| Theme |
Recent Advances in Acute Renal Failure: pathogenesis and treatment |
| Title |
Management of diuretic phase and consideration of when to stop dialysis therapy in acute renal failure |
| Author |
Fumi Takemoto |
Kidney Center, Toranomon Hospital |
| Author |
Shunya Uchida |
Teikyo University Hospital |
| [ Summary ] |
Renal (parenchymal) type acute renal failure is synonymous with acute tubular necrosis where major damage is confined to the tubules. In this setting, oliguria and azotemia ensue but after a certain period of time diuresis generally begins, leading to recovery from azotemia or acute renal failure. The mechanism underlying the occurrence of diuresis is ascribed to the recovery of damaged renal tubules, resulting in amelioration of back-diffusion and unplugging the clogged debris, which finally elicits the improvement of the decreased glomerular filtration rate. In case of polyuria, 1/2 to 1/4 saline replacement may be given to avoid dehydration. The amount of water and potassium should be carefully monitored by calculating the daily balance. It is advisable to withdraw dialysis therapy when the pre-dialysis serum creatinine shows no increase from the previous end-dialysis value. |