2: Acute Renal Failure Flashcards
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
