ARF pathophysiology and treatment

1. ACUTE RENAL
FAILURE
Dr. ROSE VEEDON

2. DEFINITION
Acute renal failure is characterised by a sudden
and usually reversible deterioration of renal
function leading to an accumulation of
metabolic waste product, blood, urea
creatinine

3. RISK FACTORS
• Advanced age
• Diabetes
• High blood pressure
• Heart failure
• Renal disease
• Liver disease

4. CAUSES OF ARF
• Acute tubular necrosis(necrosis of the tubular
cells)
• Severe/sudden dehydration
• Toxic kidney injury from poisons or certain
medications
• Auto immune kidney disease(lupus nephritis)
• Urinary tract obstruction

5. SYMPTOMS
• Vomiting
• Diarrhoea
• Naussea
• Weight loss
• Noctural urination
• Pale urine
• Less frequent urination
• Difficulty in urinating
• Itching
• Abnormal heart rhythms
• Muscle paralysis

6. • Pedal edema
• Difficulty in concentration
• Memory problems
• Dizziness
• Anorexia
• Seizure(Due to high nitrogen levels in blood)
• Shortness of breath

7. • Prerenal
 Naussea
 Vomiting
 Bad taste in mouth
 Tachycardia
 Oliguria (Small amount of urine)
 Fatigue
 Dry mucous membrane

8. • Intrarenal
 Fever
 Skin rash
 Edema
 Headache
 Anorexia(Loss of apetite)
 Vomiting
 Oliguria/Anuria(failure of kidney to produce
urine)/Nocturia(urination during night)

9. • Post renal
Difficulty in voiding (difficulty to empty
bladder)
Change in urine flow
Pain during urination

10. PATHOPHYSIOLOGY
• Pre renal (prior to the kidney)
Affects the blood flow before it reaches the kidney
 dehydration (vomiting ,diarrhoea, blood loss)
 blockage or narrowing of blood vessel carrying
blood to kidney
Disruption of blood flow to kidney (major surgery
with blood loss, severe injury of the blood stream)
Heart failure
Liver failure (causing changes in hormone that
affect blood flow and pressure to kidney)

11. Sudden decrease in blood flow to nephron
ischaemia
decreased GFR/ functional disorders

12. • Intra renal(inside the kidney)
Characterised by disease of renal tissue
 Renal problems
 Blood vessel diseases of arteries and arterioles
with in the kidney (glomerulonephritis,
pyelonephritis)
 Blood clot in a vessel in the kidney(vascular
obstruction)
 Injury to kidney tissue and cells

13. • Post renal (out side the kidney)
Obstruction of the flow of urine anywhere
along the renal tract
Becuase of the tumour of bladder, renal
calculi(stones), uretral stone, cysts.

14. COMPLICATIONS
• HYPERKALAEMIA(Arrhythmia)
• MUSCLE WEAKNESS, PARALYSIS
• PULMONARY EDEMA

15. DIAGNOSIS
Most of the times CRF is identified during investigation for some other
medical problems or during routine checkup
 Family history
 Drug history
 Social history
 History of CRF usually include
 long period of polyuria, nocturia, uraemia, lethargy, breathlessness,
anorexia ,naussea
 Anaemia
 Excruciating itch
 Poor sleep patterns
 Lack of concentrations
 Pigmented skin

16. Serum craetinine
Urine anlysis
Renal function tests

17. PATIENT COUNSELLING POINTS
• Sodium intake should be reduced
• Potassium containing should be restricted
• Protein restricted diet should be maintained
• High energy intake up to 2000-3000 kcal
• Proper carbohydrate diet

18. MEDICAL MANAGEMENT
• To relieve the symptoms
• Correcting fluid and electrolyte balance

19. DIURETICS
• High dose of furosemifde helps maintain
urinary output but dose not have any impact on
the survival and renal recovery rate of patients.
Class : LOOP DIURETIC
Dose : 20-80mg PO OD increased to 20-40
mg BD
ADR : Hyperurecaemia, Hypokalaemia

20. • Torsemide has a longer duration of action and
does not accumulate
Class : LOOP DIURETIC
Dose : 20 mg IV OD/PO initially doubled
until desired diuretic effect is acheived
ADR : Headache, excessive urination
• Ethacrynic acid inhibits symport of sodium,
potassium, chloride primarily in the ascending
limb of henle, proximal and distal tubules.
Dose : 0.5-1 mg /kg up to 100 mg /dose , slow
IV

21. ACE INHIBITORS
• As hypertension causes damage to intrarenal
vasculature and results in thickening of the walls
of arterioles , control of BP is essential
• This damage reduces renal perfusion leading to
stimulation of rennin - angiotensin - aldosterone
system
• Ramipril is used
Dose : 2.5mg PO BD
ADR : Cough, hypotension

22. BETA BLOCKERS
• Timolol, propranolol,atenolol
Dose: 10-3-mg PO OD
ADR : Arrhythmia, headache, dyspnoea

23. SODIUM BICARBONATE
• Infusion of sodium bicarbonate can be used to
treat hyperkalaemia
Dose : 5 meq IV over 5 minutes

24. DIALYSIS
• Through haemodialysis we can remove
Potassium from the body it is more effective
than haemofiltration or peritoneal dialysis

25. PREVENTION
• Enough fluid consumption
PATIENT COUNSELLING POINTS
• Low protein diet
• High carbohydrate meals
• Potassium and phosphorous containing foods
are restricted