Hospital pediatrics. Clinical picture of acute renal failure (most important)

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Hospital pediatrics. Clinical picture of acute renal failure (most important)

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19. Clinical picture of acute renal failure

Clinic- The initial period is characterized by symptoms of the underlying disease (poisoning, painful shock, anaphylactic or bacterial), hemolysis, acute poisoning, infectious disease. On the first day, a decrease in diuresis (less than 500 ml/day) can be detected, i.e., a period of oliguria, anuria begins, and homeostasis changes. In plasma, the level of creatinine, urea, residual nitrogen, sulfates, phosphates, magnesium, potassium is increased, the level of sodium, chlorine, and calcium is decreased.

Adynamia, loss of appetite, nausea, vomiting appear; in the first days, oliguria and anuria can be observed. With increasing azotemia, the level of urea increases daily by 0,5 g/l; with increasing acidosis, overhydration and ectrolyte disorders, muscle twitching, lethargy, drowsiness are observed, shortness of breath appears due to acidosis, pulmonary edema, the early stage of which is determined by x-ray. Characteristic changes in the cardiovascular system: tachycardia, expansion of the borders of the heart, dull heart sounds appear on auscultation, systolic murmur at the apex, pericardial friction noise. Heart rhythm disturbances develop as a result of hyperkalemia, which can cause death. With hyperkalemia, the ECG shows a tall, pointed T wave, the QRS complex is widened, and the R wave is reduced. Heart block and ventricular fibrillation can lead to cardiac arrest. Anemia develops during all periods of acute renal failure. The period of oliguria and anuria is characterized by the appearance of leukocytosis.

There may be complaints of abdominal pain, liver enlargement, symptoms of acute uremia occur. Death in acute renal failure develops against the background of uremic coma, changes in hemodynamics, sepsis. In acute renal failure, hypoisostenuria appears.

The oligoanuric period is manifested by a rapid (within a few hours) decrease in diuresis to 100-300 ml / day with a low specific gravity of urine no more than 1012, lasts 8-10 days, a gradual increase in weakness, anorexia, nausea, vomiting, itching of the skin. With unlimited administration of fluid and salt, hypervolemia and hypertension occur; peripheral edema and pulmonary edema may occur.

Hyperazotemia rapidly increases (up to 5-1 mmol/day urea, creatinine more than 5 mmol/l), severe acidosis, hyperkalemia (up to 2 mmol/l), hyponatremia (below 9 mmol/l) cause uremic coma. Hemorrhages, gastrointestinal bleeding, decrease in hemoglobin, leukocytes to 115 X 2,0/l. The color of the urine is red due to gross hematuria, and proteinuria is usually small - up to 109%.

The recovery period lasts about 1 year and is manifested by the gradual restoration of renal functions.

In the treatment of peritoneal dialysis and hemodialysis in the complex therapy of acute renal failure, mortality decreased to 20-30%, the outcome in chronic renal failure is rarely noted, as well as the development of acute renal failure against the background of chronic renal failure.

Author: Pavlova N.V.

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