Acute renal failure or acute kidney failure a condition in which the kidneys suddenly cant filter waste from the blood.

2. ACUTE RENAL FAILURE
PRESENTED BY:-
Mr. JITENDRA KUMAR DAS
Msc NURSING 1ST YEAR
College of Nursing , VIMSAR, BURLA
Sambalpur

3.  Kidney failure or renal failure is the partial
or complete impairment of kidney function.
It results in an ability to excrete metabolic
waste products and water.
 Renal failure can be acute, with sudden
onset of symptom, or chronic, occurring
gradually over time.
 Once renal failure occurs, it requires
immediate management and treatment.

4.  Acute renal failure/acute kidney failure/acute
kidney injury occurs when the kidneys
suddenly become unable to filter waste
products from blood and unable to maintain
fluid and electrolyte balance in the body.
 It usually marked by decreased glomerular
filtration rate (GRF), increase concentrations
of blood urea nitrogen (BUN), and creatinine
and the urine output is less than 400ml per
day(oliguria).

6.  Three categories of causes can lead to acute renal failure.
 Prerenal failure:-
 prerenal failure is the most common type of acute renal
failure(60%-70% of all cases).
 Prerenal (before the kidney) failure is associated with a
condition that slows blood flow to the kidneys.
 Prerenal failure can be caused by the following condition:-
 Blood or fluid loss due to dehydration, diarrhea, vomiting,
hemorrhage, burn, excessive use of diuretics.
 Decrease cardiac output from heart disease such as
myocardial infarction, congestive heart failure, heart attack.
 If the blood vessel carrying blood to the kidneys is blocked
or get constricted.
 Liver failure.

7.  Intrarenal(inside structured of kidney) failure:-
 It is the structural damage to the kidney or to the
glomeruli, kidney tubules and nephrons in side
kidney.
 Disease and conditions that damage the kidneys and
may lead to acute kidney failure include:-
 Prolonged renal ischemia.
 Blood clots or cholesterol deposits in the veins and
arteries in and around the kidneys.
 Infection- glomerulonephritis, pyelonephritis
 Hemolytic uremic syndrome(HUS)
 Medication such as certain chemotherapy drugs,
antibiotics and dyes used during imaging tests.

8.  Postrenal failure:-
 Postrenal (after the kidney) failure is a condition the
block the passage of urine out of the body (urinary
obstructions) and can lead to acute kidney injury
include:-
 Kidney stone
 Cancer of the urinary tract organs or structures near
the urinary tract
 Bladder stone
 Enlarged prostate
 Blood clot
 Bladder cancer
 Urethral obstruction

9.  Acute kidney failure almost always occurs in
connection with another medical condition or event.
Conditions that increase risk of acute kidney failure
include:-
 Being hospitalized, especially for a serious condition
that requires intensive care.
 Advanced age
 Blockage in the blood vessels in arms or legs
 Diabetes
 High blood pressure
 Heart failure
 Kidney disease
 Liver disease

10. Sudden and complite loss of kidney
functions
Sodium and fluid retention which leads to
edema
Damaged tubules cannot coserve sodium normally which
activates renin angiotension- aldosterone system.
Failure of renal circulation and glomerular or
tubular dysfunction
Due to etiologycal factor such as prerenal,
intrarenal and post renal failure

11. ACUTE RENAL FAILURE (ARF)
Increase circulatory over load and sodium
retention
Increase serum creatinine, BUN level and
retention of other metabolic waste
Oliguria
Sudden and complete loss of kidney
functions

12.  The following symptom may occur with acute
kidney failure. Some people have no symptoms, in
the early stage-
 Decrease urine output, although occasionally
urine output remains normal.
 Fluid retention, causing swelling in your legs,
ankles and feet.
 Patient may appear critically ill or lethargic.
 Dark colored urine.
 Skin and mucous membrane are dry from
dehydration.
 Anemia and platelet dysfunction.

13.  Oligurea or anuria.
 Shortness of breath.
 Feeling dizzy when standup.
 Cardiac problem such as tachycardia and
dysrhythmia.
 Fluid electrolyte imbalance- fluid overload,
hyperkalemia, hyponatremia, hypocalcaemia and
hypermagnesemia.
 Drowsiness, confusion
 Seizure and coma

14.  History and physical evaluation
 Urine output measurement
 Urine test- decrease amount of sodium in urine
and high potassium level
 Blood test- shows elevated blood urea nitrogen
(BUN), Serum creatinine and potassium levels,
also shows decrease level of hemoglobin levels
and Ph.
 Imaging tests- ultrasonography , KUB
radiography, renal scan, CT
 Kidney biopsy

15.  Fluid buildup- ARF may lead to a
buildup of fluid in the lungs, which
can cause shortness of breath
 Chest pain
 Muscle weakness
 Permanent kidney damage
 Death

16.  ARF is often difficult to predict or
prevent. But may reduce the risk of
ARF by taking care of the kidneys.
 Regular consultation with the doctors
who are having diabetes or high blood
pressure.
 Make a healthy life style.

17.  Treatment for acute kidney failure involves
identifying the illness or injury that originally
damaged kidneys.
 Once the cause is found, the goal of treatment is
to correct or treat the cause of kidney failure,
restore kidney function and prevent fluid and
waste from building up in the body while the
kidneys heal and prevent or treat any
complications caused by acute renal failure.

