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21.2 Acute Renal Failure (ARF)

Table of Contents

Is an abrupt or rapid decline in renal filtration function

This is (usually) reversible kidney failure, most commonly as a result of:

  • dehydration and fluid loss
  • drugs/toxins,
  • urinary tract obstruction, and
  • acute glomerulonephritis in older children

Diagnostic Criteria

  • Oedema
  • Oluguria/anuria
  • Convulsions in children

Investigations

  • Serum electrolytes, Urea and Creatinine tests
  • Ultrasound
  • Urinalysis

Non-Pharmacological Treatment

  • Give oxygen, and nurse in semi-Fowlers’ position if patient has respiratory distress.
  • Stop intake of all salt and potassium containing foods and fluids
  • Restrict fluid intake to 10 mL/kg/day daily plus visible fluid losses

Pharmacological Treatment

Adults

If diastolic blood pressure is greater than 100 mmHg or systolic blood pressure is above 150 mmHg:

C: Amlodipine (PO) 5 mg as a single dose.

If there is respiratory distress (rapid respiration, orthopnoea):

B: Furosemide, as an IV bolus, 80 mg.

Note: Do not put up a drip and do not give a fluid infusion.

Referral

All cases where adequate laboratory and clinical resources exists, management according to the hospital level guidelines may be instituted

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