ACUTE RENAL FAILURE

NARCISO A. CAÑIBAN
CATEGORIES OF ACUTE
RENAL FAILURE

• PRERENAL ARF

• INTRINSIC ARF

• POSTRENAL ARF
PRERENAL ARF

• In prerenal acute renal failure,

the problem is impaired renal
blood flow as a result of true
intravascular depletion,
decreased effective circulating
volume to the kidneys or
agents that impair renal blood
flow.
CAUSES:
1) Intravascular volume depletion

2. Decreased cardiac output

3)Renal sodium loss

4)Extrarenal sodium loss

5)Cutaneous loss

6)"Third-spacing" (low effective

arterial volume)

7)Drug effects: NSAIDs, ACE

inhibitors, cyclosporine.

8)Hepatorenal syndrome:
RISK FACTORS:

• Atherosclerosis

• Blood loss

• Chronic liver disease

• Heart disease
IS IT REVERSIBLE
OR NOT???
REVERSIBLE !!!
INTRINSIC ARF

This type involves damage

or injury within both kidneys.
Intrinsic ARF accounts for
approximately 40% of the
cases of acute renal failure.
The most common cause is
ATN or acute tubular necrosis.
1.Ischemia

2. Nephrotoxins:
Antibiotics (aminoglycosides)
Radiocontrast agents
Endogenous toxins (myoglobin,
hemoglobin, myeloma light
chains, uric acid)
3. Vascular events:
Atheroembolic disease,
Renal artery stenosis
/thrombosis,
Vasculitis
4. Acute glomerulonephritis

5. Acute interstitial nephritis

POSTRENAL ARF

Postrenal ARF is caused by

an acute obstruction that
affects the normal flow of
urine out of both kidneys. The
blockage causes pressure to
build in all of the renal
nephrons (tubular filtering
units that produce urine). The
excessive fluid pressure
ultimately causes the nephrons
to shut down.
Upper tract obstruction
 intratubular: urate, myeloma light
chains, acyclovir, methotrexate
(Can crystallize and cause
obstruction.)
 intrapelvic: stones, clots, tumors
 intraureter: stones (unilateral
usually)
Female reproductive system:
pregnancy (functional effect of fetus
pushing on ureter) , tumors
(cervical, ovarian).
Gastrointestinal tract: diverticular
disease , malignancy, abscesses
Retroperitoneal processes: fibrosis,
tumors
Lower tract obstruction bladder:
blood clots, stones, tumors,
Neurogenic, BPH.
PHASES OF ARF

• INITIATION

• OLIGURIC

• DIURESIS

• RECOVERY
The initiation phase begins
with onset of renal injury and
continues through onset of
oliguria
Rise in the serum concentration of
substances usually excreted by the
kidneys :
urea, creatinine, uric acid,
inorganic acids and the
intracellular cations (potassium and
magnesium)

Hyperkalemia develops

Minimum needed for elimination of

metabolic waste products 400 ml /
day

Uremic symptoms appear

Nonoliguric forms are found after

nephrotoxic antibiotics, burns,
traumatic injury, halogenated
anesthetic agents
Gradually the urinary output
increases because the
glomerular filtration has
started recovering

Laboratory values stop rising

Uremic symptoms may

continue

Watch for dehydration

Improvement in renal
function

May take 3 to 12 months

Lab values return to normal

gradually
IS PRERENAL ARF
OLIGURIC OR NOT?
OLIGURIC
A client suffering from acute renal failure
has an unexpected increase in urinary
output to 150ml/hr. The nurse assesses
that the client has entered the third phase
of acute renal failure. Nursing actions
throughout this phase include
observation for signs and symptoms of

a. Hypervolemia, hypokalemia, and

hypernatremia.
b. Hypervolemia, hyperkalemia, and
hypernatremia.
c. Hypovolemia, wide fluctuations in serum
sodium and potassium levels.
d. Hypovolemia, no fluctuation in serum
sodium and potassium levels.