Renal system

Renal insufficiency may result from an absolute decrease in renal blood flow and/or a change in distribution from cortex to medulla. There is a fall in glomerular filtration rate with an increase in plasma urea and creatinine, and urine output falls below 0.5 ml/kg/h. Repeated biochemical analysis and accurate measurement of urine flow by catheterization are required. Plasma electrolytes, particularly potassium, should be followed closely. Plasma-to-urine ratios of urea, creatinine, sodium, and osmolality can be helpful in distinguishing primarily prerenal failure from renal failure. Because of constantly changing conditions, frequent investigations of creatinine clearance or glomerular filtration rate may not be very helpful. Ultrasound visualization of the kidneys provides information on size, echogenicity, and ureteric dilation; this can suggest previous renal disease, parenchymal disease, or obstructed urine flow.

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