for medical profession

1. ACUTE RENAL FAILURE

2. Introduction
• Acute renal failure (ARF) is seen commonly in
the perioperative period and in the ICU.
• It is associated with a high morbidity and
mortality ( oliguric 50-80% and non oliguric
10-40%).

3. Urine Volume
• Anuria (< 100 ml/24h)
• Oliguria (100-500 ml/24h)
• Non-Oliguria (> 500 ml/24h)

4. Definition
• sudden and rapid decline in renal function,
causing retention of nitrogenous waste products
such as blood urea nitrogen and creatinine.
• The term ‘acute kidney injury (AKI)’ has now
replaced the previously used ‘acute renal
failure (ARF)’.

5. Classification
• RIFLE criteria
• Acute Kidney Injury Network definition
 GFR
 URINE OUT PUT
 serum creatinine

6. RIFLE criteria

7. Acute Kidney Injury Network definition

8. • Renal ultrasonography may show small (,9
cm) kidneys, often with cortical scarring and
possibly cyst formation, in which case chronic
disease is probable.
• Evidence of current—or a history suggestive
of recent—volume depletion implies a pre-
renal cause or ATN, and response to treatment
differentiates between the two.

9. Acute Chronic
History Short (days-week)
Long
(month-years)
Haemoglobin concentration Normal Low
Renal size Normal Reduced
Renal osteodystrophy Absent Present
Peripheral neuropathy Absent Present
Serum Creatinine
concentration
Acute reversible
increase
Chronic
irreversible

10. Etiology

11. Causes of acute renal failure
• Pre-renal
• Intrinsic renal
• Post-renal
• Oliguric
• Non- oliguric

15. Pathogenesis
• Oliguric
• Non-oliguric

17. Diagnosis
Clinical examination
Investigations

18. 5

19. Clinical feature
• Sign and symptoms resulting from loss of
kidney function:
• decreased or no urine output, flank pain,
oedema, hypertension, or discoloured urine
• Asymptomatic
• elevations in the plasma creatinine
• abnormalities on urinalysis

26. Treatment

27. PRACTICAL MANAGEMENT
• Management is directed at treating any life
threatening features, Hyperkalaemia,
pulmonary oedema, and severe acidosis.
• Fluid balance, the treatment of less severe
acidosis, the use of diuretics and dopamine, as
well as the relief of obstruction are all issues
in the further management of the patient.

29. Pulmonary oedema
• Pulmonary oedema is often the result of
excessive fluid resuscitation ,cardiac
dysfunction.
• furosemide 250 mg in 50 ml 0.9% saline
over one hour.
• Furosemide 1mg/kg iv over 1to 2 min. if no
response after 1 hour increase to 2 mg/kg
over 1 to 2 min.

30. ACIDOSIS
• Severe metabolic acidosis (blood pH ,7.2) or
HCO3 <15 meq/L.
• Reversing acidosis through administration of an
alkaline solution—sodium bicarbonate—would
seem to be sensible, but there is very little
evidence to show that it provides benefit.
• Haemodialysis or haemofiltration will usually be
required to treat severe acidosis in oligoanuric
patients

31. Treatment of oliguric renal faiure
• Fluid challenge- fluid bolus (250-500 ml of
normal saline) over 10–15 minutes may help
to differentiate between Pre-renal to other
renal causes.
• Drugs used are:-
1. Diuretics
2. Dopamine
3. Calcium channel blockers

32. Calculation of GFR
• Cockcroft-Gault equation
Estimated creatine clearnce (ml/min)=
(140-Age )x Weight
72 x pcr
Age – in years
Weight- kgs
Pcr- mg/dl

33. Calculation of GFR

34. Diuretics
Rationale for use:-
• loop diuretics may vasodilate cortical vessels
and improve oxygenation.
• augmentation of tubular blood flow may
reduce intratubular obstruction back leak of
filtrate thus rapidly accelerating resolution of
ARF

35. Dosage of furosemide
• 250 mg in 250 ml of NS IV over 1 hour.
• If out put not good, 500mg in 400ml of NS IV
over 2 hours.
• If no response , 1g in 400ml NS IV 4 hours .
• No response –hemodialysis
• Rate of infusion -<4mg/min.
• C/i:-volume depletion, hypotension,hypokelamia,
hyperuricemia

38. “PREVENTION IS BETTER
THEN CURE”
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