Changes in Body Composition in Acute Renal Failure 1

Abstract

To a large degree the therapy of acute renal failure depends on an understanding of biochemical disturbances that result from the temporary absence of renal excretory and homeostatic functions. Important among these disturbances are changes in the volume and composition of body fluids, particularly with respect to electrolyte constituents. While certain manifestations of these changes are frequently recognized on the clinical level, relatively little quantitative data are available from which can be derived a general pattern of body fluid alterations in this disease. One reason for this paucity of information, aside from the limitations of investigative techniques, is the inherent difficulty of performing adequate studies on critically ill patients.Sirota and Kroop (1) observed in 4 oliguric patients an expansion of inulin space roughly commensurate with estimated positive fluid balance. They postulated that the oliguric phase of acute renal failure is associated with cellular dehydration resulting from a shift of water out of cells, and that hyponatremia may result in part from extracellular dilution and in part from a shift of sodium into cells. The observation by Schwartz, Tomsovic, and Schwartz (2) of greater expansion of inulin space than of D20 space in one anuric child would conform with this concept. Iseri, Batchelor, Boyle, and Myers (3) also suggested that the hyponatremia and hypochloremia of oliguria may be due in part to cellular uptake of sodium and shift of water from cells to extracellular fluid. The role of catabolism in augmenting total body water through water of oxidation and release of preformed water was evaluated by Hamburger and Richet (4), largely by inference from observations made during post-oliguric diuresis. Changes in the volume and distribution of body water were also studied in anuric dogs by Hamburger and Mathe (5), who found close agreement between the expansion of total body water as measured by D20 spaces and the amount of water derived from metabolic processes. On the basis of extensive clinical observation and a limited number of isotopic dilution studies, Merrill (6) has enumerated some of the fluid and electrolyte changes frequently seen in prolonged acute renal failure, as follows: 1) an increase in total body water, 2) an increase in total body sodium with a decreasing serum concentration, 3) a decrease in total body potassium with an elevated serum level, and 4) an increased extracellular fluid volume.The primary purpose of the present study was to obtain more complete information

The management of acute reversible intrinsic renal failure

“…This was sufficient to prevent weight loss and gradually produced overhydration with development of hyponatraemia (Loughridge et al, 1960). This overhydration explains early reports of increased extracellular fluid volume in uraemic patients (Sirota & Kroop, 1951;Bluemle et al, 1956).…”

“…Studies in patients with renal failure have given contradictory results. Gj0rup (1958) showed an apparent relationship between carbohydrate intake and protein-sparing but Bluemle et al (1956) and Taylor (1957) could not confirm this. More recently Parsons & Fore (1963) have shown that with sufficient carbohydrate intake increased protein-sparing can occur even in patients with severe catabolic response following injury.…”

“…This is partly replaced by water of oxidation from tissue metabolism (300 ml) and pre-formed tissue water liberated during metabolism (125 ml) leaving some 500 ml to be supplied daily by fluid and dietary intake (Bluemle, Potter & Elkinton, 1956). Early regimens, such as that of Bull, Joekes & Lowe (1949), recommended a fluid intake of 800-1000 ml daily.…”

Clinical Review : Acute Renal Failure in Children: Principles of Management

“…In the absence of demonstrable sodium losses, hyponatremia in the early stages of acute renal failure almost invariably results in body water dilution from excessive fluid therapv, increased endogenous water production, or both. 19 That is why prompt salt and water restriction is indicated, to combat impending congestive heart failure.…”

Hemolytic Transfusion Reactions Causing Acute Renal Failure

“…per 24 hours in the average-sized adult. 19 If these measures are unsuccessful, one can assume that persisting oliguria reflects obstructive tubular damage. Therapy for more prolonged renal failure, given according to well-established guidelines/8'29-22 is indicated.…”