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Clinical manifestations of renal acute renal failure

2017-05-25 14:58

 

Acute tubular necrosis (ATN):

ATN caused by surgical treatment accounts for about 1/3 of ATN in elderly patients. Hypotension, fluid loss and arrhythmia during operation and after operation can lead to abnormal renal hemodynamics and cause ATN. Preoperative and postoperative positive fluid replacement, nutritional support and prevention and treatment of postoperative infection can significantly reduce the incidence of ATN in the elderly. In addition, infections, especially those caused by Gram negative bacteria, and septic shock are also common causes of ATN in the elderly. Elderly people prone to infection, clinically no fever, showed only weak, anorexia or confusion, therefore should be. Attention. In elderly patients with ischemic heart disease, chronic lung cancer, hypertension, diabetes, cancer, cerebrovascular disease, chronic renal failure and chronic liver disease, infection, arrhythmia, hemorrhagic shock, acute myocardial infarction and other factors can induce multiple organ failure, poor prognosis, if concurrent ARF mortality rate as high as 80%, so prevention is particularly important.

Acute interstitial nephritis (AIN):

Drug allergy is the most common cause of AIN, and NSAID related AIN is particularly evident in elderly people, with early renal biopsy and hormonal treatment rapidly restoring renal function.

Acute glomerulonephritis:

Different from the general population, acute glomerulonephritis is the major cause of ARF in the elderly, including acute infection. Nephritis for hypertension (82%), edema (73%), dyspnea and pulmonary congestion (41%) and (75%), less urine should be differentiated with congestive heart failure and the prognosis of young patients with the same, and rapidly progressive glomerulonephritis (RPGN) is the most common in the elderly ARF, and poor prognosis. The effect comparison of active immunosuppressive therapy for young people and the elderly RPGN, the treatment has a protective effect on renal function, but the relative risk of death in the elderly is still young people 5. 3 times. Early renal biopsy and began to impact the treatment of hormone and cytotoxic drugs can be used for elderly patients with RPGN, but the best solution to explore.

The most common cause of age among the elderly. Renal vascular disease caused by ARF is secondary to ACEI application. Renal artery embolization is a rare form of ARF and is usually associated with vascular sclerosis, atrial fibrillation, or myocardial infarction and has a poor prognosis. Recently, a large number of clinical studies have found that atherosclerotic plaque nephropathy is more prevalent in the elderly than in the imagination, with ARF within 1~4 weeks and progression to end-stage renal failure. Aggressive endovascular procedures should be avoided because of the lack of treatment. In addition, renal vasculitis is also an important cause of ARF in the elderly, but the clinical manifestations of the patients are more or less characteristic. Hormone and cytotoxic drugs can significantly improve the prognosis.

 

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