Obstructive causes such as benign as benign prostatic hypertrophy and hypertrophy and bladder tumor
Inhibit COX-1 and COX-2 production
Decrease renal prostaglandin production
Trauma/Injury in Muscle
Dehydration
Rhabdomyolosis
Decreased BP
Release of Myoglobin and Hemoglobin
Kidney release Renin Angiotensinogen from liver
Vasoconstriction of renal afferent arteriole
pH is <5.6 Angiotensin I Becomes ferrihemate
ACE from Pulmonary and Renal Endothelium
Vasoconstriction Vasoconstriction
Vasoconstriction
Na reabsorption reabsorption
Acute Tubular Necrosis
Hypertension
Ischemia
PRE-RENAL FAILURE
Aldosterone
Angiotensin II
Free hydroxyl radicals production
Additional Risk Factors: Hypotension Blood transfusion reactions Severe Infection (WBC:23.81) Dye/Contrast use
Injured tubular epithelial cells
Initiation Phase
Cell death and detachment from basement membrane Decrease renal perfusion
Oliguric Phase
Tubular necrosis
Decrease blood volume
Low GFR
High Creatinine
High BUN
Na reabsorption K excretion Water retention
Renal Injury Established
Maintenance Phase
Oliguric Phase (10-20 days)
Endothelial cells necrosis and sloughing
Tubular destruction
MEDICAL MANAGEMENT:
Increase tubular permeability
Objectives:
Restore normal chemical balance
Prevent complications
Low GFR (5-10mL/m)
Recognition and treatment of underlying cause BP monitoring I and O monitoring, including drainage Monitoring of electrolyte levels ECG ABG and Serum bicarbonate level monitoring May have blood transfusion May initiate dialysis Pharmacologic Therapy: Cation-exchange resins for hyperkalemia IV dextrose 50% Insulin Calcium replacement Albuterol Sulfate nebule Avoidance of nephrotoxic agents: radiocontrast agents, antibiotics with nephrotoxic potential, heavy metal preparations, cancer chemotherapeutic agents, nonsteroidal antiinflammatory drugs [NSAIDs ] Diuretic agents Nutritional therapy: Weigh patient daily Dietary proteins High carbohydrate diet Low salt, potassium, low phosphorus food Restrict potassium intake Follow up check up within 1-2 weeks
