STUDENT

SPECIFIC LEARNER’S
CONTENT TEACHER’S AV AIDS E
OBJECTIVE ACTIVITY
ACTIVITY
INTRODUCTION:

Acute RenalFailure occurs when your kidneys

suddenly become unable to filter waste products
from your blood. When your kidneys lose their
filtering ability, dangerous levels of wastes may
accumulate, and your blood's chemical makeup
may get out of balance.
Acute kidney failure — also called acute renal failure or
acute kidney injury — develops rapidly, usually in less
than a few days. Acute kidney failure is most common in
people who are already hospitalized, particularly in
critically ill people who need intensive care.

DEFINITION
define the term
Acute Renal Failure is a rapid loss of renal
Acute Renal Explaining & Listening &
function due to damage to the kidneys. Roller W
Failure asking taking notes
Brunner board R
questions
& Suddharth's

CLASSIFICATIONS OF ACUTE RENAL FAILURE

RIFLE CLASSIFICATION

Class GFR criteria Urinary output

criteria
R(Risk) GFR decreased 0.5 ml/kg/hour
>25% for 6 hours
I(Injury) GFR 0.5 ml/kg/hr for
decreased>50% 12 hours

F(Failure) GFR decreased <0.3ml/kg/he for

>75% 24 hours or
 Anuria for 12
hours.
L(Loss) Complete loss of
kidney
function>4 weeks
E(ESKD) ESKD>3 Months

CAUSES OF ACUTE RENAL FAILURE

Pre renal failure

 Volume depletion resulting from:

 Gastrointestinal losses (vomiting, diarrhea)
 Hemorrhage
 Renal losses (diuretic agents, osmotic
diuresis)
 Impaired cardiac efficiency resulting from:
 Cardiogenic shock
 Dysehythmias
 Heart failure
 Myocardial infarction
 Vasodilation resulting from:
 Anaphylaxis
 Antihypertensive medications
 Sepsis
Intrarenal Failure
 Prolonged renal ischemia resulting from:
 Hemoglobinuria (transfusion reaction,
hemolytic anemia)
 Myoglobinuria (trauma,burns,crush injuries)
 Nephrotoxic agents such as:
 Aminoglycoside
antibiotics(gentamycin,tobramycin)
 Heavy metals(lead,mercury)
 Nonsteroidal anti-inflammatory drugs
 Radiopaque contrast agents
 Solvent and chemicals (carbon
tetrachloride)
 Infectious process such as:
 Acute glomerulonephritis
 Acute pyelonephritis
Postrenal Failure
 Urinary tract obstruction,including:
 Benign prostatic hyperplasia
 Blood clots
 Calculi
  Stricture
 Tumors

PATHOPHYSIOLOGY OF ACUTE RENAL

FAILURE

Prerenal causes Intrarenal causes Postrenal

causes

Glomerular tubular
Hydronephrosis
Hypoperfusion necrosis

Retention of water & electrolytes

Pulmonary edema
Hyperkalemia
Hypocalcemia
Oliguria
Increased urea
Increased creatinine
CLINICAL MANIFESTATIONS OF ACUTE RENAL
FAILURE
 Lethargy
 Dehydration
 Drowsiness
 Headache
 Decreased urine output
 Vomiting
 Nausea
 Weight loss
 Dark coloured urine
 Hematuria
 Muscle cramps
 Swelling of the legs, ankles, feet, face and hands
 Low blood pressure
Other symptoms include
  Anorexia
 Pruritis
 Seizure
 Increased urine specific gravity
 Increased urinary sodium
 Pleural effusion
 Decrease calcium and bicarbonate

DIAGNOSTIC EVALUATIONS OF ACUTE RENAL

FAILURE
 History collection.
 Physical examination.
 Serum creatinine
 BUN
 Serum electrolytes
 Urine analysis
 Renal bladder ultra sound
 Renal scan
 CT scans and MRI
 Renal biopsy

MANAGEMENT OF ACUTE RENAL FAILURE

 Medical and Pharmacological Treatment
 Antihypertensive
 Diuretics
 Low dose dopamine(1-3g/kg) is often used to dilate
the renal arteries
 Correcting fluid and electrolyte balance
 Correct dehydration
 Keeps other body systems working properly
 Frusemide, Torsemide, Ethacrynic acid
 Calcium gluconate or insulin
 Sodium bicarbonate (correct acidosis)
 Antibiotics to treat associated infection
 Anticonvulsants (levetiracetam) for seizures
 Antiemetics
 Laxatives
 Vitamin supplements
 Dialysis

 Fluid and electrolyte replacement

 Intravenous solutions must be carefully selected
 according to the patient’s fluid and electrolyte
status
 Treat hyperkalemia with insulin, calcium gluconate
 Replace lost fluids such as water, blood, plasma.

 Nutritional therapy
 Provide protein diet
 Calorie requirement are met with high carbohydrate
meals
 Potassium and phosphorous foods are restricted
(40-60mEq/day)(banana, coffee)
 Sodium restricted to 2g/day
 Low-potassium foods include apples, cabbage,
carrots, green beans, grapes and strawberries.
 Dialysis

NURSING MANAGEMENT OF ACUTE RENAL

FAILURE

 Monitor fluid and electrolyte balance

 Reducing metabolic rate-bed rest
 Promoting pulmonary function (cough, deep
breaths)
 Preventing infection
 Providing skin care
 Providing safety measures
 Providing psychological support

PREVENTION OF ACUTE RENAL FAILURE

 Continually assess the renal function
 Drink enough fluids
 Difficulties urinating or blood in the urine should
treat promptly
 Treat hypotension properly
 Prevent and treat infection promptly
 Pay special attention to wounds, burns, and sepsis