{"id":1914,"date":"2010-09-19T13:10:00","date_gmt":"2010-09-19T18:10:00","guid":{"rendered":"http:\/\/medicinainterna.com.mx\/2010\/09\/19\/criterios-diagnosticos-de-fracaso-renal-agudo"},"modified":"2010-09-19T13:10:00","modified_gmt":"2010-09-19T18:10:00","slug":"criterios-diagnosticos-de-fracaso-renal-agudo","status":"publish","type":"post","link":"https:\/\/medicinainterna.com.mx\/?p=1914","title":{"rendered":"Criterios diagn\u00f3sticos de fracaso renal agudo."},"content":{"rendered":"
\u00a0<\/h5>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
\n

Causas de FRA<\/b><\/p>\n<\/td>\n

\n

Signos cl\u00ednicos<\/b><\/p>\n<\/td>\n

\n

Sedimento<\/b><\/p>\n<\/td>\n

\n

Confirmaci\u00f3n<\/b><\/p>\n<\/td>\n<\/tr>\n

\n

FRA prerrenal (70%) <\/p>\n<\/td>\n

\n

Signos de depleci\u00f3n de volumen o de depleci\u00f3n del volumen circulante eficaz <\/p>\n<\/td>\n

\n

Cilindros hialinos, FeNa <1%, NaU 1018 <\/p>\n<\/td>\n

\n

Puede necesitar monitorizaci\u00f3n hemodin\u00e1mica. R\u00e1pida resoluci\u00f3n al restaurar perfusi\u00f3n<\/p>\n<\/td>\n<\/tr>\n

\n

FRA intr\u00ednseco (25%)<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

1. Grandes vasos renales:<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

1.1. Trombosis de la arteria renal<\/p>\n<\/td>\n

\n

FA o IAM reciente, n\u00e1useas, v\u00f3mitos, dolor abdominal o lumbar.<\/p>\n<\/td>\n

\n

Proteinuria leve, a veces hemat\u00edes<\/p>\n<\/td>\n

\n

Transaminasas normales, LDH alta. Arteriograf\u00eda renal<\/p>\n<\/td>\n<\/tr>\n

\n

1.2. Atero\/ embolismo<\/p>\n<\/td>\n

\n

Intervenci\u00f3n a\u00f3rtica reciente, >50 a\u00f1os, placas retinianas, n\u00f3dulos subcut\u00e1neos, p\u00farpura palpable, l\u00edvedo reticularis, vasculopat\u00eda, HTA<\/p>\n<\/td>\n

\n

Normal, sin cilindros, a veces eosinofiluria<\/p>\n<\/td>\n

\n

Eosinofilia, biopsia cut\u00e1nea y renal, hipocomplementemia<\/p>\n<\/td>\n<\/tr>\n

\n

1.3. Trombosis venosa renal<\/p>\n<\/td>\n

\n

S\u00edndrome nefr\u00f3tico o embolismo pulmonar, dolor lumbar<\/p>\n<\/td>\n

\n

Proteinuria, hematuria<\/p>\n<\/td>\n

\n

Venograf\u00eda de cava inferior y vena renal selectiva<\/p>\n<\/td>\n<\/tr>\n

\n

2. Peque\u00f1os vasos y glom\u00e9rulo:<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

2.1. Vasculitis\/ glomerulonefritis<\/p>\n<\/td>\n

\n

Enfermedad multisist\u00e9mica o cl\u00ednica compatible<\/p>\n<\/td>\n

\n

Cilindros hem\u00e1ticos o granulosos, hemat\u00edes dism\u00f3rficos, proteinuria<\/p>\n<\/td>\n

\n

C3, ANCA, anti-MBG, AAN, ASO, crioglobulinas anti-ADN, biopsia renal<\/p>\n<\/td>\n<\/tr>\n

\n

2.2. SHU\/PTT<\/p>\n<\/td>\n

\n

Cl\u00ednica compatible, fiebre, palidez, equ\u00edmosis, alteraciones neurol\u00f3gicas<\/p>\n<\/td>\n

