Урология - Renal failure

Diuretic stage

Lasts 9-11 days

Has two phases

Early diuretic phase

Phase of poliuria

Convalescence stage

Lasts 6-12 month

Duration depends on severity of the disease

Criterium of reconvalescence – recovery of renal concentrational capability

Diagnosis

Anamnesis

Catheterization of vesical bladder

Radioisotope renography

Utlrasound

CT

Retrograde pyelography

Roentgenography of lungs

ECG

Blood serum analysis

Urinalysis

Treatment: initial stage

Removal of the cause

Elimination of haemodynamic changes: (infusion of colloid solutions: plasm, albumine, dextrane)

Detoxication (plasmapheresis, dialysis, infusion of Na hydrocarbonate)

Stimulation of diuresis (Lasix 2.0 mg)

Corticosteroids (prednisolone 180-210 mg than 60-90mg each 6-8 hours during 2-3 days)

Enchancement of renal bloodflow dophamine 4% -5.0 on glucose solution, euphyllini 2.4 % 10,0 iv

O2

Antibyotics

Nephrostomy if necessary

Oliguric stage

Strics control of diuresis (+400)

Diet with enough amount of carbohydrates and limited content of protein

Stimulation of diuresis

Hormones 100mg/kg/day Prednisolone, hydrocortisone

At anaemia washed-out erytrocytes

Glucose infusion

Haemodialisis when urea is > 24 mmol/l, K>7 mmol/l, creatinine > 2 mmol/l

At septic condition haemodyalisis+heamosorbtion+plasmapheresis

Antibyotics

Vitamines

Diuretic stage

Control of diuresis

Correstion of electrolytes

Activation of immunity

Antibyotics

Convalescence stage

Diet

Health resort treatment

Special labour conditions

Out-patient observation

Treatment of complications (astenoneurotic syndrome, anaemia, chronic pyelonephritis)

Chronic renal failure

Chronic renal failure is a slowly worsening loss of the ability of the kidneys to remove wastes, concentrate urine, and conserve electrolytes

Primary affection of a glomerular apparate (chronic glomerulonephritis, glomerulosclerosis)

Primary affection of tubule apparate (chronic hypercalcyaemia, inborn oxaluria, chronic impoisonment by salts of heavy metals)

Secondary affection of tubules (chronic pyelonephritis)

Bilateral anomalia of kidneys and ureters (hypoplasia of lidney, policystic kidney, neuromuscular displasia of ureters)

Obstructive diseases of upper and lower urinary tract

System collagenous diseases

Stages

Latent

Compensated

Intermittant

Terminal