Acute Renal Failure

Acute Renal Failure

Definition

Acute Renal Failure –is a sudden and almost complete loss of kidney function caused by failure of the renal circulation or by glomerular or tubular dysfunction

Causes of ARF

•               Pre-renal (60-70 % )

•               Volume Depletion

•               Hemorrhage

•               Renal losses

•               Sepsis

•               Cardiac failure

•               Anaphylaxis

Intra renal (5-10%)

•               Pigment Nephropathy

•               Myoglobinuria

•               Hemoglobinuria

•               Nephrotoxic agents

Post-renal (20-40% cases)

•               Urinary tract obstruction

•               Calculi

•               Tumors in lower urinary tract

People in risk

•               Being hospitalized especially for a serious condition that requires intensive care

•               Advanced age

Post-renal (20-40% cases)

•               Urinary tract obstruction

•               Calculi

•               Tumors in lower urinary tract

People in risk

•               Being hospitalized especially for a serious condition that requires intensive care

•               Advanced age

•               Blockages in the blood vessels in arms or legs

•               Diabetes

•               High blood pressure

•               Heart failure

•               Kidney diseases

•               Liver disease

Signs and Symptoms of ARF

•               Oliguria - Urine output less than 400ml/ day

•               Anuria - Urine output less than 100ml/day

•               Increased BUN creatinine

•               Hyper Kalemia

•               Metabolic acidosis

•               Edema

•               Mental changes

•               Heart failure

•               Nausea, vomiting

•               Pruritus

Diagnosis

•               History of underlying cause

•               Blood- Increased potassium, BUN, Creatinine

•               Urine: decreased volume and specific gravity is fixed or increased

•               Renal ultrasound, renal scan, renal biopsy, CT scan or MRI, KUB X-ray, Retrograde pyelogram.

Management

•               Removal of the underlying cause

•               Diuretics

•               Fluid restriction (600 ml plus previous day output) Calcium supplements or phosphate binding agents

•               Nutritional therapy

•               -Protein intake 0.6/kg/day

•               -Potassium restriction

•               -sodium restriction

•               -Calorie intake 30 to 35 kcal/day/kg body weight

•               -Dialysis