Acute Renal Failure

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Acute renal failure its definition, medical management, nursing management, considerations.

Acute renal failure its definition, medical management, nursing management, considerations.

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  • 1. Acute Renal Failure Presented by: Dave Jay S. Manriquez RN.
  • 2. Renal Failure
    • Acute
    • Chronic
    “ Acute renal failure is a medical emergency characterised by a rapid deterioration in renal function (GFR) over a period of hours-days. It is often reversible”
  • 3. Epidemiology
    • ARF accounts for 1% hospital admissions
    • ARF complicates ~7% inpatient episodes
    • Mortality from ARF
        • 5-10% in uncomplicated cases
        • 50-70% in severe cases (sepsis or need for dialysis)
  • 4. Presentations
    • Often no signs or symptoms
    • Oliguria
    • “ At risk” groups
        • Elderly
        • Hospital patients
        • Severely ill
        • Patients with chronic renal disease, diabetes or hypertension
    • ↑ serum creatinine and urea
  • 5. Assessment
    • History & Examination, lab results, imaging
    • ARF v. CRF
        • CRF more likely if °acute illness, long duration of symptoms, previously ↑creatinine, anaemia.
    • Obstruction?
        • Previous hx of calculi, prostate symptoms, intra-abdominal mass, palpable bladder
  • 6. Assessment II
    • Is patient euvolaemic?
    • Renal parenchymal disease?
        • Urine dipstick & microscopy
        • NSAIDs or Abx
    • Major vessel occlusion?
  • 7. Causes
    • Pre-renal 40-70%
    • Renal 10-50%
    • Post-renal (obstruction) 10%
  • 8. Causes – pre-renal
    • Due to ↓ renal perfusion
      • Hypovolaemia
        • Blood loss: haemorrhage
        • Fluid loss: D&V, burns
      • Hypoperfusion
        • Drugs: NSAIDs or ACEi
        • Vascular: AAA or renal artery stenosis
      • Hypotension (shock, sepsis)
      • Cardiac failure
  • 9. Causes - renal
    • **Acute Tubular Necrosis**
        • Ischaemia,, nephrotoxic drugs, radio-contrast media
    • Interstitial nephritis
        • Drugs: NSAIDs, contrast media
        • Infection, granuloma, infiltration
    • Glomerular disease
        • Inflammatory
        • Thrombotic
    • Vascular
        • Vasculitis, PAN…
  • 10. Causes - renal
  • 11. Causes – post-renal
    • Urinary outflow obstruction
        • Prostatic symptoms
        • Intra-abdominal malignancy
        • Renal calculi (intra-luminal)
        • Strictures and tumours (intramural)
  • 12. Management
    • Speak to nephrologist
        • No specific treatment of ARF (mainly supportive)
            • Dopamine
            • Insulin-like growth factor
            • Natriuretic peptides
        • Treat shock (but don’t fluid overload)
        • Treat sepsis
        • Exclude obstruction – catheter, USS
        • Stop nephrotoxic drugs, NSAIDs, aminoglycosides, ACEi…
        • Regular monitoring of fluid balance/weight
        • Consider dialysis for uraemic patients
  • 13. Complications
    • Hyperkalaemia
        • IV insulin and glucose
        • IV calcium
    • Metabolic acidosis
    • Pulmonary oedema
        • Oxygen
        • Furosemide
  • 14. Questions?
    • References:
      • OHCM
      • “ Acute renal failure” Rachel Hilton
    • BMJ 2006;333;786-790