Renal Failure

Kumud P Mehta
Renal Failure - Investigations
Investigations in a case of ARF is done on emergency basis to detect life threatening situations like hyperkalemia, pulmonary edema, acidosis. BUN, serum creatinine , serum sodium, potassium, blood pH, bicarbonate, serum calcium, phosphorus, alkaline phosphatase, urine examination, ECG to detect cardiac arrhythmia due to hyperkalemia, x-ray chest for diagnosis of pulmonary edema and cardiomegaly are needed. Although oliguria i.e. urine output less than 1ml/kg/day with increase in level of BUN > 20 mg/dl and serum creatinine > 1.5 mg/dl are hallmarks of diagnosis of ARF, before starting the treatment the above mentioned investigations are necessary for diagnosis of complications and to decide the indications of dialysis if conservative treatment fails. For the diagnosis of cause of ARF, clinical manifestations combined with special tests like ASO titer and serum C3 levels(for diagnosis of acute poststreptococcal glomerulonephritis); ANA, anti-dss DNA(for lupus); peripheral smear for burr cells &platelet count and coagulation studies (for diagnosis of HUS/TTP) and G-6-PD level are required. Rarely kidney biopsy may be indicated for final diagnosis of ARF to diagnose crescentic glomerulonephritis, MPGN, IgA nephropathy or lupus nephritis. Kidney biopsy is only indicated if cause of ARF is not evident by clinical, biochemical or radiological investigations.

As regards chronic renal failure, the same tests are recommended. Ultrasonography is used to assess the size of kidney (small kidney- poor outcome). In addition x-ray of hands for diagnosis of renal bone disease and hematological investigations including serum ferritin levels for diagnosis of anemia due to erythropoietin deficiency are required. GFR estimation using standard endogenous creatinine clearance test or Schwartz's formula

GFR= (k x Height in cm)/Plasma creatinine
'k' is a constant which differs with age. The above formula gives accurate measurement of renal function.

Renal Failure Renal Failure 01/10/2001
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