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  • Acute Renal Failure: DR S. Ratnayake

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    Acute renal failure is defined as an abrupt deterioration of renal function characterized by increased BUN and decreased urine output below 400ml/24hrs. The main causes are prerenal such as hypotension, renal such as acute tubular necrosis, and postrenal such as obstruction. Acute tubular necrosis is the most common cause and results from ischemic or nephrotoxic injury to the tubules. It leads to tubular damage, interstitial edema, and oliguria. With proper management, acute tubular necrosis is usually reversible and recovery is complete in most cases.

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    Acute renal failure is defined as an abrupt deterioration of renal function characterized by increased BUN and decreased urine output below 400ml/24hrs. The main causes are prerenal such as hypotension, renal such as acute tubular necrosis, and postrenal such as obstruction. Acute tubular necrosis is the most common cause and results from ischemic or nephrotoxic injury to the tubules. It leads to tubular damage, interstitial edema, and oliguria. With proper management, acute tubular necrosis is usually reversible and recovery is complete in most cases.

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    20 views19 pages

    Acute Renal Failure: DR S. Ratnayake

    Uploaded by

    rikarz
    Acute renal failure is defined as an abrupt deterioration of renal function characterized by increased BUN and decreased urine output below 400ml/24hrs. The main causes are prerenal such as hypotension, renal such as acute tubular necrosis, and postrenal such as obstruction. Acute tubular necrosis is the most common cause and results from ischemic or nephrotoxic injury to the tubules. It leads to tubular damage, interstitial edema, and oliguria. With proper management, acute tubular necrosis is usually reversible and recovery is complete in most cases.

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    of 19

    Acute renal failure

    Dr S. Ratnayake

    Definition Abrupt deterioration of renal function

    BUN

    UOP (<400ml/24hrs)

    Causes
    Prerenal

    Postrenal
    Obstruction

    Hypotension Fluid loss Septicaemia Cardiac causes

    Renal
    Acute tubular necrosis

    Cresentic GN Vasculitis Malignant hypertension Papillary necrosis

    Clinical features

    Investigations

    Acute tubular necrosis


    Commonest cause of ARF (50% of all cases) Clinical significance Reversible injury Early and proper management Complete recovery

    2 types Ischemic ATN Nephrotoxic ATN In both types the changes are due to Tubular damage Persistent and severe disturbance in blood flow

    Tubules are highly susceptible to ischemia and toxic damage due to High metabolic rate and high oxygen consumption rate Toxins are absorbed by tubular epithelium

    Ischemia
    Fluid leakage
    Epithelial dysfunction

    Tubular injury

    Interstitial oedema Interstitial pressure

    Vasoconstriction

    Reversible injury Loss of function

    Irreversible injury

    Necrosis Apoptosis

    Tubuloglomerular feedback

    Distal tubular Na

    Oliguria

    Ischaemic ATN - histology


    Tubules

    PCT - Straight portion Loop of Henle Thick ascending limb Multiple points with skip areas Loss of PT brush border Sloughing of epithelial cells Swelling and vacuolation

    Flattened tubular epithelium Casts - DCT and collecting ducts With recovery - Regenerative changes with mitotic figures Interstitium Oedema Inflammatory cells Vessels Vasa recta Dilated with neutrophils Glomeruli No significant change

    Toxic ATN - histology


    Commonly affect PCT Nonspecific changes or Specific changes in the tubular epithelium

    Carbon tetrachloride - Lipid in cells Ethylene glycol - Hydropic degeneration Mercuric chloride Large acidophilic inclusions Desquamate and calcify

    Clinical features
    3 phases Initiation Maintenance Recovery

    Initiation Due to transient blood loss Last about 36 hrs Slight reduction UOP with elevated BUN

    Maintenance UOP < 400ml/24hrs BUN Hyperkalaemia Metabolic acidosis

    Recovery phase UOP > 3L/24hrs Hypokalaemia

    Prognosis

    Depends on the initiating event and damage to other organs With modern therapy - 95% recovery

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