Acute reversible intrinsic renal failure
Griffith, G.L.; Maull, K.I.; Coleman, C.; Baehler, R.W.
Surgery Gynecology and Obstetrics 146(4): 631-640
1978
ISSN/ISBN: 0039-6087 PMID: 345507 Document Number: 138905
Acute reversible intrinsic renal failure occurs in surgical patients after shock, trauma, operation, sepsis or any combination thereof and implies parenchymatous damage to the kidney. Widespread but random tubular necrosis with loss of the basement membrane is the common pathologic finding, yet similar focal tubular necrosis eludes verification in the experimental animal. Oliguria results in part from intrarenal tubular obstruction and depressed glomerular permeability, but the maintenance of impaired renal function is more complex, involving selective cortical ischemia, aberrations in the tubuloglomerular renin feedback mechanism and, most probably, prostaglandin deficiency. Diagnosis is established by examining the urine sediment and obtaining random urine tests for urine Na and urine to plasma ratios of osmolality, urea and creatinine concentrations. Failure to diurese in response to increasing doses of furosemide confirms the diagnosis, provided postrenal failure has been excluded. Early diagnosis is essential to prevent overhydration, K intoxication and metabolic acidosis. Other complications include sepsis, respiratory insufficiency, gastrointestinal bleeding and jaundice. Proper therapy requires prompt discontinuance of nephrotoxic drugs and the provision of parenterally administered essential amino acids with adequate caloric support. When supplemented by timely dialysis to control hydration, prevent hyperkalemia and hold the blood urea nitrogen level below 100 mg%, improved patient salvage should follow.