ACUTE RENAL FAILURE

2. DEFINITION
Sudden reduction in renal function
Kidneys are unable toexcrete nitrogenouswaste
products
Pluswaterand electrolyte balance
Oliguric <400/m2/day
Non-oliguric
ARF in neonates<1ml/kg/hr

3. Classifications
Acuteversus chronic
Pre-renal, renal, post-renal
Anuric, oliguric, polyuric

4. Acute Chronic
1. sudden
onset.
2.Rapid
reduction
in urine
output
3.Usually
reversible
4.Tubularcell
death and
regeneration
1.Progressive
2.Not
reversible
3.Nephron
loss
4.75% of
function can
be lost before
its noticeable

6. PATHOGENESIS
PRE-RENAL;
Hypovolemia
Decreased GFR
Increased ADH, increased aldosterone, oliguria,
increased blood ureaand creatinine
If hypovolemiapersists, ATN

7. RENAL;
ATN
Renal vasoconstriction, tubular obstruction with
debris, passive back diffusionof glomerularfilterate
AcuteAGN of various types
Acute interstitial nephritis

8. POST-RENAL;
Obstructionof urinary tract
ATN and renal parenchymal damage

9. CLINICAL FEATURES
Oliguria, anuria
H/O vomiting, diarrhoea, fever
Signs of dehydration
Hemorrhage, nephrotoxicagent.
Weightgain
Peripheral oedema
Hypertension.

10. Physical examination
Rash; SLE, HSP
Flank masses; renal vein thrombosis
Uremia; anorexia, nausea, hypertention, fits.
Nausea/Vomiting
Pulmonaryedema
Ascites
Asterixis
Encephalopathy

11. INVESTIGATIONS
CBC
S/E
Blood urea, s.creatinine
Urine examination
Urine sodium>20mEq/L; intrinsic renal failure, urine
sodium<10mEq/L; pre-renal
C3 level
Metabolic acidosis

12. X-ray abd
IVP
MCUG
X-raychest
DTPA, DMSA
Renal biopsy

13. MANAGEMENT
GENERAL MEASURES;
IV line
Send investigations
BP
Intakeoutputrecord
Established renal failure; 400ml/m2/day
10% dextrose initially
300 calories/m2/day

14. Pre renal ARF
Fluid therapy;
Severedehydration;20ml/kg over ½ hr
Nooutput, lasix 2mg/kg
Dopamine infusion to improverenal perfusion
Renal failurewith fluid overload;
No IV fluid, only lasix, 2 doses
Peritoneal dialysis

16. MANAGEMENT OF
COMPLICATIONS
Hyperkalemia;
>6mEq/L
i. CaLCIUM
ii. soda bicarb,
iii. glucoseplus inulin,
iv. kayexalate

17. Acidosis;
ARF, catabolism, inability tosecrete hydrogen and
ammunia
Soda bicarb
Hypocalcemia;
Calciumgluconate
Hyponatremia;
Fluid overload, <120,3%NaCl

18. Hypertention;
Nifedipine, IV nitroprusside
Seizures;
Uremia, hypertention, hypocalcemia, hyponatremia
Diazepam
Infection; cathetrization, dialysis,
antibiotics

19. Anemia;
Packed cell
GI bleeding;
Cimetidine
DIALYSIS;
Peritoneal usually
Recovery phase;
diuresis

20. PROGNOSIS
Cause
Oliguria>3 wks, anuria, GAURDED
PRE-RENAL, HUS, ATN, good
B/L cortical necrosis, B/L renal vein thrombosis,
rapidly progressive GN; GAURDED