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Treatment  of Acute Renal Failure

Correction of life threatening complications

Electrolyte disorders



Pulmonary edema

Uremic coagulopathy with bleeding

Pericarditis with tamponade

Uremic encephalopathy

Look for reversible causes

Differential diagnosis

Prerenal azotemia

Intrinsic renal failure

Postrenal (obstructive) uropathy

Laboratory investigation

Routine blood studies - BUN, creatinine, CBC with differential, glucose, electrolytes, calcium, phosphate, albumin, globulin, uric acid

Special tests as indicated - CPK, ANCA, ANA, protein electrophoresis

Urine studies - urinalysis, volume output, urinary indices (osmolality, fractional excretion of sodium), occasionally urinary eosinophils, urinary uric acid/creatinine ratios, urine protein electrophoresis (for Bence-Jones proteinuria).

Renal radiology

Plain abdominal film (KUB)

Ultrasound of kidneys and bladder + Doppler study of renal vasculature

Abdominal CT scan + radiocontrast

Intravenous, retrograde or antegrade pyelography

Radionuclide renal scan

Magnetic resonance angiography

Radiocontrast angiography

Invasive maneuvers

Urethral catheterization

Hemodynamic evaluation

Fluid and/or diuretic challenge

Trial of dopamine and/or in future, a trial of atrial natriuretic peptide

Renal biopsy

Symptomatic treatment to maintain acute kidney failure homeostasis

Fluid balance - Replace estimated, measured and insensible fluid losses

Nutrition - Protein, potassium, sodium and phosphate restriction, avoid malnutrition

Drug management - Decrease doses of renally excreted drugs to appropriate levels based on clearance

Dialysis - Hemodialysis, peritoneal dialysis, continuous arteriovenous (CAVH) or venovenous (CVVH) hemofiltration + dialysis (CAVHD or CVVHD).

Biocompatibile dialyzer important to renal recovery

Correction of Hyperkalemia

Eliminate K+ intake

Antagonize K+ effect on ECG - Immediate effect