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Renal failure

Renal failure is the condition where the kidneys fail to function properly. Physiologically, renal failure is described as a decrease in the glomerular filtration rate. Clinically, this manifests in an elevated serum creatinine. more...

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It can broadly be divided into two categories: acute renal failure and chronic renal failure.

  • Chronic renal failure (CRF) develops slowly and gives few symptoms initially. It can be the complication of a large number of kidney diseases, such as IgA nephritis, glomerulonephritis, chronic pyelonephritis and urinary retention. End-stage renal failure (ESRF) is the ultimate consequence, in which case dialysis is generally required while a donor for renal transplant is found.
  • Acute renal failure (ARF) is, as the name implies, a rapidly progressive loss of renal function, generally characterised by oliguria (decreased urine production, quantified as less than 400 to 500 mL/day in adults, less than 0.5 mL/kg/h in children or less than 1 mL/kg/h in infants), body water and body fluids disturbances and electrolyte derangement. An underlying cause must be identified to arrest the progress, and dialysis may be necessary to bridge the time gap required for treating these underlying causes.

Acute renal failure can present on top of (i.e. in addition to) chronic renal failure. This is called acute-on-chronic renal failure (AoCRF). The acute part of AoCRF may be reversible and the aim of treatment, like in ARF, is to return the patient to their baseline renal function, which is typically measured by serum creatinine. AoCRF, like ARF, can be difficult to distinguish from chronic renal failure, if the patient has not been followed by a physician and no baseline (i.e. past) blood work is available for comparison.

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Management of acute renal failure
Acute renal failure is present in 1 to 5 percent of patients at hospital admission and affects up to 20 percent of patients in intensive care units.
Daily hemodialysis improves survival in acute renal failure in the ICU
To the Editor: In the excellent special report by Dr. Vincent on evidence-based medicine in the ICU, no mention was made about the beneficial effect ...
Diuretics in patients with acute renal failure may be harmful - Tips from Other Journals
Diuretics are frequently given to treat acute oliguric renal failure, but the response to diuretics in this setting may actually be a marker for severe ...
Are diuretics helpful in acute renal failure? - Patient Oriented Evidence that Matters
Mehta LM, Pascual MT, Soroko S, Chertow GM. Diuretics, mortality, and nonrecovery of renal function in acute renal failure. JAMA 2002; 288:2547-2553.
Renal failure secondary to acute tubular necrosis : epidemiology, diagnosis, and management
Acute tubular necrosis (ATN) is a form of acute renal failure (ARF) that is common in hospitalized patients. In critical care units, it accounts for ...
The impact of renal dysfunction in outpatients with systolic heart failure
PURPOSE: Renal function is an underappreciated prognostic factor in heart failure (HF), and renal insufficiency is commonly viewed as a relative contraindication ...
Coenzyme Q10 for chronic renal failure
Ninety-seven patients (mean age, 48 years) with chronic renal failure (serum creatinine > 5 mg/dl), with a history of declining renal function for ...
High troponin levels in critically ill patients with renal failure and no acute coronary syndrome: incidence and impact on mortality
PURPOSE: High cardiac troponin levels are commonly seen in medical intensive care (MICU) patients with renal failure and no clinical evidence of acute ...

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