A BRIEF OVERVIEW ABOUT ACUTE RENAL FAILURE {ARF} AND CASE PRESENTATION OF ARF IN SOAP FORMAT. THANK YOU.

1. ACUTE RENAL FAILURE
{after cholecystectomy}.

2. A Presentation by

3. Acute Renal Failure
A condition in which the kidneys suddenly can't filter
waste from the blood.
Acute renal failure develops rapidly over a few hours
or days. It may be fatal. It's most common in those
who are critically ill and already hospitalized.

4. Diagnostic criteria for AKI:
● An abrupt (within 48h hours) reduction in kidney function:.
● Absolute increase in serum creatinine of either > 0.3 mg/dl (>25 micromole/L) or a
percentage increase of 50%or a reduction in urine output (documented oliguria of
<0.5ml/kg/ hr. for > 6 hours).

5. 1. Swollen ankles or feet
2. Increased need to urinate
3. Blood in urine
4. Fatigue and lack of focus
5. Muscle cramps
6. Insomnia
7. Puffy eyes
8. Itchy dry skin
9. Loss of appetite
Symptoms of Kidney Disease

6. Pathophysiology

7. Treatment

8. SOAP ANALYSIS

9. Subjective Data
Patient Detail
Admitted to hospital- for cholecystectomy and after 2 days
heart failure worsened.
Current problem- acute renal failure after 10 days of
surgery

10. Subjective Data
● Hypertension from 20 years
● Chronic heart failure.
● Coronarography done 2004.
● Hypothyreosis
● Normal renal function before operation
Past History

11. Objective Data
PARAMETERS RESULTS
Hgb 99hms
Urine output 500-600ml/dl
Phosphate 1.61mmol/L
ABE -4.5
PTH 44.79pg/mL
FT4 16.91
TSH 0.9mIU/L
Sodium 134mEq/L
Potassium 4.9millimoles
Chloride 102millimol/L
BUN 24 mg/dl
Creatinine 1.67mg/decilitre
Glucose 5.1mmol/L
Calcium 8.8mg/dl
Albumin 25
Blood pressure 140/80
Laboratory Exam :-

12. ASSESSMENT
Provisional diagnosis –
After the ten days of cholecystectomy the Laboratory
examination reveled
The increase in creatinine level and decrease in
diuresis level to 300ml/day.
Diagnosed with- Acute renal failure

13. GOALS OF TREATMENT
Recovery:
1. Complete (Return to near baseline GFR).
2. Partial (Failure to return to baseline, but without the need for
chronic renal replacement).
• Kidneys may recover even after dialysis requiring AKI.

14. ASSESMENT OF THERAPY
● INDICATION - It is used to treat high blood pressure. Lowering high blood pressure helps prevent strokes, heart
attacks, and kidney problems
● MOA- The active metabolite of enalapril, inhibits ACE-Inhibition of ACE decreases levels of angiotensin II, leading
to less vasoconstriction and decreased blood pressure.
● SIDE-EFFECT - Dry, tickly cough that does not go away. feeling dizzy or lightheaded, especially when you stand
up or sit up quickly. This is more likely to happen when you start taking enalapril or move on to a higher dose. Eg.
headache. Diarrhea, mild skin rash, blurred vision.
● CONTRAINDICATIONS- Low amount of sodium in the blood, high levels of potassium in the blood. inherited
disorder of continuing episodes of swelling, decreased function of bone marrow.
● INTERACTIONS-Potassium-sparing diuretics, potassium supplements, and potassium-containing salt
substitutes
Enalapril tab.(10mg):

