This document provides an overview of acute renal failure (ARF). It defines ARF as a sudden decline in renal function associated with increased BUN and creatinine and oliguria. ARF can be pre-renal, post-renal, or intra-renal in origin. Clinical manifestations include fluid overload, electrolyte imbalances, and declining kidney function. Treatment involves addressing the underlying cause, fluid hydration, diuretics, and possibly dialysis. Nursing care focuses on monitoring fluid balance and labs, preventing complications like infection, and supporting the patient.

1. MEDICAL-SURGICAL
Practice Teaching1
Topic – Acute Renal Failure
Presented By –
Mr. Simon Raju
BSc 2nd` year

2. Introduction
ARF is a syndrome of varying
causation that results in a sudden
decline in renal function.
Associated with :
 Increase in BUN & creatinine
 Oliguria (less than 500ml urine /24h)
 Hyperkalemia
 Sodium retention

3. Anatomy & Physiology

4. Pathophysiology & Etiology
1. Pre renal cause - result from
hypovolemia
, shock,hemorrhage,burns,impaired
cardiac outut,diuretic therapy.
2. Post renal cause – arise from
obstruction or disruption to urine flow
anywhere along urinary tract.
3. Intra renal cause – results from injury to
renal tissue & associated with intra
renal ishemia , toxins , immunologic
processes ,systemic and vascular
disorders

5. Contd….

6. Contd…

7. Clinical Course
 Onset - lasts from hours to days
 Oliguric phase – anuric phase ( urine
less than 400 to 500ml/24h)
a)Accompanied in rise in serum
concn.which are excreted by kidneys
b) There can be decrease in renal
function with increase in N2 retention
even when the pt.is excreting more
than 2 to 3 L of urine daily – called
non oliguric or high output renal
failure.

8. Contd…
 Diuretic phase – begins when the 24hr
urine vol.exceeds 500ml and when
BUN & serum creatinine levels stop
rising.
 Recovery phase -
a) Several months to 1 yr
b) Probably some scar tissue remains

9. Clinical Manifestations
 Pre renal – decreased tissue turgor ,
dryness of mucous membrane , weight
loss , hypotension , oliguria or anuria ,
tachycardia
 Post renal – obstruction to urine flow,
nephrolithiasis , obstructive symptoms of
BPH
 Intra renal – edema , presentation
based on cause
 Changes in urine vol. and serum conc. of
BUN , creatinine , potassium and so
forth…

10. Contd….
 Objective
symptoms
◦ Oliguric phase –
 vomiting
 disorientation,
 edema,
 ^K+
 decrease Na
 ^ BUN and creatinine
 Acidosis
 uremic breath
 CHF and pulmonary
edema
 hypertension caused
by
hypovolemia, anorexia
 sudden drop in UOP
 convulsions, coma
 changes in bowels

11. Diagnostic Evaluation
1. Urinalysis – reveals proteinuria
, hematuria
2. Rising serum creatinine and BUN
levels; 41:1
3. Urine chemistry examinations
4. Renal ultrasonography

12. Contd…
 Diagnostic tests
◦ H&P
◦ BUN, creatinine, sodium, potassium.
pH, Hgb
◦ Urine studies
◦ US of kidneys
◦ KUB
◦ Renal CT/MRI
◦ Retrograde pyloegram

13. Treatment
 Treat underlying cause
 Blood pressure
 Infections
 Stop inciting medications
 Nephrostomy tubes/ureteral stents if
obstruction
 Hydration
 Diuresis (Lasix)
 Dialysis
 Renal Transplant

14. Acute Renal Failure
 Medical treatment
◦ Fluid and dietary restrictions
◦ Maintain E-lytes
◦ May need dialysis to jump start renal
function
◦ May need to stimulate production of urine
with IV fluids, Dopamine, diuretics, etc.

15. Contd…
 Medical treatment
◦ Hemodialysis
 Subclavian approach
 Femoral approach
◦ Peritoneal dialysis
◦ Continous renal replacement therapy
(CRRT)
 Can be done continuously
 Does not require dialysate

16. Contd..
 Spl. Attention to draining wounds
, burns ,
 Avoid infections
 Care while administering blood

17. Complications
1. Infection
2. Arrhythmias
3. Electrolyte abnormalities
4. GI bleeding
5. Multiple organ systems failure

18. Nursing diagnosis
 Fluid volume excess r/t decreased glomerular
filtration rate & sodium retention
 Risk for infection r/t alterations in immune
system & host system
 Altered nutrition: less than body requirements
r/t catabolic state ,anorexia ,malnutrition
associated with ARF
 Risk for injury r/t GI bleeding

19. Acute Renal Failure
 Nursing interventions
◦ Monitor
I/O, including all
body fluids
◦ Monitor lab results
◦ Watch hyperkalemia
symptoms:
malaise, anorexia, p
arenthesia, or
muscle
weakness, ECG
changes
◦ watch for
hyperglycemia or
hypoglycemia if
receiving TPN or
insulin infusions
◦ Maintain nutrition
◦ Safety measures
◦ Mouth care
◦ Daily weights
◦ Assess for signs of heart
failure
◦ Skin integrity problems

20. Nursing management
 Stay focused on the primary
disorder, and monitor all complications.
 Assist in emergency treatment of fluid
and electrolyte imbalances.
 Assess progress and response to
treatment; provide physical and
emotional support.
 Keep family informed about condition
and provide support.

21. Nursing Management
 Monitoring Fluid and Electrolyte levels
 Reducing Metabolic Rate
 promoting pulmonary Function
 Avoiding Infection
 Providing Skin Care
 Providing Support During Dialysis

22. Summary & Conclusion

23. Thank you