By Michael Boulton-Jones MB, B.CHIR, MRCP (auth.)
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Additional info for Acute and Chronic Renal Failure
This patient had taken an overdose of paracelamol. Plate 4. Chronic renal failure. Typical skin colouring. Plate 5. Itching is common in chronic renal failure and scratching never quite relieves it although it may cause extensive damage to the skin. Plate 6. Chronic renal failure. This patient had to give up football because of the deformity. He had played for a Celtic Junior Team until eight weeks before the photograph was taken. Plate 7. Needles in position during dialysis. The tortuous veins on the forearm are a consequence of the creation of a Cimino fistula.
The disease appears to be self-limiting, the patient being left with severe renal failure and hypertension. Therefore regular dialysis treatment can be successful, although nephrectomy may be required to control hypertension. Glomerulonephritis Both acute exudative (or post-streptococcal) glomerulonephritis and rapidly progressive (or crescentic) glomerulonephritis are associated with ARF. The kidney may be the only organ involved, or it may be part of a more generalized illness such as occurs in systemic lupus erythematosus, polyarteritis nodosa, Wegener's granulomatosis, Henoch-Schonlein purpura or Goodpasture's syndrome.
Peritoneal dialysis is usually appropriate and, if malignant obstruction is considered, the first peritoneal effluent fluid should be sent for cytological examination. Postobstruction Diuresis Following relief of acute obstruction, a diuresis of several Iitres may occur in the first 24 hours. Sodium and potassium losses are large. Therefore, an intravenous infusion should be set up at the time of the operation and accurate hourly fluid charts kept. The urinary sodium and potassium concentration should be measured, and an appropriate replacement regimen prescribed.
Acute and Chronic Renal Failure by Michael Boulton-Jones MB, B.CHIR, MRCP (auth.)