Acute renal failure (ARF) refers to the abrupt loss of kidney function.

Over a period of hours to a few days, the GRF falls, accompanied by concomitant rise in serum creatinine and urea nitrogen. A healthy adult eating a normal diet needs a minimum daily urine output of approximately 400 ml to excrete the body’s waste products through the kidneys. An amount lower than this indicates a decreased GFR. ARF affects approximately 1% of patients on admission to the hospital, 2% to 5% during the hospital stay, 4% to 15% after cardiopulmonary bypass surgery and 10% of cases acute renal failure occurs in isolation (i.e. single organ failure).

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Contents [hide] 1 Causes 2 Manifestations 3 Diagnostic Procedures 4 Medical Management

Prerenal  Hypovolemia      Heart failure Hemorrhage Excessive diarrhea Vomiting Diuresis

Intrarenal  Acute tubular necrosis Postrenal  Kidney stones   Tumor Spinal cord injury

An ultrasound is a noninvasive type of test. Some patients may also have iron deficiency due to blood loss in their gastrointestinal system.  The acid–base balance of the blood is usually disrupted as well. Benign Prostatic Hypertrophy Manifestations        Anemia – decreased in erythropoietin and bleeding Bleeding – result from hypocalcemia and altered pH function because of increase in BUN Pruritus – accumulation of waste products in the blood excreted in the skin. The presence of protein in the urine indicates kidney damage. Patients are divided into five stages of chronic kidney disease based on their GFR. especially potassium. The urine may be analyzed for protein and waste products (urea nitrogen and creatinine).  Blood cell counts: Because kidney disease disrupts blood cell production and shortens the survival of red cells. It decreases in most people with age.  High potassium (hyperkalemia) is a particular concern. hypocalcemia and elevated BUN Constipation – because of the use of phosphate binders.  Twenty–four–hour urine tests: This test requires you to collect all of your urine for 24 consecutive hours. the red blood cell count and hemoglobin may be low (anemia). and calcium.  Decreased production of the active form of vitamin D can cause low levels of calcium in the blood. fluid restrictions Fatigue – because of anemia Pathologic fractures – because of hypocalcemia and hyperparathyroidism Diagnostic Procedures Urine tests  Urinalysis: Analysis of the urine affords enormous insight into the function of the kidneys. Inability to excrete phosphorus by failing kidneys causes its levels in the blood to rise. The level of these substances rises in the blood as kidney function worsens.  Urine Specific Gravity – This is a measure of how concentrated a urine sample is.  Creatinine is a breakdown product of normal muscle breakdown. Other nutritional deficiencies may also impair the production of red cells. Neurologic manifestations – because of uremic encephalopathy.  Glomerular filtration rate (GFR): The GFR is a standard means of expressing overall kidney function. phosphorus. immobility. Electrolyte levels and acid–base balance: Kidney dysfunction causes imbalances in electrolytes. The GFR may be calculated from the amount of waste products in the 24–hour urine or by using special markers administered intravenously.    Urea is the waste product of breakdown of protein. GFR falls. The normal GFR is about 100–140 mL/min in men and 85–115 mL/min in women.030 or 1.040 Blood tests  Creatinine and urea (BUN) in the blood: Blood urea nitrogen and serum creatinine are the most commonly used blood tests to screen for. and monitor renal disease. As kidney disease progresses. Other tests  Ultrasound: Ultrasound is often used in the diagnosis of kidney disease. . The amount of creatinine and urea excreted in the urine can be used to calculate the level of kidney function and the glomerular filtration rate (GFR). A concentrated urine sample would have a specific gravity over 1.

indication for dialysis. Hyponatremia – restriction of fluids  Fluid restrictions 3. Hypermagnesemia – impaired excretion of Magnesium by the kidneys Magnesium – mainly excreted in the urine. Electrolyte Balance 1. Fluid Balance  Monitor fluid volume status  Weight – most accurate indicator (daily)   Input and Output monitoring Assessment of skin turgor and mucous membrane  Fluid restrictions  Amount of fluids to be taken per day (400 ml (insensible fluid loss) + previous days urine output. hyperphosphatemia  Calcium Carbonate. Hyperkalemia – impaired potassium excretion. can be given orally or rectally Avoid salt substitutes 2. although they may be normal or even large in size in cases caused by adult polycystic kidney disease. Medical Management I. Hypocalcemia – decreased activation of Vit. Usually. D. Biopsy: A sample of the kidney tissue (biopsy) is sometimes required in cases in which the cause of the kidney disease is unclear. this can caused dementia  Calcium base phosphate binders – excrete phosphorus but increased Ca.   Calcium Carbonate Calcium Acetate 5. Promote Fluid and Electrolyte and Acid Base Balance A. Calcium Lactate and Vitamin D  Emergency Hypocalcemia – give Calcium Gluconate IV 4. result from metabolic acidosis  If there is Emergency Hyperkalemia – give 50% dextrose and regular insulin    Can give sodium bicarbonate – for acidosis Client can be given with Sodium Polystyrene Sulfonate (Kayexalate) – can be given with Sorbitol to promote evacuation. and amyloidosis. give ice chips  Diuretic therapy  Furosemide and Mannitol are often use B. a biopsy can be collected with local anesthesia only by introducing a needle through the skin into the kidney.  Moisten the lips.  In general. diabetic nephropathy. kidneys are shrunken in size in chronic kidney disease. seen in antacids or enemas  Diuretic therapy  Avoid magnesium containing antacids or enemas . Hyperphosphatemia – impaired excretion of Phosphate by the kidneys in the urine  Phosphate binders – they bind phosphate in the GI tract for excretion   Aluminum hydroxide –cause constipation so stool softener maybe given Aluminum Carbonate –if use for a long period.

metabolic encephalopathy nursing diagnosis. creatinine and uric acid Hyperkalemia    Give Sodium Bicarbonate – alkalinic meds Give Sodium Lactate – alkalinic meds Give Shohl’s solution – treatment of metabolic acidosis. Optimal Nutrition  High CHO diet – to spare CHON metabolism   Low CHON diet but with essential amino acids (50 proteins). Acute Renal Failure Nursing Management. diet and weight control III. caused stomatitis II. Improve Body Chemistry  Dialysis    Hemodialysis Peritoneal dialysis Kidney Transplantation nursing diagnosis for metabolic encephalopathy. Emergence Hypermagnesemia – Give Calcium Gluconate C. 50 mg/day Serve foods in small amount – because of nausea. nursing care plan for metabolic encephalopathy. Acid Base Balance Metabolic Acidosis  Impaired hydrogen ion excretion    Increased excretion of bicarbonate Accumulation of urea. nursing management of acute renal failure . Reserve Renal Function  Dopamine Hydrochloride – to dilate renal arteries promoting renal perfusion  Control of hypertension with the use of ACE inhibitors. anorexia and stomatitis IV.

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