15. ASSESMENT OF THERAPY
● INDICATION - it is used to treat certain infections caused by bacteria such as bronchitis (infection of the airway
tubes leading to the lungs); gonorrhea (a sexually transmitted disease); and infections of the ears, throat, tonsils,
and urinary tract.
● MOA- selectively and irreversibly inhibits bacterial cell wall synthesis by binding to transpeptidases, also called
transamidases, which are penicillin-binding proteins (PBPs) that catalyze the cross-linking of the peptidoglycan
polymers forming the bacterial cell wall.
● SIDE-EFFECT - stomach upset/pain, diarrhea, nausea, constipation, loss of appetite, headache, dizziness.
● CONTRAINDICATIONS- diarrhea from an infection with Clostridium difficile bacteria, chronic kidney disease
stage 3A (moderate), 3B (moderate) , 4 (severe) chronic kidney disease stage 5 (failure).
● INTERACTIONS- Warfarin
Longaceph amp(1mg):-

16. ASSESMENT OF THERAPY
● INDICATION - It is a prescription medicine used to treat the symptoms of fluid retention (edema) in individuals
with congestive heart failure, liver disease or kidney disorder.
● MOA- Furosemide, like other loop diuretics, acts by inhibiting the luminal Na-K-Cl co-transporter in the thick
ascending limb of the loop of Henle, by binding to the chloride transport channel, thus causing sodium, chloride,
and potassium loss in urine.
● SIDE-EFFECT - increased urination, thirst, muscle cramps, itching or rash, weakness, dizziness, spinning
sensation, diarrhea.
● CONTRAINDICATIONS- Diabetes, a type of joint disorder due to excess uric acid in the blood called gout, low
amount of magnesium in the blood, low amount of calcium in the blood, low amount of sodium in the blood, low
amount of potassium in the blood, low amount of chloride in the blood, hearing loss.
● INTERACTIONS- Aminoglycoside antibiotics, ethacrynic acid, aspirin, lithium, sucralfate, nonsteroidal anti-
inflammatory drugs (NSAIDs), cisplatin, cyclosporine, methotrexate, phenytoin,and steroids
Lasix inj.(10mg/ml):-

17. ASSESMENT OF THERAPY
● INDICATION - It used to treat certain stomach and esophagus problems (such as acid reflux).
● MOA- Controloc Control, pantoprazole, is a proton-pump inhibitor. It works by blocking 'proton pumps', proteins
found in specialized cells in the stomach lining that pump acid into the stomach. By blocking the pumps,
pantoprazole reduces acid production, relieving the symptoms of acid reflux.
● SIDE-EFFECT – Headache, diarrhea, stomach pain, nausea or vomiting, gas, dizziness, joint pain.
● CONTRAINDICATIONS- Diarrhea from an infection with Clostridium difficile bacteria. Inadequate vitamin B12.low
amount of magnesium in the blood. A type of kidney inflammation called interstitial nephritis. Subacute
cutaneous lupus erythematosus. Systemic lupus erythematosus.an autoimmune disease.
● INTERACTIONS- Afatinib. atazanavir, dasatinib, delavirdine, digoxin, edoxaban, indinavir, itraconazole.
Controloc amp iv (40mg):-

18. ASSESMENT OF THERAPY
● INDICATION - It is used alone or together with other medicines to treat high blood pressure (hypertension).
● MOA- reversibly binds to beta adrenergic receptors on cardiac myocytes. Inhibition of these receptors prevents
a response to the sympathetic nervous system, leading to decreased heart rate and contractility.
● SIDE-EFFECT – Dizziness, Fatigue, Low blood pressure (hypotension) ,Weight gain, High blood sugar
(hyperglycemia),Diarrhea, Slow heart rate, Nausea.
● CONTRAINDICATIONS- Bronchial asthma or related bronchospastic conditions.
● INTERACTIONS- antianginal drugs, inotropic agents, anti- arrhythmic, NSAIDs, psychotropic drugs, anti-ulcer
medications, anesthetics, HMG-CoA reductase inhibitors, warfarin, oral hypoglycemics and rifampicin (rifampin)
Milenol tab. (5mg):-

