Renal Failure View Full Chapter Figures Only Tables Only Videos Only Print Share Email Send Email Your Name (required) ! Example: John Doe Email Address (required) ! Please enter a valid sender email address. Example: firstname.lastname@example.org CC Me Recipient Email Address (required) ! Separate multiple email address with semi-colons (up to 5). Subject Subject for your email. Message (Maximum characters: 1,000) Please enter your name Please enter your email address Please enter a valid recipient email address. Example:email@example.com Thank you! Your email has been sent to: The recipient(s) will receive an email message that includes a link to the selected article. Recipients may need to check their spam filters or confirm that the address is safe. Return to: Send Another Email An error has occurred sending your email(s). Please try again later or contact an administrator at OnlineCustomer_Service@mheducation.com. Return to: Twitter Facebook Linkedin Reddit Get Citation Citation AMA Citation Renal Failure. In: Doherty GM. Doherty G.M. Ed. Gerard M. Doherty.eds. Quick Answers Surgery New York, NY: McGraw-Hill; 2010. http://accesssurgery.mhmedical.com/content.aspx?bookid=853§ionid=49662265. Accessed November 23, 2017. MLA Citation . "Renal Failure." Quick Answers Surgery Doherty GM. Doherty G.M. Ed. Gerard M. Doherty. New York, NY: McGraw-Hill, 2010, http://accesssurgery.mhmedical.com/content.aspx?bookid=853§ionid=49662265. Download citation file: RIS (Zotero) EndNote BibTex Medlars ProCite RefWorks Reference Manager Mendeley © Copyright Tools Search Book Top Return Clip Autosuggest Results + Essential Features Print Section + • Oliguric (urinary output < 400 mL/d) and nonoliguric• Mortality in surgical ICU of 50-90%• Etiologies of parenchymal disease include:-Acute tubular necrosis-Pigment nephropathy-Nephrotoxic agents-Acute rejection following transplantation-Prerenal and postrenal causes + Clinical Findings Print Section ++ Symptoms and Signs + • Diminished urinary output• Altered mental status• Abdominal pain• Edema• Prolonged bleeding time secondary to platelet dysfunction• Tenderness over transplant allograft• Hypertension ++ Laboratory Findings + • Elevated creatinine• Hyperkalemia• Hyperphosphatemia• Elevated blood urea nitrogen• Urine osmolarity isotonic with serum levels• Urine sodium > 40• Fractional excretion of sodium > 3%• Hyponatremia• Hypocalcemia• Metabolic acidosis• Anemia ++ Imaging Findings + • Renal US: Shows dampened waveform in arterial thrombosis or diastolic reversal of flow in venous obstruction or allograft rejection post-transplantation + Diagnostic Considerations Print Section + • Duration since transplantation• Underlying critical illness in acute renal failure ++ Rule Out + • Renal artery or vein thrombosis immediately post-transplant• Ureter obstruction or leak post-transplant + Work-up Print Section + • History and physical exam• Serum and urine creatinine• Serum and urine sodium• Serum potassium• Serum phosphate• Renal US + Treatment and Management Print Section ++ Surgery ++ Indications + • Removal of allograft if hyperacute rejection ++ Medications + • Optimization of cardiac output• Diuresis and renal replacement therapy (intermittent hemodialysis, continuous venovenous hemofiltration and dialysis if hemodynamically unstable)• Adequate nutrition• Treatment of underlying disease• Pulse corticosteroids and/or OKT3 for acute allograft rejection ++ Prognosis + • 50-90% mortality (highest if oliguric)• 90% recover renal function if survive underlying inciting illness (recovery unlikely if > 6 weeks postresolution of illness) ++ Prevention + • Avoidance of nephrotoxic agents and maintain organ perfusion in critically ill• Adequate immunosuppression and compliance post-renal transplant + Resources Print Section ++ References ++Zacharias M. et al. Interventions for protecting renal function in the perioperative period. Cochrane Database of Systematic Reviews. 2008. (4):CD003590. ++Rabindranath K. Adams J. Macleod AM. Muirhead N. Intermittent versus continuous renal replacement therapy for acute renal failure in adults. Cochrane Database of Systematic Reviews 2007. (3):CD003773.