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Correction of life threatening complications
Electrolyte disorders
Hyperkalemia
Acidosis
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