Renal Failure

Treatment & Management

The relief of obstruction is the main aim of treatment in this situation. When the underlying problem is bladder outlet obstruction then the problem needs to be corrected. In older male patients the problem is usually an enlarged prostate. This condition is also knows as benign prostate hyperplasia (BHP). Learn more about BHP at healthmad.com .

Insertion of a Foley or supra pubic catheter will usually relieve the obstruction temporarily. IF the underlying cause is bilateral renal calculi in one or both ureters then the calculi must be removed surgically or by other means. In some instances the insertion of bypass drainage tubes to drain urine from the kidneys through an opening in the skin may be necessary. These are called percutaneous nephrostomy tubes.

Complications of postrenal ARF

Treatment of urinary tract obstruction is often associated with a variety of undesired outcomes. These include, but are not limited to the following:

Haematuria: This may occur when a catheter is passed into the bladder. This is often the result of the sudden decrease in the internal bladder pressure. This decrease causes the bladder veins to bleed. Some studies show that slow decompression of the bladder does not prevent gross haematuria.

Reflex hypotension: Is another which condition which may occur, sometimes. This is the result of sudden stimulation of the vagus nerve during the process of catheter insertion.

Postobstructive diuresis: Occurs in some patients. This is a rare condition during which there is high urine output. Initially, it may be in excess of 500 to 1000 mls. each hour. This occurs when the obstruction is removed. In this situation it may be necessary to give IV fluids in large amounts to prevent severe dehydration and associated complications.

Prognosis: Long Term. The rate and amount of recovery is largely determined by the duration and severity of underlying obstructive disease. Most of the expected recovery will occur within 7 to 14 days after the obstruction has been removed. A few patients may require short-term dialysis until their renal function recovers. Hemodialysis involves removal of waste products from the blood via mechanical filtration outside of the body. This is a highly specialized skill which must be done in a hospital or a specialized renal unit.

Some patients with postrenal ARF will develop irreversible tubular defects with the following symptoms.

• Hyperkalemia: Elevated blood potassium.
• Metabolic acidosis: Elevated level of chlorides in the body.
• Polyuria: Excessive amounts of urine.

Table: Differences in Lab. Results for the three stages of ARF's.

Disclaimer: This article is for educational purposes only. It does not discuss all possible ramifications of ARF for all possible patient situations and conditions. It must not be used for treatment and management of ARF. Only medical practitioners are authorized to treat and manage ARF.

Key words used in this article: hyperkalemia, hypokalemia, metabolic acidosis, polyuria. Prerenal ARF, Intrarenal ARF, postrenal ARF, hemodialysis, dehydration, postobstructive diuresis, diuresis, vagus nerve, reflex hypotension, atheroembolism, oliguria, sepsis, toxins, flank pain, hydronephrosis, hypo volumia, circulatory overload, hyponatremia, hypernatremia, multiple organ failure, traumatic crush injury, Rhabdomyolysis, hyperphosphatemia, restriction of phosphates, hypocalcemia, calcium carbonate, calcium gluconate. hypermagnesemia, percutaneous nephrostomy.