Renal failure Medical Assignment Help

Acute renal failure is a common and serious complication of critical illness which adversely affects the prognosis. The importance of preventing renal failure by rapid and effective resuscitation, as well as the avoidance of nephrotoxic drugs (especially NSAIDs), cannot be overemphasized. Shock and sepsis are the commonest causes of acute renal failure in the critically ill but it remains important to diagnose the cause of renal dysfunction and exclude reversible pathology, especially obstruction.
Oliguria is usually the first indication of renal impairment and should prompt immediate attempts to optimize cardiovascular function, particularly by expanding the circulating volume. Low-dose dopamine may be used to enhance renal blood flow. If these measures fail to reverse oliguria some recommend administration of diuretics such as frusemide or mannitol.
If oliguria persists, it is important to reduce crystalloid intake and review drug doses. Dialysis is indicated for fluid overload, electrolyte disturbances (especially hyperkalaemia), acidosis and, to a lesser extent, uraemia. Intermittent haemodialysis has a number of disadvantages in the critically ill. In particular it is frequently complicated by hypotension and it may be difficult to remove sufficient volumes of fluid. Peritoneal dialysis is also frequently unsatisfactory in these patients and is contraindicated in those who have undergone intra-abdominal surgery. The use of continuous haemofiltration, usually with dialysis, is therefore preferred.

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