This document summarizes acute and chronic kidney failure. For acute failure, it discusses causes like pre-renal issues and acute tubular necrosis, investigations, management focusing on treating underlying causes and symptoms like hyperkalemia, and indications for dialysis. Chronic kidney failure is defined by decreased glomerular filtration rate over 3 months and stages are described. Causes and management target complications like fluid balance, blood pressure control, removing toxins and planning for long term renal replacement therapy if needed.

1. Ben Savage

2.  Acute
◦ Causes
◦ Investigation
◦ Management
◦ Hyperkalaemia
 Chronic
◦ Cause
◦ Staging
◦ Management

4.  Significant reduction in renal failure in hours or days.
 Maybe no symptoms, oliguria is common
(<400ml/24hrs)
 Biochemically detected by increasing Urea &
Creatinine.
 Can occur in isolation but usually secondary to other
pathology.
 Pre Renal and acute tubular necrosis account for 80%
of acute renal failure.

5.  Systemic cause that reduce perfusion of the
kidney
◦ Hypovolemia
◦ Sepsis
◦ Post Surgery
◦ Shock
◦ Hepatic Failure
◦ Drugs – NSAIDs, ACEi
◦ Renal artery/vein occlusion

6.  Acute Tubular Necrosis
 Glomerulonephritis
 Nephrotoxic drugs
◦ NSAIDs, Gentamicin
 Rabdomyolysis
 Interstitial nephritis
 Myeloma
 Haemolytic Uremic Syndrome

7.  Stones
 Fibrosis
 Cancer
◦ Prostate, Cervix
◦ Bladder, Ureters
 BPH

8.  Urine Dip
 Bloods
 ECG
 Imaging relative to history

9.  Rapid diagnosis and appropriate treatment of
underlying pathology crucial.
 Crucial empirical management
◦ Oxygenation
◦ Ensure adequate circulation – fluids, blood
◦ Treatment of any hyperkalaemia
◦ Dialysis if indicated

10.  Indications for immediate dialysis
◦ Pulmonary oedema
◦ Potassium >6.5mM
◦ Acidosis pH<7.2
◦ Pericarditis
◦ Encephalopathy

11.  Normal potassium levels 3.5
and 5.0 mmol
 Treat aggressively if:
◦ Potassium >6 mmol
◦ ECG changes
 ECG changes
◦ Peaked T-waves
◦ Widened QRS
◦ Small/ absent p-waves
◦ Sine wave appearance

12.  Calcium Gluconate (IV)
 Insulin & Dextrose (IV)
 Calcium Resonium (PO/PR )
 Dialysis if indicated

13.  Causes
◦ Pre-renal
◦ Renal
◦ Post-renal
 Pre Renal and acute tubular necrosis account for 80% of
acute renal failure.
 Rapid diagnosis and treatment of underlying pathology
crucial.
 Symptomatic management and empirical treatment vital.
 Always be aware of hyperkalaemia

15.  Defined as kidney damage or a decreased
kidney glomerular filtration rate (GFR) of less
than 60 for 3 or more months
 ESRD aged >65, increases mortality 6x
 Usually asymptomatic in stage 1-3
 CRF alter the dose of certain drugs and
contraindicate others depending on the GFR

16.  Glomerular Nephritis (20%)
 Interstitial nephritis & reflux nephropathy (20%)
 Polycystic kidneys (10%)
 Diabetes Mellitus
 Renovascular disease/HTN (10%)
 Obstructive/ unknown (20%)

17.  Stages: -measured using GFR
1. >90 }GFR alone not sufficient for
2. 60-89 }diagnosis of stage 1&2
3. 30-59
4. 15-29
5. <15 (ESRF)

18.  Salt & water homeostasis
◦ Fluid overload
◦ Fluid depletion
 BP control
◦ HTN
 Removal of uraemic toxins
◦ Uraemia
 Calcium/phosphate balance
◦ Hyperphosphalipadeamia
◦ Hypocalcaemia
◦ Renal Bone disease
◦ 3ry hyperparathyroidism

19.  Erythropoietin production
◦ Anaemia
 Potassium Balance
◦ Hyperkalaemia
 Acid-Base balance
◦ Metabolic acidosis
 Also affect immunity – increasing infections

20.  Is it truly chronic?
 Treat any reversible causes or acute
exacerbations
 Treatment of consequences of chronic renal
failure
 Long term planning esp renal replacement
therapy

21.  Review medication during progression of
renal failure.
 Symptoms can reflect failure of any the action
of the kidneys.
 Treat any reversible causes promptly
 Plan long term therapy early

22. Any question