A C U T E R E N A L F A I L U R E

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A C U T E R E N A L F A I L U R E

  1. 1. ACUTE RENAL FAILURE M.JANGIR ICU,AAH AL AIN
  2. 2. DEFINATION <ul><li>Acute Renal Failure is a sudden and almost complete loss of kidney function caused by failure of the renal circulation or by by glomerular or tubular dysfunction. </li></ul><ul><li>OR </li></ul><ul><li>ARF is rapid beakdown of renal function that occurswhen high levels of uremic toxins accumulate in the blood. </li></ul>
  3. 3. ARF <ul><li>Based on the amount of the urine that is excreted over a 24 hrs period, Pts with ARF are separated into two groups: </li></ul><ul><li>Oliguric:Pts who excrete less than 400 mls per day. </li></ul><ul><li>Nonoliguric:Pts who excrete more than 400 mls per day. </li></ul>
  4. 4. CAUSES <ul><li>Three major categories of conditions cause ARF: </li></ul><ul><li>Prerenal(Hypoperfusion of kidney) </li></ul><ul><li>Intrarenal or Intrinsic(Actual damage to kidney tissue) </li></ul><ul><li>Postrenal(Obstruction to urine flow) </li></ul>
  5. 5. PRERENAL ARF <ul><li>Prerenal conditions occur due to a blood flow problem which leads to hypoperfusion of kidney and a drop in GFR. The main causes are: </li></ul><ul><li>Volume depletion </li></ul><ul><li>Hemorrhage </li></ul><ul><li>Renal losses(Diuretics,osmotic diuretics) </li></ul><ul><li>GI losses(Vomiting,diarrhea,NG tubes) </li></ul><ul><li>Impaired cardiav efficiency,MI,CHF </li></ul><ul><li>Cardigenic shock </li></ul><ul><li>Sepsis </li></ul>
  6. 6. INTRARENAL(INTRINSIC)ARF <ul><li>It’s due to structural damage to the glomeruli or kdney tubules. The main causes are: </li></ul><ul><li>Prolonged renal ischemia </li></ul><ul><li>Myoglobinuria(trauma,crush injuries,burns) </li></ul><ul><li>Hemoglobinuria(Transfusion reactions,hemolytic anemia) </li></ul><ul><li>Nephrotoxic agents(NSAIDs) </li></ul><ul><li>Aminoglycoside antibiotics(gentamycin,tobamycin) </li></ul><ul><li>Acute pyelonephritis,Acute glomerulonephritis) </li></ul><ul><li>Infectious processes </li></ul>
  7. 7. POSTRENAL ARF <ul><li>It’s caused by an acute obstruction distal to the kidneys that affects normal outflow of the urine from kidneys.The blockage causes pressure to build in all of the renal nephrons,eventualy the GFR decreases. The main causes are: </li></ul><ul><li>Urinary tract obstruction </li></ul><ul><li>Tubule obstruction(End chanel of renal nephrones) </li></ul><ul><li>Calculi </li></ul><ul><li>Tumors </li></ul><ul><li>Benign prostate hyperplasia </li></ul><ul><li>Strictures </li></ul><ul><li>Blood clots </li></ul><ul><li>Retroperitoneal fibrosis </li></ul>
  8. 8. PHASES OF ARF <ul><li>Mainly 4 clinical phases of ARF: </li></ul><ul><li>Initiation period: It begins with the initial insult and ends when oliguria develops. </li></ul><ul><li>Period of oliguria:(UOP less than 400 mls/24 h) It’s is accompanied by a rise in serum concentration of sustances usually excreted by the kidneys(Ur,Cr,Uric acid, Pottasium and Mg) </li></ul>
  9. 9. Cont.. PHASES OF ARF <ul><li>Period of diuresis: Pt. experiences a gradually increasing UOP, which signal that glomerular filtration has started to recover.Doeward trend starts in Ur, Cr. </li></ul><ul><li>Period of recovery: This signals the improvement of renal function and may take from 3-12 months. Lab value returns to a normal level for the Pt. </li></ul>
  10. 10. RISK FACTORS <ul><li>Atherosclerosis </li></ul><ul><li>Blood loss </li></ul><ul><li>Chronic Liver Diseases </li></ul><ul><li>Heart disease </li></ul><ul><li>Hypercalcemia </li></ul>
  11. 11. SIGNS & SYMPTOMS <ul><li>PRERENAL S&S : </li></ul><ul><li>Dizziness,Headache,muscle twitching and seizures </li></ul><ul><li>Dry mouth,dry mucous membrane </li></ul><ul><li>Uremic fetor(Uremic odor in breath) </li></ul><ul><li>Lethargy,N/V and diarrhea </li></ul><ul><li>Hypotension, Tachycardia </li></ul><ul><li>Thirst </li></ul>
  12. 12. Cont.. SIGNS & SYMPTOMS <ul><li>INTRARENAL(INTRINSIC) S & S: </li></ul><ul><li>Fever,rash,arthralga(Asso. With allergic interstitial nephritis) </li></ul><ul><li>Flank pain-asso. With renal artery or vein obstruction,severe glomerulonephritis </li></ul><ul><li>Headache, dizziness,confusion,seizures-asso. With malignant HTN </li></ul><ul><li>Oliguria,edema,HTN,Papilledema,heart failure </li></ul><ul><li>Increased BUN and Cr levels </li></ul>
