and cancer.
5. There is a large blood clot in the bladder or bladder.
6. Gynecological disorders: pelvic tumors compress the ureter and bladder. Urethra and so on.
7. Neurogenic bladder: It is a common complication of diabetes, severe hypokalemia, ganglion blockers, etc. can cause dysuria, which in turn causes acute renal failure.
Examine
an examination
Related inspection
Urine routine retroperitoneal angiography
1. The medical history should include the following:
(1) Understand crush injuries, burns, major bleeding and the situation at the time.
(2) Whether there is a history of serious infection such as sepsis, septic shock, infectious, infective endometritis, suppurative cholangitis, acute pancreatitis, epidemic hemorrhagic fever, toxic bacillary dysentery, shock pneumonia, etc.
(3) Understand the history of severe dehydration, electrolyte imbalance and acid-base balance disorders; whether there is a history of various shocks.
(4) Understand the symptoms of edema, hypertension, and urinary tract irritation. History of glomerulonephritis, pyelonephritis, and urinary tract obstruction, such as dysuria or poor urine flow.
(5) Understand the history of exposure to toxic substances, medication history, fluid replacement, blood transfusion and estimate the amount of fluid.
(6) Understand the history of cardiovascular disease.
In general, the medical history can determine the cause and then diagnose the disease in order to determine prerenal, renal and post-renal acute renal failure.
2. Physical examination: focus on the degree of anemia, venous filling, degree of dehydration, rash, blemishes, ecchymoses. Examination of cardiopulmonary signs. Abdominal mass and abdominal tenderness, palpation of the kidney and tenderness in the kidney area, pain, and urine retention in the bladder.
3. Laboratory examination: It is an important diagnostic tool to establish a diagnosis and to infer the cause, and to judge the severity of acute renal failure.
(1) Urine examination: including changes in urine volume and urine relative density. In acute renal failure, the urine volume is less than 400 ml per day or less than 17 ml per hour. Complete anuria indicates renal cortical necrosis or bilateral urinary tract obstruction. Urine sediment examination includes protein qualitative urine cells and various tube types, urine sugar qualitative and so on. The relative density of urine is low and fixed. Under the premise of oliguria, the relative density of urine is 1.018. L.014 below can basically diagnose, 1.010-1.012 can definitely diagnose.
(2) blood routine blood biochemical examination: routine can determine the degree of anemia infection and blood concentration. Biochemical performance of refractory metabolic acidosis, high urea nitrogen, high creatinine, low creatinine clearance. Electrolyte examination is prone to hyperkalemia, hyponatremia (usually dilute hyponatremia, low blood calcium, high blood phosphorus. Hyperkalemia is one of the causes of death.
(3) Determination of urinary sodium: The discharge of raw steel in acute renal failure is greater than 30~40 mih/L, and the functional oliguria discharge is less than 10 min/L, indicating that the renal tubules absorb sodium barrier.
(4) Determination of urine osmotic pressure: normal human urine osmotic pressure>550min/kg.H2o, at this time can show a significant decline.
(5) Renal failure index (RFI): RFI = serum creatinine X urinary creatinine: ratio >1.
Diagnosis
Differential diagnosis
The identification of prerenal, renal, and post-renal acute renal failure depends mainly on medical history and physical examination combined with laboratory tests, and can generally be distinguished.
Renal acute renal failure
It refers to the primary disease in the kidney itself, divided into five categories: acute tubular necrosis, acute glomerulonephritis and glomerular disease, acute interstitial nephritis, acute renal parenchymal necrosis and renal vascular disease.
Prerenal acute renal failure
1. Acute blood volume deficiency
(1) Digestive tract loss: such as vomiting, diarrhea.
(2) Major bleeding caused by various causes: shock caused by massive bleeding and insufficient blood volume, sometimes coexisting with both, severe renal perfusion, decreased glomerular filtration rate, tubular degeneration and necrosis, common acute renal failure the reason.
(3) a large amount of skin loss: seen in heat stroke and a lot of sweat did not timely replenish blood volume.
(4) third gap loss of fluid: such as large area burns, peritonitis, necrotizing pancreatitis, a large amount of liquid into the third gap caused severe blood volume deficiency, leading to kidney failure.
(5) Excessive diuresis: diuretic can cause loss of water and loss of salt.
2. Cardiovascular disease due to severe cardiac output, renal insufficiency is seen in:
(1) Congestive heart failure.
(2) acute myocardial infarction: especially combined with cardiogenic shock or severe arrhythmia is more likely to be associated with acute renal failure.
(3) Pericardial tamponade: At this time, the body circulation is congested, which seriously affects the cardiac output.
(4) Renal artery embolization or thrombosis.
(5) Large area lung infarction.
(6) Severe arrhythmia.
3. Peripheral vasodilation or infection poisoning: At this time, the effective circulation of blood volume is redistributed, which is seen in the blood pressure reduction too fast or excessively toxic shock.
4. Increased renal vascular resistance: seen after major surgery and anesthesia, hepatorenal syndrome, prostaglandin inhibitors cause decreased secretion of prostaglandins such as aspirin, indomethacin and ibuprofen.