\n

Normal o hemat\u00edes o proteinuria leve. Raro cilindros hem\u00e1ticos o granulosos<\/p>\n<\/td>\n

\n

Anemia, trombocitopenia, esquistocitosis, LDH aumentada, biopsia renal<\/p>\n<\/td>\n<\/tr>\n

\n

2.3. HTA maligna<\/p>\n<\/td>\n

\n

HTA severa, cefalea, ICC, retinopat\u00eda, disfunci\u00f3n neurol\u00f3gica, papiledema<\/p>\n<\/td>\n

\n

Hemat\u00edes, cilindros hem\u00e1ticos, proteinuria<\/p>\n<\/td>\n

\n

HVI, resoluci\u00f3n con control de TA<\/p>\n<\/td>\n<\/tr>\n

\n

3. NTA:<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

3.1. Isqu\u00e9mica<\/p>\n<\/td>\n

\n

Hemorragia reciente, hipotensi\u00f3n, cirug\u00eda mayor, quemaduras<\/p>\n<\/td>\n

\n

Cilindros granulosos o epiteliales marrones, Fe Na > 1%, NaU >20, densidad 1010<\/p>\n<\/td>\n

\n

Son suficientes cl\u00ednica y an\u00e1lisis de orina<\/p>\n<\/td>\n<\/tr>\n

\n

3.2. Toxinas ex\u00f3genas<\/p>\n<\/td>\n

\n

Contraste radiol\u00f3gico reciente, antibi\u00f3ticos nefrot\u00f3xicos o antineopl\u00e1sicos, con o sin depleci\u00f3n de volumen, sepsis o FRC<\/p>\n<\/td>\n

\n

Cilindros granulosos o epiteliales marrones, Fe Na > 1%, NaU >10, densidad 1010<\/p>\n<\/td>\n

\n

Son suficientes cl\u00ednica y an\u00e1lisis de orina<\/p>\n<\/td>\n<\/tr>\n

\n

3.3. Toxinas end\u00f3genas<\/p>\n<\/td>\n

\n

1. Antecedentes de rabdomiolisis <\/p>\n

2. Antecedentes de hem\u00f3lisis <\/p>\n

3. Antecedentes de lisis tumoral (a), mieloma (b) o ingesti\u00f3n de etilenglicol (c)<\/p>\n<\/td>\n

\n

Sobrenadante rosado, + para hemo <\/p>\n

Sobrenadante rosado, + para hemo <\/p>\n

Cristales de urato (a), proteinuria (b), o cristales de oxalato (c)<\/p>\n<\/td>\n

\n

HiperK+, hiperCa++, hiperP, aumento de mioglobinemia, CPK MM y \u00e1cido \u00farico <\/p>\n

HiperK+, hiperCa++, hiperP, hiperuricemia, plasma rosado + para hemoglobina <\/p>\n

HiperK+, hiperuricemia, y (a) hiperP, (b) paraprote\u00edna urinaria o circulante o (c) estudio toxicol\u00f3gico, acidosis hiato osmolar<\/p>\n<\/td>\n<\/tr>\n

\n

4. E. T\u00fabulo\/ intersticiales agudas:<\/p>\n<\/td>\n

\u00a0<\/td>\n\u00a0<\/td>\n\u00a0<\/td>\n<\/tr>\n
\n

4.1. Nefritis intersticial al\u00e9rgica<\/p>\n<\/td>\n

\n

Ingesti\u00f3n reciente de f\u00e1rmacos, fiebre, rash o artralgias<\/p>\n<\/td>\n

\n

Cilindros leucocitarios, leucocitos, hemat\u00edes, proteinuria<\/p>\n<\/td>\n

\n

Eosinofilia sist\u00e9mica, biopsia cut\u00e1nea de la erupci\u00f3n, biopsia renal<\/p>\n<\/td>\n<\/tr>\n

\n

4.2. Pielonefritis bilateral aguda <\/p>\n<\/td>\n

\n

Dolor lumbar, pu\u00f1opercusi\u00f3n +, estado t\u00f3xico y febril <\/p>\n<\/td>\n