18.  Drugs are used to reduce the blood pressure
(antihypertensive); diuretics (drug that increase
urine output) are used in some cases to
increase blood flow unless oliguria is present.
Low dose dopamine (1-3g/kg) is often used to
dilate the renal arteries.
 Sodium polystyrene sulfonate (kayexalate);
cation- exchange resins orally or by retention
enema is administered to reduce elevated
potassium level (hyperkalemia).

19.  Calcium or glucose/insulin will be given
through a vein to help avoid dangerious
increases in blood potassium level.
 Administered intravenous sodium bicarbonate
for more sever hyperkalemia symptoms and for
the correction of acidosis and elevated
phosphate level.
 Antibiotic may be needed to treat associated
infection (predominantly only antibiotic
excreted by the lever are used if there is no
liver disease.

20.  Fluid replacement must be done very carefully to avoid
fluid overload and dehydration.
 Accurate measurement of urine output is essential to
prevent volume of overload.
 Intravenous solutions must be carefully selected
according to the patient’s fluid and electrolyte status.
 Treat hyperkalemia with glucose and insulin, calcium
gluconate, sodium polystyrene sulfonate or dialysis.
 Replace lost fluids, such as water , blood, and plasma,
and restore blood flow to the kidneys.
 In case of prerenal ARF caused by dehydration or blood
loss, for example, kidney function may quickly return to
normal after fluid and blood level are corrected.

21.  A high calorie diet that’s low in protein, sodium
and potassium is usually prescribed to meet
the metabolic needs of a patient in renal
failure.
 Potassium intake usually restricted to 40 to 60
mEq/day and sodium is usually restricted to 2
g/day.
 Low –potassium food include apples, cabbage,
carrots, green beans, grapes and strawberries.

22.  If the patient’s kidneys
do not respond to
treatment, and
adequate kidney
function dose not
return, they will need to
undergo dialysis.
 Dialysis is a process
used to remove fluid
and uremic waste
products from the body
when the kidneys are
unable to do so.

23.  Measure and record intake and output, including body
fluids, such as wound drainage, nasogastric output
and diarrhea. Weight the patient daily.
 Measure blood pressure at various times during the
day with patients in supine, sitting, and standing
positions.
 Monitor BUN, creatinine, and electrolyte. Monitor ABG
levels as necessary to evaluate acid base balance.
Watch for symptoms of hyperkalemia and ecg
change.
 Follow strict aseptic technique while caring for patient
with renal failure because patient is highly susceptible
to infection.

24.  Watch for cardiac dysrhythmias and heart failure
from hyperkalemia, electrolyte imbalance, or fluid
overload. Have resuscitation equipment available
in case of cardiac arrest.
 If the patient requires hemodialysis, check the
blood access site every 2 hours for patency and
signs of clotting. Weight the patient before
dialysis.
 During dialysis monitor vital signs, clotting time,
blood flow, function of the vascular access site
and arterial and venous pressure.

25. 1.Excess fluid volume related to renal failure
evidenced by oliguria, tissue edema, and weight
gain.
 Intervention:-
 Accurately record intake and output chart.
 Monitor urine specific gravity.
 Weight daily at same time of day on same scale.
 Assess skin, face, dependent area for edema.
 Auscultate lung and heart sounds.

26. 2.Imbalance nutrition less thyan body requirements
related to protein catabolism, dietary restriction as
evidenced by weakness and weight change.
 Intervention:-
 Assess and document dietary intake.
 Provide frequent, small feedings.
 Weight daily.
 Provide high calorie, low to moderate protein diet.
 Maintain proper electrolyte balance by strictly
monitoring levels.

27. 3.Risk for infection related to invasive procedures,
as evidenced by high temperature.
 Intervention:-
 If possible avoid invasive procedures.
 Use aseptic technique when caring and
manipulating IV and invasive lines.
 Provide routine catheter care.
 Monitor vital signs.
 Monitor WBC count.

28. 4.Knowledge deficiency related to lack of exposure
evidenced by questioning for information.
 Intervention:-
 Explain the renal function.
 Discuss renal dialysis or transplantation if these
are likely options for the future.
 Answer the patient questioning politely about the
disease condition.

30.  The topic ARF is summarized by introduction,
definition, etiology, risk factors,
pathophysiology, clinical manifestation,
diagnostic evaluation, complication, prevention,
medical management, nursing management,
nursing diagnosis.

31.  Administration of mesenchymal stem cells (MSCs)
improves recovery of acute kidney injury (AKI).
Result:-
 They found that MSC-MV are able to stimulate in
vitro proliferation and apoptosis resistance of
TEC. In additional, microvesicle(MVs) were found
to accelerate in vivothe morphological and
functional recovery of AKI by inducing tubular cell
proliferation.

32. What is AKI, write down the
etiology and management
of ARF?

33. From this topic we gain the
knowledge about ARF/AKI/AKF. And
understand about the treatments of
ARF. And know the nurses role of
ARF and can manage a ARF
patient.

34.  Brunner and Suddarth’s.(2016), Text book of medical
surgical nursing; 12th edition: publish by. Lippincott Williums
and wilkins, page no.
 Javed Ansari and Davinden kaur.(2011), Text book of
medical surgical nursing volume-ii; 1st edition: publish by pee
vee, page no. 427-430
 Lewis.Bucher, Heitkempeer, Harding, Kwong.(2017),
Roberts medical surgical nursing, assessment and
management of clinical problems; 3rd south asia edition:
publish by RELX India pvt.ltd , new delhi; page no. 657-666
 https://en.wikipedia.org/wiki/ARF
 https://www.mayoclinic.org/diseases-conditions/kidney-
failure/symptoms-causes/syc