ACUTE AZOTEMIA

ACUTE AZOTEMIA

1. Rapid increase of BUN and creatinine due to decreased GFR.

2. Types

   • Prerenal
     • Renal hypoperfusion.
     • Causes
       • Dehydration
       • Hemorrhage
       • Heart failure
       • Sepsis
   • Intrinsic
     • Renal parenchymal damage.
     • Causes
       • Acute tubular necrosis (ATN)
       • Glomerulonephritis
       • Interstitial nephritis
   • Postrenal
     • Urinary obstruction.
     • Causes
       • BPH
       • Nephrolithiasis
       • Tumors

3. Signs and Symptoms

   • Oliguria
   • Nausea
   • Vomiting
   • Fatigue
   • Edema
   • Flank pain
   • Altered mental status

4. Pathophysiology

   • Acute kidney injury
   • Decreased filtering capacity
   • Accumulation of nitrogenous waste products
     • Urea
     • Creatinine

5. Diagnosis

   • Increase creatinine
   • Increase BUN
   • Urinalysis
   • FeNa <1%
     • Prerrenal
   • FeNa >2%
     • Intrinsic
   • Renal ultrasound

6. Complications

   • Hyperkalemia
   • Metabolic acidosis
   • Fluid overload
   • Uremia
   • Arrhythmias

7. Treatment

   • Prerenal
     • IV fluids
     • Restore perfusion
   • Intrinsic
     • Supportive care
     • Avoid nephrotoxins
   • Postrenal
     • Relieve obstruction
     • Catheter or nephrostomy

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