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ACUTE RENAL FAILURE

It means the acute deterioration the renal function. It is generally a toxic damages of the kidney. Damage may be resulted from drugs aminoglycosides, pencillin derivatives.
The other toxic damage of the kidney are resulted from radio graphic contrast dyes,
methanol, glycol, carbontetra chloride, heavy metals, formicacid, insecticides etc. The
toxicity leads to the precipitation of haemoglobin and mayoglobin which lead to the kidney failure.
The other common causes are haemorrage, loss of plasma in bones, diarrhea and other gastro intestinal causes of loss of water or electrolites, prolonged hypertension inflammation of blood or lymph vessels(anglitis) and malignant renal hardening (nephroscleroeis)

As a result of acute renal failure kidney appear slightly enlarged, Glomerular filtration is reduced. So urinary output is reduced. The first sign of acute renal failure is oliguria (diminished amount of urine) The patient will also show symptoms jugular veinous pressure, pedal edema, ascite (accumulation of serous fluidin the peritoniai cavity) and difficulty in breathing (dyspnea)and preliminary edema.

Blood urea and creatinine increase. Drowsiness, nausea, vomitting and excessive loss
of bicorbonate occur.. The condition may lead to cardiac arrest. The patients are more susceptible to infections.
Sodium should be avoided in the severe phase and potassium should be controlled.
Diet should contain 2000 ca!ories with only 18.20 gm protein in 24 hours.
The high blood pressure should be contained by diet restriction and if necessary by a
administering anti hypertensive drugs in case of severe anemia blood transfusions may be
required.

CHRONIC RENAL FAILURE
Chronic renal failure is due to the progressive destruction of nephrons. The renal failure continues for more than 6 months it is termed as chronic renal failure since the nephrons are destroyed the parenchyma shrink and the remaining nephrons are swollen. It is these nephrons that maintain the renal function. The urine volume becomes defective. The blood pressure goes up. The blood urea and creatinine increase and bi-corbonate may be reduced.
The common causes for chronic renal failure are chronic glomerulonephritis, infection
excessive use of analgesics and other drugs, hypertension, diabetic nephropathy gout,
amyloidosis, connective tissue diseases etc,

The usual symptoms that appear in chronic renal failure patients are fatigue,
insomnia.nausea, vomitting, peptic ulcer, anaemia, skin problems, bone problems, cardiac problems, red eyes, and breathing problems.

Water intake of the patients should be guided according to the ability of the kidney to
excrete water. Sodium and pottassium intake should be restricted. Bi-corbonate should
be supplemented. Adequate calories have to be provided by a diet containing carbohydrates
and fats. Protein intake should be restricted to 40gm a day or even 20gm a day incase of
uremia. In case of severe anaemia blood transfusion should be done.


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