The retention of waste products is not as acutely life threatening as a fluid overload or hyperkalaemia.
Acute renal failure often results in a rapid accumulation of the products of nitrogen metabolism. Some conditions (e.g. acute renal failure following sepsis, trauma or major surgery) cause a rapid increase in accumulation of waste products. As above there is dietary restriction of protein, sodium and potassium (but with an adequate calorific input). Dialysis may be required for these patients.
A guideline for use of dialysis is if the blood urea exceeds 40 mmol per litre or the serum creatinine exceeds 800 mu mol per litre (although it is important to consider these criteria with respect to the size and relative muscle mass of the patient e.g. in a 80 kg 20 year old man a creatinine of 500 mu mol/l would not indicate need for dialysis, whereas in a 40 kg 70 year old female it might).
In renal failure in post surgical or trauma cases a strategy may be the early use of dialysis with a protein intake of about 70 g per day (adult) so to promote wound healing as well as manage the acute renal failure.
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