Non-Modifiable Factors Modifiable Factors

Age (60 y/o above) Weight (obese)

Genetics/Family history Diet
of kidney disease Lifestyle (smoker)
Past surgical procedure Diabetic
(heart & bone marrow High blood
transplant) pressure
race
It is the abrupt deterioration in
ACUTE RENAL FAILURE renal parenchymal function
due to damage to the kidneys
and often associated with

Pre-Renal Post-Renal
Intrinsic
Fraction excretion Anuria
Fraction excretion of
of Na <1% Hydronephrosis
Na >2% Elevated post-void
Urine osmolality
Urine osmolality <350
>500 mOsm/L residual volume
Urine Na+ >40
Urine Na+
Urine SG: 1.010-1.020
<20mEq/L Tubular/granular casts
Urine SG >1.020
Few hyaline casts

Heart failure & Glomerulonephritis Hypertension, Toxin, Rash, Ischemia,

Renal artery stenosis , Atheroembolic Hemolytic Fever, nephrotoxins,
Renal hypoperfusion due disease anemia, Arthralgia, granular casts
to hypovolemia
Glomerular atherosclerosis
Vascular Interstitial NephritisEosinophilia Acute Tubular
(& urine) necrosis
M.I, Dysrhythmias,
Cardiogenic Shock Hypertension,
Causes Causesproteinuria, hematuria, Microvascular Macrovascula
RBC casts, dysmorphic r Often drug - Ischaemia:
RBC hypersensitivity shock, burns,
reactions M.I
Management
TTP, HUS, Renal artery
HELLP, Pre- occlusion, Sulphora Nephrotoxins:
IV fluid Management
eclampsia, abdominal mides, aminoglycosides,
replacement tumor tetracycline,
Antheroembolic aortic disease
Monitor Consider biopsy, work lysis ampho B,
disease
CVP/JVP up for systemic
Mana disease, syndrome, NSAIDs, ACE-I,
Monitor VS corticosteroids, penicillin, lithium
especially BP cyclophosphamide Management Management
NSAIDs,
Monitor urinary (Cytoxan) allopurino Rhabdomyolysis
I&O Consider biopsy, Consider
l,
Blood culture & corticosteroids or surgery Hepatorenal
cephalosp
treat sepsis plasmapheresis, syndrome
orin,
Monitor VS

Management

Eliminate toxins, Supportive care,

consider corticosteroids, reverse ischemia,
biopsy eliminates toxins,
maintain euvolemia
 Causes of obstruction: (calyces to
Symptoms
urethra)
Swelling especially on the
Renal stones
legs and feet
BPH
Little or no urine output
Pelvic masses
Thirst and dry mouth
Rapid heart race
Loss of appetite
N/V Management
Confused, anxious, restless

Possible Complications

Pulmonary edema
Hyperkalemia Insert urinary catheter
Cardiac arrhythmias Examine: bladder, masses,
Encephalopathy prostate
pericarditis Abdominal CT
(uncontrasted)
Relieve obstruction
Urology consult

Always treat complications & Precipitating Factors!

Electrolyte NB K+ : arrhythmias and cardiac arrest, NB ECG (Rx: Insulin, glucose and calcium gluconate)
Pulmonary Edema: FMO2/CPAP, morphine, furosemide, IV nitrates
Bleeding: transfusion
Treat sepsis: avoid nephrotoxic drugs
Indications for dialysis: persistent hyperkalemia, severe metabolic acidosis, refractory pulmonary edema, uremic
pericarditis/encephalopathy
Adjust dose of renal excreted drugs