Acute renal failure (ARF) is a sudden reduction in kidney function that results in waste accumulating in the blood. It occurs in 5% of hospitalized patients and 35% of intensive care unit patients. ARF can be prerenal from decreased blood flow, renal from direct kidney damage, or postrenal from urinary tract obstruction. Causes include dehydration, heart issues, infections, kidney diseases, and nephrotoxic drugs. Symptoms include reduced urine output and waste buildup in the blood. Treatment focuses on fluid management, electrolyte control, and potentially dialysis. Prevention involves proper hydration and treating infections promptly.

3.  ARF is an abrupt decline in glomerular and tubular function,
resulting in the failure of the kidneys to excrete nitrogenous
waste products and to maintain fluid and electrolyte
homeostasis
 ARF = a sudden reduction of GFR expressed clinically as
elevations in blood BUN and creatinine
 Generally elevation of BUN, creatinine occurred within 3
months
 May heal partially or completely or progress to more severe
renal insufficiency, including end-stage renal disease
 Incidence of ARF varies on setting:
◦ Community <1%
◦ Hospital 2-7%;

4.  Definition of ARF
 Epidemiology
 Etiology of ARF
 Management of ARF
◦ Diagnosis of ARF
◦ Treatment of ARF

5. • It occurs in
– 5%of all hospitalized patients and
– 35% of those in intensive care units
• Mortality is high:
• up to 75–90% in patients with sepsis
• 35–45% in those without

9.  DEFINITIONS
Acute renal failure is a sudden reduction in kidney function
that results in nitrogenous wastes accumulating in the blood.

10.  ETIOLOGY

11.  Pre-renal (functional/hypoperfusion)
 Renal (structural/intrinsic)
 Post-renal (obstructive)

12. Causes of acute renal failure

14. ◦ Volume depletion
 Renal losses (diuretics, polyuria)
 GI losses (vomiting, diarrhea)
 Cutaneous losses (burns, Stevens-Johnson syndrome)
 Hemorrhage
 Pancreatitis
◦ Decreased cardiac output
 Heart failure
 Pulmonary embolus
 Acute myocardial infarction
 Severe valvular heart disease
 Abdominal compartment syndrome (tense ascites)

15. Problems affecting the flow of blood before it
reaches the kidneys
1) Dehydration
vomiting, diarrhea, water pills, or blood
loss.
2) Disruption of blood flow to the kidneys .
*Major surgery with blood loss,
severe injury or burns, or infection in
the bloodstream.

16. * Blockage or narrowing of a blood vessel carrying
blood to the kidneys.
* Heart failure or heart attacks causing low blood flow.
* Liver failure causing changes in hormones that affect blood
flow and pressure to the kidney

19. ◦ Ureteric obstruction
 Stone disease,
 Tumor,
 Fibrosis,
 Ligation during pelvic surgery
◦ Bladder neck obstruction
 Benign prostatic hypertrophy [BPH]
 Cancer of the prostate
 Neurogenic bladder
 Drugs(Tricyclic antidepressants, ganglion blockers,
 Bladder tumor,
 Stone disease, hemorrhage/clot)
◦ Urethral obstruction (strictures, tumor)

20. Problems affecting the movement of urine out of the
kidneys.
a) Kidney stone: usually only on one side.
b) Cancer of the urinary tract organs or structures near
the urinary tract that may obstruct the outflow of urine.
c) Medications.

21. d) Bladder stone.
e) Benign prostate hyper plasia (the most common cause in
men).
f) Blood clot.
g)Bladder cancer.

23. ◦ Glomerular
 Anti–glomerular basement membrane (GBM) disease (Goodpasture
syndrome)
 Anti–neutrophil cytoplasmic antibody-associated glomerulonephritis
(ANCA-associated GN) (Wegener granulomatosis, Churg-Strauss
syndrome, microscopic polyangiitis)
 Immune complex GN (lupus, postinfectious, cryoglobulinemia, primary
membranoproliferative glomerulonephritis)
◦ Tubular
 Ischemi
 Totoxic
 Heme pigment (rhabdomyolysis, intravascular hemolysis)
 Crystals (tumor lysis syndrome, seizures, ethylene glycol poisoning,
megadose vitamin C, acyclovir, indinavir, methotrexate)
 Drugs (aminoglycosides, lithium, amphotericin B, pentamidine,
cisplatin, ifosfamide, radiocontrast agents)

24.  Renal Problems with the kidney itself that prevent proper
filtration of blood or production of urine(25-40%).
 Blood vessel diseases
 Blood clot in a vessel in the kidneys
 Injury to kidney tissue and cells

25. Glomerulo nephritis
e.g, Streptococcal bacterial infections may damage the
glomeruli.
Acute interstitial nephritis
1) Medications such as antibiotics, anti-inflammatory
medicines (for example, aspirin, brufen), and water pills .
2) infections and immune-related diseases such as lupus ,
leukemia, lymphoma, and sarcoidosis.

