2: Acute Renal Failure Flashcards
(14 cards)
What is acute renal failure
Sudden decrease in GFR. Causing an increase in urea and creatinine.
How can the causes of renal failure be divided
Pre-renal
Renal
Post-renal
What are pre-renal causes of renal failure
- Sepsis
- Hypovolaemia
What can cause hypovolaemia
Gastroenteritis, haemorrhage, DKA
What are renal causes of renal failure
- Acute tubular necrosis
- Interstitial nephritis
- Haemolytic-Uraemia Syndrome
- Pyelonephritis
What are post-renal causes of renal failure
- Obstruction
- Neurogenic bladder
Explain pathophysiology of HUS
- Shiga toxin causes inflammation endothelial cells
- Damage cells release toxins causing vasoconstriction and platelet microthrombus formation
- this narrows blood vessels causing mechanical destruction of RBC
- results in decreased perfusion, particularly of the kidneys, cause drop in GFR
What is triad of symptoms in HUS
- Haemolytic anaemia
- Thrombocytopenia
- Decreased renal function
How does acute renal failure in children usually present
Oliguria
What may sore-throat prior to acute renal failure indicate
Post-streptococcal glomerulonephritis
What investigations should be ordered in acute paediatric renal failure
- U+E
- Urinalysis
- Urine MC+S
- A:Cr (nephrotic syndrome)
- Ecoli O157:H7 if suspecting infection
- USS
If suspecting nephritis, what investigation may be ordered
Antistreptolysin O titre (ASOT)
Complement
ANA
Who should acute paediatric renal failure be referred to
Paediatric nephrology
How should HUS be managed
- Supportive: Fluids, Blood
There is NO role for antibiotics despite diarrhoea illness
2: Plasma exchange - reserved for cases of HUS without dialysis
3: Eculizumab (C5 inhibitor) - beneficial in atypical adult
