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Acute renal failure

  • Prerenal ddx (FENa < 1)

    • hypovolemia, hypotension, shock, DIC, CHF
  • Renal ddx (proteinuria)

    • glomerulonephritis, vasculitis, interstitial nephritis (NSAIDs, nafcillin, pyelonephritis), ATN (aminoglycosides, prolonged ischemia)
  • Postrenal ddx (hydronephrosis)

    • obstruction, tumor, BPH, PUV, catheter kink
  • Admission orders

    • Admit: Telemetry Floor
    • Diagnosis: Acute Renal Failure
    • Condition: Guarded
    • Vital Signs: Routine, orthostatic vitals q shift
    • Allergies:
    • Nursing:
      • Place Foley catheter (check for kinks if one already in)
      • Strict I/Os
      • Daily weights
    • Diet: Renal Diet (low Na, K, PO4)
    • Activity: As tolerated
    • Labs:
      • CBC, Chem
      • Ca, Mg, PO4
      • UA with microscopy
      • urine Na and creatinine; FENa = UNa x PCr / (PNa x UCr) x 100
      • Renal ultrasound
    • IV: if hypovolemia, NS 250 mL/h for 3 hours, then reassess
    • Special: Renal consult RE hemodialysis
    • Medications:
      • Phosphate binders for high PO4
    • Call HO: UO < 200 mL/shift, O2 sat < 92
  • Discharge

    • Education: Renal diet, weigh daily, call if gains 3-4 lbs (volume overload)

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