Diagnosis of Acute Renal Failure (ARF)

Diagnosis of Acute Renal Failure

1. Inquire the family history and make a careful physical inspection

2. Check urine and urine output as follows:

Urine output per hour

Physical property of urine

Urine specific gravity or urine osmotic pressure

Routine Urine

3. Routine blood test

Blood routine test

Acidophilic cells increase significantly which prompts the possibilities of acute interstitial nephritis.

Blood urea nitrogen and creatinine

Creatinine and urea nitrogen rise progressively, daily blood urea nitrogen increases 3.6--7.1mmol/L while creatinine 44.2～88.4μmol/L.

Measurement of serum electrolytes, pH or plasma [HCO3]

Precautions

Notice high levels dangerous factors.

High levels dangerous factors may include severe trauma, major surgery, systemic infection, durative hypotension or renal toxicity substance.

ARF can be avoided through correcting imbalance of water, electrolytes and acid-base positively; taking anti-shock treatment properly and timely. Those measures above could help avoiding the effective hypovolemia insufficiency, relieving renal vasoconstriction.

For those who have severe crush injury in soft tissues or mistaken blood transfusion. Primary diseases should be remedied first; meanwhile, application of certain drugs can prevent obstruction of renal tubules by hemoglobin and muscle hemoglobin or damage of epithelial cells in renal tubules.

We should dilate blood volume before operation which would influence kidneys’ blood flow. Medications should be used during or after the surgery to protect renal function. Make oliguric ARF switch to non-oliguric ARF. Dopamine could dilate blood vessels which would increase the glomerular filtration rate and renal plasma flow.

When oliguria appears, we should use dehydration test, which can not only identify prerenal ARF or renal ARF, but also precaution prerenal ARF develop to renal ARF.