Physicians, however, prefer hemodialysis because of reimbursement trends (Wellbery).
Dietary Changes - Many patients also prefer peritoneal dialysis to hemodialysis because the latter restricts the diet (NKUDICC 2000). Peritoneal dialysis removes body wastes slowly but it always does. In hemodialysis, on the other hand, wastes can build up for two or three days between treatments. In addition, a patient on hemodialysis must observe a restrictive diet. Some clinics help plan the meals of patients undergoing peritoneal dialysis. Their dietitians can give advice on how to prepare more satisfying meals (NKUDICC).
Management and Implications - Managing acute renal failure begins with determining the cause (Agrawal and Swartz 2000). It includes a thorough history and physical examination, blood tests, urine studies and a renal ultrasound examination. Renal failure warrants supportive therapy to maintain fluid and electrolyte balances, reduce the production of nitrogenous wastes, and to sustain nutrition. Death is most frequently the result of an infection or cardio-respiratory complications. Acute renal failure happens to 5% of hospitalized patients, of whom 0.5% require dialysis. In the last decade, the survival rate has not improved because most patients are now older and have already developed enhancing health conditions. Of the causes of death, infection accounts for 75%. The second most common are cardio-respiratory complications. Their GFR goes down for days and weeks, reducing the excretion of nitrogenous wastes. Fluid and electrolyte balances can no longer be maintained. Most patients suffering from acute renal failure show no symptoms. It is diagnosed only by high levels of blood urea nitrogen or BUN and serum creatinine. Authorities define the condition as an acute increase of the serum creatinine level from baseline. Cephaloxporins and trimethoprim-sulfamethoxazole may also cause acute renal failure by simply inhibiting the tibular secretion of creatinine without damaging the kidneys. The BUN can also increase if a patient receives costicosteroids or if they have increased catabolism or gastrointestinal bleeding (Agrawal and Swartz).
Diagnostic Strategy and Differential - the standard approach is to first eliminate pre-renal and post-renal causes and then examine the potential renal etiologies (Agrawal and Swartz 2000). BUN and serum electrolyte, creatinine, calcium, phosphorus and albumin levels, and a complete blood with differential are all taken. The patient should also undergo the dipstick test, microscopy, sodium and creatinine levels and urine osmolality determination tests (Agrawal and Swartz).
Initial treatment should first correct fluid and electrolyte balances and uremia while the cause of acute renal failure is being determined (Agrawal and Swartz 2000). The patient is resuscitated with saline. Often, however, the problem of volume overload occurs. The first treatment to volume overload is furosemide administered intravenously every six hours at between 20 and 100 mg dose. It can be doubled and repeated. The final resort is ultrafiltration through dialysis. Main electrolyte problems may be hyperkalemia and acidosis. Treatment should be aggressive, depending on the degree of hyperkalamia. Calcium, intravenously administered, can reverse the cardio-protective and temporarily contains the neuromuscular effects of hyperkalemia (Agrawal and Swartz).
Acute renal failure can also render a patient's nutrition deficient (Agrawal and Swartz 2000). His total caloric intake should be between 30 and 45 kcal per kg per day. Most of the intake should cosist of carbohydrates and fats. If he is not on dialysis, his protein intake should be controlled at 0.6 g per kg per day. If he is on dialysis, his protein intake should be 1 to 1.5 g pr kg per day. Lastly, the physician should review all the patient's medications. The dosages should be adjusted according to the GFR, and the serum levels of medication. Records show that 20-60% of patients will need short-term dialysis, especially when the patient's BUN goes over 100 mg per dL and the serum creatinine level goes beyond the 5-10 mg per dL Indications for dialysis include acidosis or electrolyte disturbances. These disturbances do not respond to pharmacologic therapy, fluid overload, which does not respond to diuretics, and uremia. A patient who has progressive acute renal failure should see a nephrologist (Agrawal and Swartz).
Agrawal. M. And Swartz, R. (2000). Acute renal failure. 9 pages. American Family Physicians: American Academy of Family Physicians
Anderson, R.A. (2005). Renal failure: mortality and depression. 2 pages. Townsend Letter for Doctors and Patients: The Townsend Letter Group
Cannon, J.D. (2004). Recognizing chronic renal failure - the sooner, the better. 5 pages. Nursing: Springhouse Corporation
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