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Acute Renal Failure

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Acute Renal Failure

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    1. Acute Renal Failure David Dayya, D.O., M.P.H. St. Barnabas Hospital Dept. of Family Medicine

    2. ARF Classification Prerenal Azotemia = Renal blood flow Renal Azotemia = Intrinsic renal parenchymal disease Postrenal azotemia = Obstruction in urine outflow

    4. Diagnosis Record Review i.e. Baseline function? Infection? Drugs? Contrast? Low Blood Pressure? Transfusion? Surgery? P.E. Hemodynamic status, hydration status, UA Sediment exam, Urinary indices, Bladder Catheterization, Fluid Challenge Radiology US, Renal Scan, IVP Biopsy

    5. Management Restrict dietary protein to control uremia improves nausea, vomiting, malaise, and encephalopathy Calories to control catabolic breakdown products Limit high phosphate containing products Increase Fiber Consult Nutritionist Phosphate Binders Ca X PO4 >70 Diuretics D.O.C. for HTN and volume overload

    6. MGT. continued K-Binding Resins, Calcium Gluconate, Insulin, Dextrose, Bicarbonate Calcium/Vitamin D, Rocaltrol (0.25-1mcg po qd) supplementation Avoid heavy metal containing products Control coagulopathy, Transfuse, Epogen(50-100U/kg SC/IV 3X/week) Pneumovax, Influenza vaccines Fertility referral i.e. invitro fertilization, artificial insemination, fertility drugs Dialysis Transplantation

    7. Complications Fluid Overload, HTN Pericardial Tamponade Hyperkalemia Hypermagnesemia Metabolic Acidosis Neurotoxicity (asterixis)

    8. ARF VS. CRF History Normal Incr. BUN/CR Kidney Size Normal Decreased Bone Films R.O. Absent R.O. Present H/H Normal Anemia Present

    9. Questions?

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