MSc nursing Tulsi Dhidhi Government college of nursing Rajnandgaon Chhattisgarh

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Acute Renal
Failure

2. Table of Content
 What is Acute Renal Failure?
 Pathophysiology
 Statistics and Incidences
 Types of Acute Renal Failure
 Causes
 Phases
 Symptoms
 Diagnosis and Treatment
 Prevention
 Complications

3. What is Acute Renal Failure?
Renal failure results when the kidneys cannot remove
the body’s metabolic wastes or perform their regulatory
functions.
 Acute renal failure (ARF) is a rapid loss of renal
function due to damage to the kidneys.
 Acute renal failure is also known today as acute
kidney injury (AKI).
 It is a problem seen in hospitalized patients and
those in outpatient settings.
 A healthy adult eating a normal diet needs a
minimum daily urine output of approximately 400 ml
to excrete the body’s waste products through the
kidneys. An amount lower than this indicates a
decreased GFR.

4. Pathophysiology
 Underlying problems. There are underlying
problems that cause the development of ARF such
as hypovolemia, hypotension, reduced cardiac
output and failure, and obstruction of the kidney.
 Blood flow. As these underlying problems affect the
body, the blood flow to the kidneys reduces.
 Decreased kidney function. With inadequate blood
flow to the kidney, there is impaired kidney function.
 Failure. If the underlying conditions are not treated
and corrected, they can lead to permanent damage
of the kidneys,

5. Statistics and Incidences
 ARF affects approximately 1% of patients on
admission to the hospital, 2% to 5% during the
hospital stay, 4% to 15% after
cardiopulmonary bypass surgery, and 10% of
cases acute renal failure occurs in isolation
(i.e. single organ failure).
 In the United States, the annual incidence of
acute renal failure is 100 cases for every
million people. It’s diagnosed in 1% of hospital
admissions. Hospital-acquired acute renal
failure occurs in 4% of all admitted patients
and 20% of patients who are admitted to
critical care units.

6. Types of Acute Renal Failure

7. Types of Acute Renal Failure
Prerenal
 Prerenal failure is caused by interference
with renal perfusion (e.g., blood volume
depletion, volume shifts [“third-space”
sequestration of fluid], or excessive/too-
rapid volume expansion), manifested by
decreased glomerular filtration rate (GFR).
 Disorders that lead to prerenal failure
include cardiogenic shock, heart failure
(HF), myocardial infarction (MI), burns,
trauma, hemorrhage, septic or anaphylactic
shock, and renal artery obstruction.

8. Types of Acute Renal Failure
Renal (or intrarenal)
 Intrarenal causes for renal failure are
associated with parenchymal changes caused
by ischemia or nephrotoxic substances.
 Acute tubular necrosis (ATN) accounts for
90% of cases of acute oliguria.
 Destruction of tubular epithelial cells results
from (1) ischemia/hypoperfusion (similar to
prerenal hypoperfusion except that correction
of the causative factor may be followed by
continued oliguria for up to 30 days) and/or (2)
direct damage from nephrotoxins.

9. Types of Acute Renal Failure
Postrenal
 Postrenal failure occurs as the result of an
obstruction in the urinary tract anywhere
from the tubules to the urethral meatus.
 Obstruction most commonly occurs with
stones in the ureters, bladder, or urethra;
however, trauma, edema associated with
infection, prostate enlargement, and
strictures also cause postrenal failure

11. Phases
 Initiation. The initiation period begins with the
initial insult, and ends when oliguria develops.
 Oliguria. The oliguria period is accompanied
by an increase in the serum concentration of
substances usually excreted by kidneys.
 Diuresis. The diuresis period is marked by a
gradual increase in urine output, which signals
that glomerular filtration has started to recover.
 Recovery. The recovery period signals the
improvement of renal function and may take 3
to 12 months.

12. Symptoms

13. Diagnosis
 blood urea nitrogen (BUN)
 serum potassium
 serum sodium
 estimated glomerular filtration rate
(eGFR)
 urinalysis
 creatinine clearance
 serum creatinine

15. Prevention
 Hydration. Provide adequate hydration to patients at risk
for dehydration.
 Shock. Prevent and treat shock promptly with blood and
fluid replacement.
 Close monitoring. Monitor central venous and arterial
pressures and hourly urine output of critically ill patients to
detect the onset of renal failure as early as possible.
 Blood administration. Take precautions to ensure that
the appropriate blood is administered to the correct
patient in order to avoid severe transfusion reactions.
 Infections. Prevent and treat infections promptly because
they can produce progressive renal damage.

16. Complications
Depending on the duration and severity of
ARF, a wide range of potentially life-
threatening complications can occur.
 Metabolic acidosis. Waste products could
not be eliminated by the kidneys and they
can contribute to metabolic acidosis.
 Fluid and electrolyte imbalances.
Imbalances may occur due to hemorrhage,
renal losses, and gastrointestinal losses.

17. References
 Google.com
 Wikipedia.org
 Studymafia.org
 Slidespanda.com

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