Postrenal Failure Diagnosis

Postrenal Failure Diagnosis

The pediatrician must be alert to the possibility of renal obstruction. When a child presents with the signs of azotemia and a sudden decrease in urine output, the history and physical examination can help determine the location and cause of obstruction. The patient may have had frequent urinary tract infections, hematuria, trauma, underlying lesions, an alteration in the urinary pattern (decrease in urine stream, dribbling), and presence of lower abdominal or flank pain secondary to renal enlargement and dilatation of the collecting system. The physical examination may reveal a palpable suprapubic mass, such as in male newborns who have posterior urethral valves. This is the most common cause of postrenal failure in boys.

Rectal and gynecologic examinations should be done to exclude extrinsic causes of renal obstruction. The patency of the urinary tract must be established first in every patient who has Acute Renal Failure (ARF). Thus, in patients who have ARF, assessment by renal ultrasonography must include evaluation of the lower urinary tract and bladder.

Urinalysis can reveal microscopic or macroscopic hematuria with eumorphic (normal-appearing) red blood cells, pyuria in case of infection, crystals such as calcium oxalate in nephrolithiasis, or ethylene glycol intoxication. A plain abdominal radiograph can demonstrate radiopaque stones or an ileus secondary to colic, suggest abdominal masses, and provide data about bony structures. Renal ultrasonography can detect the pattern of hydronephrosis and sometimes the site of obstruction.



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Title Post: Postrenal Failure Diagnosis
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