26. Acute tubular necrosis

27.  Causes include shock (decreased blood supply to the
kidneys), drugs (especially antibiotics)
and chemotherapy agents, toxins and poisons, and
dyes used in certain kinds of x-rays.
 Accidents, injuries
 complications from surgeries (eg.Heart-bypass
surgery)
 Polycystic kidney.
 produce less erythropoietin

28. RISK FACTORS
 Advanced age
 Blockages in the blood vessels in your arms or legs
 Diabetes
 High blood pressure
 Heart failure
 Kidney diseases
 Liver disease

29. Symptoms
 Vomiting and/or diarrhea, which may lead to dehydration.
 Nausea.
 Weight loss.
 Nocturnal urination.
 pale urine.
 Less frequent urination, or in smaller amounts than usual,
with dark coloured urine

30.  Haematuria.
 Pressure, or difficulty urinating.
 Itching.
 Bone damage.
 Non-union in broken bones.
 Muscle cramps (caused by low levels of calcium which
can cause hypocalcaemia).:
 Abnormal heart rhythms.
 Muscle paralysis.

31.  Swelling of the legs, ankles, feet, face and/or hands.
 Shortness of breath due to extra fluid on the lungs
 Pain in the back or side
 Feeling tired and/or weak.
 Memory problems.
 Difficulty concentrating.
 Dizziness.
 Low blood pressure.

32. Other symptoms include
 Anorexia
 Pruritus
 Seizures (if blood urea nitrogen level is very high)
 Shortness of breath (if volume overload is present).
 Decrease osmolality(A measurement of urine concentration
that depends on the number of particles dissolved in it).
 Increase urinary sodium.
 Pericarditis.
 Pericardial effusion.
 Pleural effusion.
 Decrease calcium and bicarbonate.
 Defect in platelet functionings

33. PHASES OF ARF
 Initiating phase
 Oliguric phase
 Diuretic phase
 Recovery phase

34. Diagnosis
 History collection.
 Physical examination.
1 Asterixis and myoclonus
2 Peripheral edema (if volume overload is present)
3 Pulmonary rales (if volume overload is
present)
4 Elevated right atrial pressure (if volume overload is
present)

35.  Identification of precipitating cause.
 Serum creatinine and BUN level .(n 7-18mg/dl)
 Serum electrolytes.
 Urine analysis.
 Renal bladder ultra sound.
 Renal scan.
 CT scans and MRI scan (to identify lesion and masses)
 The urine will be examined under a microscope.
 biopsy

36. Prenal Renal
BUN/Cr >20 <20
FeNa <1% >1%
RFI <1% >1%
UNa (mEq/L) <20 > 40
Specific gravity high low

37. Medical and Pharmacological Treatment
 correcting fluid and electrolyte balance.
 Correct dehydration.
 Correct dehydration.
 Keeps other body systems working properly
 Furosemide, Torsemide, ethacrynic acid
 calcium gluconate
 Sodium bicarbonate
 dialysis

39.  Anuria (< 100 ml/24h)
◦ Acute bilateral arterial or venous occlusion
◦ Bilateral cortical necrosis
◦ Acute necrotizing glomerulonephritis
◦ Obstruction (complete)
◦ ATN (very rare)
 Oliguria (100-500 ml/24h)
◦ Pre-renal azotemia
◦ ATN
 Non-Oliguria (> 500 ml/24h)
◦ ATN
◦ Obstruction (partial)

40.  NUTRITIONAL THERAPY
 Provide protein diet.
 Calori requirements are met with high carbo-hydrate meals
(carbo-hydrates have a protein-sparing effect.
 Foods and fluid containing potassium or phosphorous (banana,
coffee) are restricted.
 Patient may require parenteral nutrition.

41. Prevention
 A careful history(nephrotoxic antibiotic agent
aminoglycosides, gentamicin, tobramicine, etc.)
 blood tests and urinalysis
 Drink enough fluids
 Difficulties urinating or blood in the urine should prompt a
visit
 Treat hypotension promptly.
 Prevent and treat infections promptly.
 Pay special attention to wound, burns and other precursors of
sepsis.

42.  COMPLICATIONS
 ARF can affect the entire body
 Infection
 Hyperkalaemia, Hyperphosphataemia, hyponatraemia
 water overload
 Pericarditis
 Pulmonary oedema.

43.  Reduced level of consciousness.
 Immune deficiency.
NURSING MANAGEMENT
 Excess fluid volume related to decreased Glomerular filtration
rate and sodium retention
 Risk for infection related to alterations in the immune system
and host defenses
 Imbalanced nutrition: less than body requirements

44.  Risk for injury related to GI bleeding
 Sleep pattern disturbances related to disease condition
 Providing skin care
 Providing support
Patient Teaching and Home Healthcare Guidelines
conclusion

45. THANK YOU