Prerenal Failure Diagnosis

Prerenal Failure Diagnosis

The patient who has prerenal failure will evidence the signs and symptoms of decreased effective blood volume or perfusion. There may be a history of vomiting, diarrhea, recent febrile illness, surgery, imbalance between input and output, heart problems, thirst, weight loss, or decrease in urine output. Signs of moderate or severe dehydration (hypotension, tachycardia, decreased skin turgor, dry mucous membrane, oliguria/ anuria) or of congestive heart failure (hepatomegaly, pulmonary edema, peripheral edema, gallop) may be present.

Laboratory studies will demonstrate hemoconcentration with an increase in hematocrit, uric acid, and total protein and a markedly elevated BUN. The BUN/SCr ratio usually is more than 20. Urinalysis will show a trace to + 1 protein, and sediment usually is normal, but hyaline and fine granular casts may be present as well. Urinary indices will reflect a maximally concentrated urine (specific gravity >1.016 to 1.030, urine osmolality >400 mOsm per kg H2O), preserved tubular integrity (urine/ plasma osmolality ratio > 1.5, urine/ plasma creatinine ratio >40, urine/ plasma urea ratio >20), and salt conservation (urine sodium <720 mEq/L, FENA <1%). In the case of metabolic alkalosis, a spot urine chloride of less than 20 mEq/L usually indicates perserved tubular function.

The chest radiograph may evidence signs of heart failure. Findings on renal ultrasonography usually are non specific, and kidney size is normal.


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Title Post: Prerenal Failure Diagnosis
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