ACUTE RENAL FAILURE

University of Al-Ameed / College of

Medicine Department of Paediatrics

DR.MOHAIMEN A.M ALKABI

RENAL SYSTEM

2 Kidneys
2 Ureters
Bladder
Urethra
RENAL FUNCTION

1. Detoxify blood
2. Regulate blood pressure , electrolyte and fluid balance
3. Increase calcium absorption (calcitriol)
4. Stimulate RBC production (erythropoietin)
TO FUNCTION PROPERLY KIDNEYS REQUIRE

Normal renal blood flow

Functioning glomeruli and tubules
Clear urinary outflow tract
for drainage and elimination of formed urine from the body.
ACUTE RENAL FAILURE

 Acute kidney injury (AKI), formerly termed acute renal failure, refers to an abrupt decrease in glomerular
filtration rate (GFR) and tubular function .
 This may lead to decreased excretion of waste products (e.g., urea) and a disturbance in fluid and electrolyte
homeostasis.
CLASSIFICATION

• Pre-renal (55%)
• renal(40%)
• post-renal(5-15%)
CAUSES OF ACUTE KIDNEY INJURY

PRERENAL
1. Dehydration
2. Hemorrhage
3. Septic shock
4. Burns
5. Heart failure
6. Cirrhosis
POSTRENAL (OBSTRUCTION)
1. Urethral obstruction (stricture, posterior urethral valves)
2. Ureteral obstruction
3. Ureterocele
4. Extrinsic tumor compressing bladder outlet
5. Neurogenic bladder (myelomeningocele, spinal cord injury)
INTRINSIC
1. Acute tubular necrosis
2. Nephrotoxins (medications, contrast, myoglobin)
3. Infection (sepsis)
4. Interstitial nephritis
5. Glomerular injury (primary glomerulonephritis, vasculitis, hemolytic uremic syndrome)
6. Vascular (renal vein thrombosis, arterial emboli, malignant hypertension)
CLINICAL MANIFESTATION OF ARF

 Decrease urine output (70%)

 Edema, esp. lower extremity
 Mental changes
 Nausea, vomiting
 Tachypenia
INVESTIGATION

 Blood urea ,serum creatinine (both increase )

 Serum electrolyte (hyperkalemia ,hypocalcemia ,metabolic acidosis and hyperphosphatemia )
 Urine analysis may show mild hematuria and/or proteinuria with a specific gravity of 1.015 or less. With
glomerular and vascular injury, the amount of hematuria and proteinuria is usually moderate to severe.
 Renal ultrasound is often helpful in determining the AKI category (eg, hydronephrosis in post renal cause )
MANAGEMENT

 volume repletion in dehydration

 stopping an offending nephrotoxic medication
 relieving urinary tract obstruction.
A large part of AKI treatment involves management of its complications.

Hyperkalemia
 A large part of AKI treatment involves management of its complications.
Hyperkalemia
HYPERKALAEMIA

 Potassium range is 3.5 – 5mmol/L

 Rise in serum K+ >5mmol/l
 Signs/symptoms: muscle weakness

 ECG changes:
 Flattened P waves
 Broad QRS complex
 Slurring of ST segment
 Tall tented T waves
TREATMENT OF HYPERKALEMIA

1. Intravenous calcium will lower risk of arrhythmia

2. measures are initiated to shift potassium into cells
 Bicarbonate
 beta-agonists
 insulin/dextrose
3.Hasten removal
 diuretics,
 sodium-potassium exchange resins
 dialysis
Dialysis
DIALYSIS

 Diffuse harmful waste out of body

 Control BP
 Keep safe level of electrolytes and acid base level in body
 2 types
 Hemodialysis
 Peritoneal dialysis
PERITONEAL DIALYSIS
INDICATION FOR PERITONEAL DIALYSIS

 Fluid overload that is unresponsive to diuretics

 Uncontrollable hypertension , hyperkalemia or acidosis
 Serious and potentially life-threatening complications due to fluid overload such as pulmonary
edema, heart failure, and hypertension that is refractory to pharmacologic therapy
 Uremic encephalopathy
 Toxin
COMPLICATIONS

Complications of PD include:
 Peritonitis
 Catheter malfunction
 Electrolyte abnormalities
 Protein loss
 Hydrothorax due to dialysate leakage into the pleural space.
 Hernia due to fluid in the peritoneal space and increased abdominal pressures.
Questions?