Acute injury of kidneys represents rather frequent pathology of intensive care units. Earlier given pathology carried the name of an acute renal failure, but the term existing now most fully defines an essence of this process. This tranzitorny injury of kidneys, that is is meant that in many cases adequate and timely treatment is capable to warn or minimize organ dysfunction. Nevertheless, acute injury of kidneys is also capable to lead also to a lethal outcome.
Acute injury of kidneys is determined by existence of certain criteria which the following is among:
● Increase in level of creatinine in serum on 26.5 µmol/l and more within 48 hours
● Increase in level of creatinine by 1.5 times and more (in comparison with the basic level measured or assumed in the last 7 days)
● the Level of a diuresis is less than 0.5 ml/kg/h within 6 hours
How classified earlier acute renal failure by the level of a diuresis, allocate acute injury of kidneys with the kept diuresis, with an oliguria and with an anury.
The reasons of acute injury of kidneys are divided into three big groups: prerenalny, renal and prerenal. The Prerenalny reasons include shock, a hypovolemia, liquid redistribution, decrease in inotropic function of heart. Renal reasons: toxic damages of kidneys, defeats of balls (glomerulonephritis), an acute canalicular necrosis owing to hemolysis, a rabdomioliz and other reasons, defeat of an interstitium (intersticial nephrite, effect of medicines).
The prerenal reasons are most often urological pathology - it is obstruction at the level of ureters or a bladder, or obstructive pathology at the level of an urethra.
Diagnostics of acute injury of kidneys is based on a research of the anamnesis, clinical data, laboratory and tool researches. It is necessary to understand that creatinine level cannot serve in blood serum as an early marker of acute injury of kidneys in view of the fact that its increase is observed only in day two after a renal failure. The best marker of function of kidneys on the present the glomerular filtration rate is considered. For its calculation use special formulas.
For the purpose of an exception of obstruction of urinary tract carry out ultrasonography of kidneys and a bladder. Ultrasonic dopplerography of vessels of kidneys can be executed. Monitoring when maintaining the patient with acute injury of kidneys includes control of indicators of a hemodynamics (noninvasive arterial blood pressure, heart rate, TsVD, if necessary use invasive monitoring of a hemodynamics), control of a diuresis, an ECG, a pulsoksimetriya, control of water and electrolytic balance.
Treatment of acute injury of kidneys first of all has to include cancellation of all nefrotoksichny medicines (if it allows a clinical situation). Non-steroidal anti-inflammatory drugs, some antibiotics, APF inhibitors, cytostatics and X-ray contrast means first of all belong to nefrotoksichny medicines. Carry out careful control of a diuresis, define the volemichesky status of the patient proceeding from what plan infusional therapy. It is necessary to limit use of synthetic colloids as they adversely influence renal function. It is the best of all to carry out nutritive support by an enteral way, resort to parenteral food only at impossibility to implement an enteral way. In the presence at the patient of an infection antibacterial drugs are appointed. If necessary carry out control of a glycemia. According to indications appoint replacement renal therapy.
Dopamine does not influence the frequency of permission of acute injury of kidneys therefore the recommended earlier "renal" doses of this drug do not use neither for treatment, nor for prevention of acute injury of kidneys now.
Concerning use of furosemide at acute injury of kidneys there is no consensus today. On the one hand, it allows to control better a water balance and to avoid an overload volume if the diuresis is kept and kidneys react to furosemide. On the other hand, administration of furosemide does not make sense at a full anury. Furosemide in itself makes an adverse effect on tubules of kidneys.
Timely diagnostics and treatment of complications of acute injury of kidneys, such as hyperpotassemia, metabolic acidosis, overload volume is extremely important, the fluid lungs also swelled a brain.