Examination with edema

Swelling of the lungs with renal failure. Examination with renal failure.

With pulmonary edema, there is dyspnea. common wheezing in the lungs, wheezingrespiration and hypoxemia. On the chest X-ray, diffuse alveolar darkening is defined in the lower parts of the lungs. Development of pulmonary edema with OPN is accelerated with concomitant diseases of the heart, therefore the ECG and echocardiography should be included in the examination plan.
• Give the patient a sitting position andprovide a supply of 35-60% oxygen through the mask, maintaining a saturation> 90%. If the effectiveness of oxygen therapy is inadequate, consider using a system with a constant positive pressure. Intubation and artificial ventilation of the lungs can be shown with refractory hypoxemia: discuss this issue with the reanimatologist.
• Intravenously slowly, inject 5-10 mg of morphine (or 2.5-5 mg of diamorphine) to reduce the distress syndrome.

• Use an intravenous infusion of 100 mg furosemidewithin 60 minutes. In the absence of a significant increase in diuresis in response to the administration of furosemide (<500 ml for 4 hours), renal replacement therapy is necessary.
• With severe pulmonary edema before hemodialysis or hemofiltration, bleeding in a volume of 100-200 ml can be made.

What is the probable cause of acute renal failure?

• In most patients, the cause of OPN can be identified on the basis of clinical examination, urinalysis and ultrasound of the urinary tract.
• ARVs developed in a hospital environment are often the result of a combination of factors such as hypovolemia, arterial hypotension, sepsis, and the use of nephrotoxic drugs.

Clinical examination.
It is necessary to pay attention to the following points:
Anamnesis (analyze the medical history, surveillance data, the list of prescriptions, the chart of accounting for the injected and discharged liquid).
- Was there anuria, oliguria or polyuria? Anuria is observed with severe arterial hypotension or complete obstruction of the urinary tract. More rare causes of anuria are bilateral occlusion of the renal arteries (for example, with aortic dissection), necrosis of the cortical layer of the kidneys or necrotizing glomerulonephritis.

- Whether the arterial pressure was normal, low or high; if low, then for how long?
- Is hypovolemia possible? Whether there was bleeding, vomiting, diarrhea. Whether there was a surgical intervention or diuretics were taken recently?
- Is it possible to sepsis? What are the results of the sowing of blood, urine and other body fluids?
- Is there a history of kidney disease orurinary tract? Based on the results of previous biochemical studies, estimate how long the function of the kidneys remained normal? How long has a kidney dysfunction?

- Is there a history of heart disease with heart failure, arterial hypertension or atherosclerosis of peripheral arteries (often there is atherosclerotic stenosis of the renal arteries)?
- Is there a liver disease (hepatorenal syndrome)?
- Is there diabetes or other systemic disease with possible kidney damage? Do not forget about such causes of kidney failure as infective endocarditis and myeloma.
- Has renal failure developed after catheterization of the femoral artery (risk of atheroembolism of renal vessels)?
- Has the patient been exposed to nephrotoxic drugs (including contrast agents) or poisons? Think about the possibility of professional poisoning.

Physical examination.
• Level of consciousness, body temperature, pulse, blood pressure, breathing rate, saturation.
• Signs of dehydration (tachycardia, lowpressure in the jugular veins with their collapse, arterial or orthostatic hypotension) or fluid overload (swelling of the jugular veins, additional cardiac tones, arterial hypertension, wheezing in the lungs, effusion in the pleural cavities, ascites, peripheral edema).
• Presence of pericardial friction noise (uremic pericarditis is an indication for renal replacement therapy).

• Palpation of the abdomen (including the kidney and bladder) and rectal examination (to evaluate the prostate and exclude pelvic neoplasm).
• Peripheral pulse.
• Purple (ARF with purple can be observed whensepsis complicated by DIC syndrome; meningococcal sepsis; thrombotic thrombocytopenic purpura; hemolytic-uremic syndrome, hemorrhagic vasculitis [purpura Shenlaine-Genocha] and other vasculitis).
• Jaundice (arthritis with jaundice may occur whenhepatorenal syndrome; poisoning with paracetamol; severe congestive heart failure; severe sepsis; leptospirosis; transfusion of incompatible blood; hemolytic-uremic syndrome).