\n

Leucocitos, hemat\u00edes, proteinuria, bacteriuria <\/p>\n<\/td>\n

\n

Urocultivo, hemocultivos<\/p>\n<\/td>\n<\/tr>\n

\n

FRA postrrenal (5%) <\/p>\n<\/td>\n

\n

Dolor abdominal o lumbar, vejiga palpable <\/p>\n<\/td>\n

\n

Normal o hematuria sin cilindros ni proteinuria <\/p>\n<\/td>\n

\n

Radiograf\u00eda simple, ecograf\u00eda renal, pielograf\u00eda,TAC<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

FRA: <\/b>fracaso renal agudo; FeNa: <\/b>fracci\u00f3n de excreci\u00f3n de sodio; NaU:<\/b> concentraci\u00f3n de sodio urinario; FA:<\/b> fibrilaci\u00f3n auricular; IAM:<\/b> infarto agudo de miocardio; LDH: <\/b>deshidrogenasa l\u00e1ctica; HTA: <\/b>hipertensi\u00f3n arteria\u00f1, C3:<\/b> fracci\u00f3n 3 del complemento, ANCA: <\/b>anticuerpos contra el citoplasma de los neutr\u00f3filos, anti-MBG<\/b>: anticuerpos antimembrana basal del glom\u00e9rulo; AAN:<\/b> anticuerpos antinucleares; ASO:<\/b> antiestreptolisinas; ADN:<\/b> \u00e1cido desoxirribonucleico; SHU\/PTT:<\/b> s\u00edndrome hemol\u00edtico ur\u00e9mico\/ p\u00farpura tromb\u00f3tica trombocitop\u00e9nica; ICC:<\/b> insuficiencia card\u00edaca congestiva, HVI:<\/b> hipertrofia de ventr\u00edculo izquierdo; TA:<\/b> presi\u00f3n arterial; NTA:<\/b> necrosis tubular aguda; FRC:<\/b> fracaso renal cr\u00f3nico; hiperK+:<\/b> hiperkaliemia; hiperCa++:<\/b> hipercalcemia; hiperP:<\/b> hiperfosforemia; CPK MM:<\/b> fracci\u00f3n muscular de la creat\u00edn fosfokinasa; TAC: <\/b>tomograf\u00eda axial computerizada.<\/p>\n

Fuente: Brady HR, Singer GG. Acute renal failure. Lancet 1995; 346: 1533-1540.<\/p>\n

<\/div>\n","protected":false},"excerpt":{"rendered":"

\u00a0 Causas de FRA Signos cl\u00ednicos Sedimento Confirmaci\u00f3n FRA prerrenal (70%) Signos de depleci\u00f3n de volumen o de depleci\u00f3n del volumen circulante eficaz Cilindros hialinos, FeNa <1%, NaU 1018 Puede necesitar monitorizaci\u00f3n hemodin\u00e1mica. R\u00e1pida resoluci\u00f3n al restaurar perfusi\u00f3n FRA intr\u00ednseco (25%) \u00a0 \u00a0 \u00a0 1. Grandes vasos renales: \u00a0 \u00a0 \u00a0 1.1. Trombosis de la … Continue reading “Criterios diagn\u00f3sticos de fracaso renal agudo.”<\/span><\/a><\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[13],"tags":[],"class_list":["post-1914","post","type-post","status-publish","format-standard","hentry","category-nefrologia"],"jetpack_sharing_enabled":true,"jetpack_featured_media_url":"","_links":{"self":[{"href":"https:\/\/medicinainterna.com.mx\/index.php?rest_route=\/wp\/v2\/posts\/1914","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicinainterna.com.mx\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicinainterna.com.mx\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicinainterna.com.mx\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/medicinainterna.com.mx\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1914"}],"version-history":[{"count":0,"href":"https:\/\/medicinainterna.com.mx\/index.php?rest_route=\/wp\/v2\/posts\/1914\/revisions"}],"wp:attachment":[{"href":"https:\/\/medicinainterna.com.mx\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1914"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicinainterna.com.mx\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1914"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicinainterna.com.mx\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1914"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}