How to treat acute renal failure? Teach you four methods

1. Actively control the primary cause and remove reversible factors that aggravate acute kidney injury

Acute kidney injury should first be treated with corrective measures. Appropriate treatment should be given to various serious injuries, heart failure, acute blood loss, etc., including volume expansion, correction of hypovolemia, shock and infection control. Discontinue drugs that affect renal perfusion or are nephrotoxic. Be careful to adjust drug dosage and monitor serum drug levels if possible.

2. Maintain the body's water, electrolyte and acid-base balance

(1) Maintaining fluid balance During the oliguric phase, patients are prone to excessive water load, which can easily lead to pulmonary edema. In severe cases, cerebral edema may also occur. The patient's weight, blood pressure, and cardiopulmonary symptoms and signs should be closely monitored, and the patient's 24-hour fluid intake and output should be strictly calculated. Follow the principle of "living within your means" when rehydrating. Daily fluid replacement = sensible fluid loss + insensible fluid loss - endogenous water. If acute heart failure occurs, the most effective treatment is dialysis treatment as soon as possible.

(2) Correction of hyperkalemia: When the blood potassium exceeds 6.0 mmol/L, the heart rate and electrocardiogram should be closely monitored and emergency treatment should be given: 10% calcium gluconate should be slowly injected intravenously; 11.2% sodium lactate should be injected intravenously. For patients with metabolic acidosis, 5% sodium bicarbonate can be given intravenously; 25% glucose 200 ml plus regular insulin can be given intravenously; oral potassium-lowering resin drugs or potassium-excreting diuretics such as furosemide should be used to promote urinary potassium excretion. If the above measures are ineffective, start dialysis treatment as soon as possible.

(3) Correct metabolic acidosis. If HCO3- is lower than 15 mmol/L, 5% sodium bicarbonate intravenous drip can be used according to the situation. For patients with severe acidosis, dialysis treatment should be started immediately.

(4) Other electrolyte disorders: If weight is increased, sodium should be restricted; if sodium is normal, water should not be restricted. If symptoms of water intoxication such as disorientation, convulsions, and coma occur, hypertonic saline infusion or dialysis treatment can be given. No treatment is required for asymptomatic hypocalcemia. After acidosis is corrected, tetany often occurs due to a decrease in the free calcium concentration in the blood. 10% calcium gluconate can be diluted and injected intravenously.

3. Infection Control

Once signs of infection appear, effective antibiotics should be used actively for treatment. Drugs that are non-toxic or have low toxicity to the kidneys can be selected based on bacterial culture and drug sensitivity tests, and the dose can be adjusted according to eGFR.

4. Blood purification treatment

Blood purification plays a key role in the treatment of acute renal failure. Commonly used modes include three basic types: hemodialysis, hemofiltration and peritoneal dialysis. It has a good effect on correcting symptoms such as azotemia, heart failure, severe acidosis and encephalopathy. The application of continuous renal replacement therapy (CRRT) in recent years has greatly reduced its mortality rate.