How the diagnosis of acute renal failure?

Acute renal failure - (ARF) refers to a variety of reasons led to a sharp decline in kidney function, resulting in a series of metabolites of retention, water and electrolyte disorders, such as acid-base balance the performance of a clinical syndrome. ARF currently accepted standards for the diagnosis: a few days to several weeks glomerular filtration sexual function was a sharp decline in serum creatinine increase daily 44-88 umol / L (0.5-1.0mg/dl). Where any clinical encounter with a azotemia and sexual increase, in consultation before the ARF, first of all to exclude chronic renal failure and chronic renal insufficiency based on the role of certain incentives to the rapid deterioration of kidney function , For ABF and ambiguous history of chronic renal failure of the identification of type-B ultrasonic examination at this time kidney size (especially renal cortical thickness) and serum creatinine (3-4 to reflect on before serum creatinine level) tests Would be helpful. Increased or renal normal, normal creatinine nail for acute renal failure, renal or normal narrow, nail creatinine levels increased, compared with chronic renal failure. Besides calcium, phosphorus, metabolic disorders, anemia extent also for reference. ARF diagnosis after the establishment - is its focus on diagnosis, including kidney ago, after the kidney and renal substance of three categories. The former refers to the kidney renal insufficiency and kidney effectively reduce blood volume caused ARF; organic but has not yet led to kidney disease. After the kidney and urinary tract obstruction that caused the ARF. Renal tubular substantive means of various diseases, interstitial renal tubules small vascular lesions caused by ARF. At this point should be based on more detailed history and physical examination, urine test, blood biochemical and imaging examination, and other comprehensive judgement, clear as early as possible causes. After the kidney of the ARF shall first row, in particular the absence of renal ischemia and history of exposure to toxic kidney patients. Medical examination on the bladder is filling, and imaging examination. (Including B-ultrasound, CT and abdominal plain film), and so help to determine whether there after the kidney of the ARF. Before the ARF kidney and renal of substantive ARF (especially that of acute renal necrosis) in the differential diagnosis index based on urine tests and rehydration. Kidney ago of a blood volume are often inadequate or do not take heart function, Niaobi Chong ≥ 1.18, urinary sodium <2> 40, renal failure index <1,> 40 mEq / L, urine osmolality <400> 1, Urinary sodium excretion scores of> 1. Of course, these indicators are not absolute. Shitomae not stay in the use of drugs such as diuretics and mannitol, otherwise interfere with the results. Shock individual patients can not collect urine, can be measured to support the identification of central venous pressure, kidney before those of less than 0.49 kPa, and renal substantive ARF, normal or high. Clinical difficult to identify substantive kidney and renal of the former, to be careful rehydration 500-1000 ml, if the blood volume of patients has been corrected, and normal blood pressure and urine output is still small, azotemia no improvement in the support of renal ARF. Except in the kidney and kidney after the previous offerings of the ARF. After considering for renal ARF, acute renal tubular necrosis substantive ARF is the most common causes. Kidney qualitative ARF process by lesions can be divided into four types: renal disease (such as acute renal necrosis), renal disease (such as drug allergies acute interstitial nephritis), glomerular diseases (such as severe Acute nephritis, radical nephritis) and renal disease: (such as kidney vasculitis and microvascular disease). Then it is necessary to ascertain whether the ARF kidney substantive secondary to systemic diseases such as lupus nephritis, Purpura nephritis, which helps correct and timely treatment. Of unknown etiology, renal function can not explain the reasons for the sharp decline in patients confirmed to have no obvious bleeding tendencies such as contraindications are advised to visit renal biopsy, which is the diagnosis and differential diagnosis of the most reliable method. In addition to ARF diagnosis but also to carry out sub-type, mainly referring to kidney substantive ARF. In accordance with changes in urine can be divided into oliguria ARF-00 ml/24h) and non-oliguric type (> 400 ml/24h); metabolic basis of the situation at "high catabolism" and "non-high-catabolism" ARF, the former principal Characterized by blood urea nitrogen increased more than 14.3 mmol L-1 .. d_1 serum creatinine increase greater than 177 um0L. l.d_1, potassium increased more than 1-2 mmol. L.d_1, plasma HCq-dropped more than 2,5 nanol.L.d_1, which do not meet the above criteria. Decomposition of high-ARF to active use of alternative treatment, such as the continuous replacement therapy, arteriovenous hemofiltration, rather than the election of peritoneal dialysis, this type of treatment to choose.