19. ASSESMENT OF THERAPY
● INDICATION - It works by preventing blood clot formation and also prevents blockages in the blood vessels of
the body.
● MOA- Enoxaparin binds to and potentiates antithrombin (a circulating anticoagulant) to form a complex that
irreversibly inactivates clotting factor Xa. It has less activity against factor IIa (thrombin) compared to
unfractionated heparin (UFH) due to its low molecular weight.
● SIDE-EFFECT – Bleeding, pain and irritation at the injection site, skin reactions such as itching, hives and
redness, blood clots which form a solid swelling at the injection site (hematoma). Decrease in the number of
platelets in the blood (thrombocytopenia)
● CONTRAINDICATIONS- Hepatic insufficiency, uncontrolled arterial hypertension, a history of gastrointestinal
ulceration, impaired haemostasias, recent ischemic stroke, diabetic retinopathy
● INTERACTIONS- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, or naproxen. Platelet
inhibitors, such as clopidogrel, prasugrel, ticagrelor, or dipyridamole, Herbal supplements, such as ginkgo biloba,
fish oil, garlic, ginseng, and ginger.
Clexan sc (2ml)

20. ASSESMENT OF THERAPY
● INDICATION - It use of molsidomine include ischemic heart disease, angina, chronic heart failure, and pulmonary
hypertension
● MOA- The SIN-1A metabolite of molsidomine has a pharmacologically active group of nitric oxide, which increases
levels of cyclic GMP, and decreases intracellular calcium ions in smooth muscle cells. This leads to relaxation of
smooth muscle in the blood vessels, and inhibits platelet aggregation.
● SIDE-EFFECT – Dizziness, nausea, reflex tachycardia (fast heartbeat), hypersensitivity reactions, Headache
● CONTRAINDICATIONS- Acute cardiac arrest or severe hypotension (low blood pressure), during lactation.
● INTERACTIONS- avanafil, Bepridil, Amyl Nitrate
Molsidomine tab. (2mg):-

21. PLANNING

22. Initial treatment of AKI
Focused on fluid management:
-Hypovolemia potentiates and exacerbates all forms of ARF
-Rapid fluid infusion can result life threatening fluid overload
-Urinary catheter for measurement of Urine Output.
Indications for Dialysis:
-A : Acidosis
-E: Electrolyte disbalance: usually hyperkalemia
-I: Intoxications (Lithium, Ethylene glycol...)
-O: Overload (volume overload)
-U: Uremia (symptoms, signs)

23. Monitoring Parameters:
• Blood pressure.
• Urine output.
• Keep watch on urine flow and signs and symptoms related to it.
• Do health checkup at regular interval of time

24. POINT TO PHYSICIAN
• Their is no need to give the Longaceph amp(1mg)

25. POINT TO PATIENT
• Drink less fluid.
• Keep a record of everything she eat and drink.
• Measure the amount of urine and stool you have each day.
• Keep a daily record of her daily weights.
• Take her temperature every day, Keep a record of the results.
• Learn to take your own blood pressure (BP). Keep a record of your results. Bring the record to your follow-up
appointments.
• Ask your healthcare provider when you should seek emergency medical attention. Your provider will tell you
what blood pressure reading is dangerous.
• Stay away from people who have infections (colds, bronchitis, or skin conditions).
• Practice good personal hygiene, Wash your hands often. She may need frequent blood and urine tests.
These are done to monitor your kidney function.

26. POINT TO PATIENT
Call your healthcare provider right away if you have any of these:
• Signs of bladder infection, such as urinating more often, burning or pain when you pee, pain above your
pubic bone, blood in your urine, or trouble starting your urine stream.
• Signs of infection around your catheter, such as redness, swelling, warmth, or fluid leaking.
• Rapid weight loss/weight gain, such as 3 pounds or more in 24 hours or 6 pounds or more in 7 days.
• Fever above 100.4° F ( 38°C ) or as directed by your healthcare provider.
• Chills, Muscle aches, Night sweats, Very little or no urine output, Swelling of your hands, legs, or feet, Back
pain, Abdominal pain, Extreme tiredness.

28. REFERENCE
• Case study of Dr. Jasmina Mrgud (Resident in nephrology)
• drugs.com
• practo.com