  13. 13. Cont..SIGNS & SYMPTOMS <ul><li>POSTRENAL ARF S & S: </li></ul><ul><li>Difficult urination,distended bladder </li></ul><ul><li>Edema(Fluid retention and swelling) </li></ul><ul><li>HTN </li></ul><ul><li>Pain in the lower back,lower abdomen,groin,genitalia </li></ul><ul><li>Severe hematuria </li></ul>
  14. 14. COMPLICATIONS OF ARF <ul><li>Dyspnea </li></ul><ul><li>Heart failure </li></ul><ul><li>Edema </li></ul><ul><li>Venous engorgement </li></ul><ul><li>Metabolic acidosis </li></ul><ul><li>Hyperkalemia </li></ul><ul><li>Inntravascular overload </li></ul><ul><li>Uremia </li></ul><ul><li>Confusion, disorientation and stupor </li></ul>
  15. 15. DIAGNOSIS <ul><li>Physical exam. </li></ul><ul><li>Lab. Study often reveal high Ur, Cr, hyperkalemia, hyperphosphatemia, hypocalcemia </li></ul><ul><li>Urine analysis shows RBC and WBC, high Na, Proteinuria </li></ul><ul><li>Severe anemia </li></ul><ul><li>USG, CAT SCAN, MRI </li></ul><ul><li>Renal biopsy </li></ul>
  16. 16. PREVENTION <ul><li>Provide adequate hydration to Pts at risk for dehydration: </li></ul><ul><li>*Surgical Pts :before, during and after surgery </li></ul><ul><li>*Pts undergoing intensive diagnostic studies requiring fluid restriction and contrast agents </li></ul><ul><li>*Pts with disorders of metabolism (Gout) and those receiving chemotherapy </li></ul><ul><li>Prevent and treat shock promptly with blood and fluid replacement </li></ul><ul><li>Monitor critically ill Pts for CVP,ABP and hrly UOP to detect early onset of renal failure </li></ul>
  17. 17. Cont.. PREVENTION <ul><li>Manage hypotension promptly </li></ul><ul><li>Continually asses renal function (UOP, Lab values) </li></ul><ul><li>Follow proper blood transfusion protocols to avoid transfusion reactions </li></ul><ul><li>Prevent and treat infection promptly </li></ul><ul><li>Pay special attention to wounds, burns and other causes of sepsis </li></ul><ul><li>Proper care of indwelling catheters </li></ul><ul><li>Closely monitor all </li></ul><ul><li>mediations metabolized or excreted by the kidneys for dosage, duration and blood levels to prevent toxic effects. </li></ul>
  18. 18. MANAGEMENT <ul><li>Maintenance of fluid and electrolytes. Ion exchange resins (Na polysterene sulfonate) to control hyperkalemia. </li></ul><ul><li>IV fluids and diuretics: adequate blood flow to the kidneys in some Pts may be restored by IV fluids and medications. Mannitol, ferusemide may be prescribed to initiate a diuresis and prevent subsequent renal failure. </li></ul><ul><li>Correction of acidosis and elevated phosphate levels: Serial ABG, appropriate resp. ventilatory measures </li></ul>
  19. 19. Cont.. MANAGEMENT <ul><li>Appropriate antibiotics to treat infection. </li></ul><ul><li>Dietary proteins are limited to approximately 1gm/kg during the oliguric phase to minimize protein breakdown and to prevent accumulation of toxic end products. </li></ul>
  20. 20. Cont.. MANAGEMENT <ul><li>DIALYSIS: </li></ul><ul><li>Dialysis may be initiated to prevent serious complications of ARF, such as hyperkalemia, pericarditis and seizures. </li></ul><ul><li>Dialysis corrects many biochemical abnormalities, allows for liberalization of fluid, protein and Na intake. </li></ul>
  21. 21. NURSING MANAGEMENT <ul><li>Close monitoring of fluid and electrolytes balance. </li></ul><ul><li>Reduce metabolic rate by adequate bed rest to reduce catabolism and subsequent release of K+ and accumulation of endogenous waste products. </li></ul><ul><li>Promote pulmonary function by frequent deep breaths, cough to prevent atelectasis and respiratory infectin. </li></ul><ul><li>Avoiding infection by practicing aseptic techniques in invasive lines care. </li></ul>
  22. 22. Cont.. NURSING MANAGEMENT <ul><li>Provide meticulous skin care as dry and edematous skin more prone to breakdown. Turn Pt frequently to prevent skin breakdown. </li></ul><ul><li>Follow strict aseptic techniques with Pts who are on dialysis to prevent infection. </li></ul><ul><li>Provide psychological support to Pt and family. </li></ul>
  23. 23. THANKS FOR YOUR ATTENTION

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