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Acute Renal Failure Part 2
Alan B. Schwartz, MD, is professor of medicine at Drexel University College of Medicine where he is also director of continuing medical education. Here, he discusses the diagnosis of acute renal failure associated with oliguria and nonoliguric conditions. He emphasizes the value of urinalysis and reviews the pathogenesis of acute tubular necrosis … and comments on the benefits of ultrasound of the abdomen to demonstrate hydronephrosis and hydroureter. The lecture features a number of illustrative case presentations. Dr Schwartz notes that acute renal failure (ARN) can be grouped into three major categories—pre-renal; intra-renal, and post-renal—and he emphasizes the importance of the history and physical in arriving at a diagnosis. He discusses the oliguric response in normal subjects, and nonoliguric ARF. The author continues with six indications for dialysis and the six major chemical and physical properties to be looked for in the urinalysis of patients being evaluated for ARF. In addition, he discusses dehydration and the urinalysis of acute tubular necrosis (ATN) The prognosis for ATN has improved to a 50% recovery in two weeks and 90% in six weeks, and Dr Katz describes the role of the so-called Loop of Henley in this process. He goes on to discuss acute cortical necrosis, types of glomerulonephritis, and acute interstitial nephritis. In a review of acute postrenal failure, he notes that this is suspected from intrinsic lesions of the ureter, such as stones, clots, crystals and tumors. Lower urinary tract obstruction associated with bladder cancer, neurogenic bladder prostate disease and urethral stricture and fibrosis is included in the diagnosis of post renal failure ARF. The lecture concludes with a discussion and case histories of obstructive uropathy, anuric acute postrenal failure, and its examination by cystoscopic retrograde pyelogram. The lecture is composed of 39 boards and 17 illustrations slides. You must log in to view lectures. |
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