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Acute Renal Failure

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A short presentation on clinical presentation, causes and management of ARF

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Acute Renal Failure

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

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