Clinical Presentation Complications

ARF results in signs and symptoms that reflect loss of the regulatory, excretory, and endocrine functions of the kidney. The loss of excretory ability of the kidney is ressed by a rise in the plasma of specific substances normally excreted by the kidney. The most widely monitored indices are the concentrations of BUN and creatinine in the serum. In patients without other the BUN rises by about 10 to 20 mg/ dL/ day, and the bicarbonate level falls to a steadystate level of 17 to 18 mEq/L.

The serum potassium level need not rise appreciably, except in the presence of a state, gastrointestinal bleeding, or extensive tissue trauma. Because ATN is inherently a catabolic disorder, patients with ATN generally lose about 0.5 lb per day. Further weight loss can be minimized by providing adequate calories(1800 to 2500 kcal) and about 40 g of protein per day. The use of with 50% dextrose and essential amino acids has had little effect on minimizing mortality and morbidity in ATN, except in patients who also have significant burns. Hyperkalemia is a life-threatening complication of and often necessitates urgent intervention. The electromechanical effects of hyperkalemia on the heart and are potentiated by hypocalacemia, acidosis, and hyponatremia. Thus, the electrocardiogram, which measures the summation of these effects, is a better guide to therapy than a single potassium determination. The cardiac effects of hyperkalemia are primarily referable to of the magnitude of the action potential in response to a depolarizing stimulus. The sequential electrocardiographic changes observed in peaked waves, prolongation of the PR interval, widening of the QRS complex, and a sine wave pattern, and changes indications prompt treatment. The most common abnormality responsible for death in patients with ATN is hyperkalemia. Moderate acidosis is generally well tolerated and does not need treatment unless it is used as an adjunct to controlling hyperkalemia or when plasma bicarbonate levels fall to less than 15 mEg/L. Hyperkalemia and acidosis not easily controlled by medical therapy are indications for initiating dialysis.

In most patients, hypocalcemia is asymptomatic and In most patients, hypocalcemia does not require treatment. Phosphate-binding be used in patients with significant hyperphosphatemia. Anemia regularly in symptomatic or does not require treatment unless it is contributes to heart failure In a well-managed patient(with use of early dialysis), many of the uremic manifestations outlined in form either do not develop or are minimal.

However infection remains the main cause of death despite vigorous dialysis. Thus, meticulous aseptic care of intravenous catheters and wounds and avoidance of the use of indwelling urinary catheters are important in the management of such patients