Supportive care and specific therapy to prerenal azotemia

And the second group of treatment includes inotropic agents. And we know there are a cup of choice including dopamine, dobutamine. And dopamine you may need to consider for renal vasodilation dosage. So renal dosing is good for this group of patients with ARF. And dobutamine yet actually has inotropic effects and no truly effects to further help kidney. And other supportive treatments are most important thing as treated those patients fluid status and those electrolytes and the acid-base balance. So determine the patient’s fluid status by the CVP or calculate their urine output and total by their urine output and extra renal losses and see if their total intake is enough or not and provides adequate fluid. That’s very important.

And also electrolyte balance and that’s a very big lesson though for patient with ARF. And for nutrition and nutrition because the patient is the actually under hypercatabolic status. So the patient may actually has significant weight loss during this time and we usually very careful about treating a patient, but if the patient has no adequate nutrition, they couldn’t fight by themself alone. So have a dietician to help and checking those nutrition status for those group patient is also very important. So you don’t want to have those patient actually losing weight quickly during the time with ARF and we did not provide anything to help them. So there was actually a disaster for a patient.

So but when we are provide nutrition, we don’t want to provide too much protein or too much sodium. So and also the patient may have a fundamental issue about phosphorus and the electrolytes So having a dietician to help is important. So let’s review some specific therapy for each different type of ARF. For patient with the pre-renal azotemia that top of issue is replaced their fluid loss. So for those patient with no reason of fluid loss from hemorrhage you probably need to provide an packed red blood cell. And or some with plasma loss, isotonic saline is enough.

And for patient with the GI loss hypotonic solution is important And for those patient with a acites, paracentesis or sometimes with their peritoneojugular shunt are very important to actually reallocated those fluids interspace. And for those patient with prerenal azotemia some of patient need to have a fluid challenge. especially for those patient without volume overload. And so 500 to one liter normal saline with the furosemide and sometimes as some other diuretics are important to help those patients to softly issue of renal blood flow. So after fluid challenge those healthy actually healthy kidney will actually recover. And for those patient with cardia failure inotropic agent with the dose for cardiac failure is important.