Clinical management of Acute Renal Failure in Uganda

Clinical Features

Oliguria (<1 ml/kg/hour), generalised oedema, hypertension, heart failure, lethargy, convulsions.

Investigations

Urine analysis (blood, proteins, casts), Urea, creatinine and electrolytes.

General Care

Treat underlying condition (e.g. dehydration). Monitor fluid input/output (Daily fluid = 10 ml/kg + total losses). Restrict salt (<2 g) and potassium.

Oliguria

Give Furosemide IV according to response (high doses may be necessary).

Failure to respond/Anuria

If anuria (<100 ml/24 hours) or worsening, refer to a hospital with facilities for peritoneal or haemodialysis immediately. Avoid nephrotoxic drugs (gentamicin).