- Postpartum haemorrhage.
- Low output cardiac failure.
- Acute tubular necrosis.
- Acute cortical necrosis (hypertension, pregnancy).
- Acute interstitial nephritis (drugs e.g “kushta” infection).
- Acute glomerulonephritis.
- Acute polynephritis.
Obstructive uropathy (prostate cancer, cervical cancer).
Anuria/ oliguria are main complaints.
Patient may present with hiccups, dyspnoea, vomiting, confusion, loss of consciousness or fits, uraemic smell.
- Oliguria, vomiting, confusion & GIT bleed.
- Signs of fluid overload (oedema, dyspnoea, and cough, raised JVP).
- Signs of volume depletion (hypotension, dehydration).
- CBC will indicate anemia that is partly dilutional & increased TLC if infection is present.
- Urinalysis will show casts.
- Serum Urea & Serum Creatinine will be raised.
- Serum electrolytes may show a raised K+, decreased Na+, decreased Ca++, & raised PO4++.
- Renal USG for obstructive lesions.
1 Catheterize the patient to measure urinary output.
2- If there is evidence of fluid overload, Inj. Mannitol: 200 ml of 20 % Mannitol is given I/V within 20 min. If urinary output increases in one hour, a second dose is given. If there is no response, then discontinue Mannitol. N.B.: -Before using Mannitol, make sure that patient does not have CCF.
3 If there is no increase in urinary output in 6 hrs, then Inj. Lasix 500 mg in 500 ml of 5% distilled water I/V within 1-2 hrs. If patient does not show improvement after 6 hrs of above therapy, then dialysis is indicated.
4 Symptomatic Treatment
(a) For Acidosis: 100 ml NaHCO3 is given.
(b) For Hyperkalemia: 10-20 ml of Inj. Ca gluconate OR
Infusion of 200 ml in 10% glucose with 16 units of plain insulin.
(c) In case of bleeding: Packed cell volume is given. Avoid whole blood transfusion.
(d) Inj. Maxolon is given for nausea / vomiting.
While treating the patient, over infusion is avoided by monitoring the JVP & auscultation of the chest (basal crepts).
Give antibiotics after C&S. Titrate the dose according to S/Creatinine & GFR values.
- Relieve the obstruction if present (stone, prostate).
- Give cimetidine to avoid bleeding from stress ulcers.
- Provide a diet rich in calories and high quality proteins (2000 to 4000 Cal/day).
Indication for Urgent Dialysis
- Serum K+ level persistently high (76 mmol/L) Acidosis (pH<7.2)
- Pulmonary oedema.
- Pericarditis & cardiac tamponade.
- High catabolic state with rapid progression.