Emergency care in acute renal failure

Management of complications and general tactics

In patients over 18 years of age, emergency therapy aims at the immediate elimination of life-threatening conditions. All complications are divided into two main groups:

• Surgical: require immediate emergency intervention. These include acute intestinal obstruction, internal bleeding, and perforation of hollow organs.
• Therapeutic: include correction of water and electrolyte disturbances, treatment of concurrent infectious processes, and adequate pain management.

This approach has a recommendation validity level of B (LEL 5).

Algorithm for involving multidisciplinary specialists

In the event of severe conditions, comorbid pathology, or suspected complications, the algorithm requires emergency consultations by subspecialists:

1. Anesthesiologist-intensivist: called no later than 30 minutes from the moment of the patient's admission to the hospital. The main goal is to determine indications for the emergency transfer of the patient to the intensive care unit (ICU). This is particularly relevant in severe and complicated courses of viral hepatitis or other urgent conditions.
2. Surgeon: consultation is indicated upon the appearance of intense abdominal pain, a sharp drop in blood pressure (hypotension), and the development of hemorrhagic syndrome for the timely detection of acute gastrointestinal pathology.
3. Neurologist: engaged to provide specialized care in the event of encephalopathy (e.g., hepatic encephalopathy against the background of acute liver failure).

In all cases of suspected infectious etiology of the lesion (e.g., acute viral hepatitis), strict differential diagnosis with diseases presenting with jaundice syndrome is recommended.

ARF in the structure of hemorrhagic fever with renal syndrome

Acute renal failure and the development of uremia are the leading and most dangerous syndromes in hemorrhagic fever with renal syndrome (HFRS). Under modern conditions, a pathomorphosis of the infection is noted: the disease runs significantly more severely, and the frequency of ARF and infectious-toxic shock (ITS) is steadily increasing.

The physician must be able to purposefully collect the history morbi and epidemiological history, as well as conduct a physical examination to identify the following specific complications:

• Infectious-toxic shock.
• Massive hemorrhage.
• Acute renal failure and uremia.
• Spontaneous rupture of the renal capsule.
• Acute pituitary insufficiency.

A critical aspect of theoretical preparation is understanding the essence of these complications from the standpoint of pathogenesis. The physician is required to know strict indications for hemodialysis, be able to analyze biochemical tests, and apply emergency care algorithms.

Therapeutic complications: electrolyte disorders

In severe water and electrolyte shifts accompanying renal pathology, hypocalcemic (spasmophilic) syndrome may develop. The clinical picture is characterized by increased neuromuscular excitability and hyperreflexia.

Specific manifestations of muscle spasms:

• Face: eyelid twitching, contraction of facial muscles.
• Upper extremities: flexion posture of the hand in the "obstetrician's hand" position.
• Lower extremities: plantar flexion of the feet with a predominance of extensor tone.
• Visceral manifestations: smooth muscle spasm (bronchospasm, renal colic) and life-threatening laryngospasm capable of leading to acute respiratory failure and asphyxia.

The most severe variant is the eclamptic form with generalized tonic-clonic seizures and loss of consciousness, requiring measures as in status epilepticus.

Class and exam questions

What else to study on this topic

• Pathogenesis and development of infectious-toxic shock in HFRS
• Algorithm for the differential diagnosis of diseases with jaundice syndrome
• Strict clinical and laboratory indications for hemodialysis
• Emergency care for spontaneous rupture of the renal capsule
• Provision of care for the eclamptic form of status epilepticus

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.