Acute renal

failure
pabricio, eunice c.
bsn 4-a
 What is Acute renal failure?
 Acute renal failure (ARF) is a rapid loss of renal function due to
damage to the kidneys.

 Acute renal failure is also known today as acute kidney injury (AKI).

 Depending on the duration and severity of AKI, a wide range of

potentially life-threatening metabolic conditions can occur, including
metabolic acidosis as well as fluid and electrolyte imbalance.

 It is a problem seen in hospitalized patients and those in outpatient

settings.

 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
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indicates a decreased GFR.
 pathophysiology

Although the pathogenesis of ARF and oliguria is not always

known, many times there is a specific underlying problem.

Underlying problems. There are underlying problems that

cause the development of ARF such as hypovolemia,
hypotension, reduced cardiac output and failure, and
obstruction of the kidney.

Blood flow. As these underlying problems affect the body, the

blood flow to the kidneys reduces.
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 pathophysiology

Decreased kidney function. With inadequate blood flow to the

kidney, there is impaired kidney function.

Failure. If the underlying conditions are not treated and

corrected, they can lead to permanent damage of the kidneys.

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CLASSIFICATIONS OF ACUTE KIDNEY INJURY

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 CATEGORIES OF ACUTE KIDNEY INJURY
ARF OR AKI can be divided into three major classifications, depending on
site:
PRE RENAL Intra renal Post renal
 result of impaired  Result of actual  Post renal failure
blood flow that leads parenchymal occurs as the
to hypoperfusion of damage to the result of an
the kidney commonly glomeruli or kidney obstruction in the
caused by volume urinary tract
tubules.
depletion (burns,
anywhere from the
hemorrhage, gi
losses), hypotension tubules to the
(sepsis, shock), and urethral meatus.
renal stenosis,
ultimately leading to
decrease in GFR. 6
 Phases of acute kidney injury
There are four phases of ARF: initiation, oliguria, diuresis, and recovery.

 Initiation. The initiation period begins with the initial insult, and ends
when oliguria develops.

 Oliguria. The oliguria period is accompanied by an increase in the serum

concentration of substances usually excreted by kidneys.

 Diuresis. The diuresis period is marked by a gradual increase in urine

output, which signals that glomerular filtration has started to recover.

 Recovery. The recovery period signals the improvement of renal function

and may take 3 to 12 months.

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 causes
The causes of ARF depend on its categories: prerenal, intrarenal, and
postrenal.

 Prerenal. Examples of prerenal causes are volume depletion,

impaired cardiac efficiency, and vasodilation.

 Intrarenal. Examples of intrarenal causes are prolonged renal

ischemia, nephrotoxic agents, and infectious processes.

 Postrenal. An example of a postrenal cause is urinary tract

obstruction.

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 Clinical manifestations
Almost every system of the body is affected by the failure of the normal
renal regulatory mechanisms.

 Lethargy. Since waste products cannot be filtered, it slowly

accumulates in the different parts of the body.

 Dryness. The skin and mucous membrane are dry from dehydration.

 Central nervous system symptoms. This include drowsiness,

headache, muscle twitching, and seizures.

 Increased creatinine. All phases of ARF exhibit an increase in

creatinine.
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 Prevention

 Hydration. Provide adequate hydration to patients at risk for dehydration.

 Shock. Prevent and treat shock promptly with blood and fluid
replacement.

 Close monitoring. Monitor central venous and arterial pressures and

hourly urine output of critically ill patients to detect the onset of renal
failure as early as possible.

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 Prevention
 Blood administration. Take precautions to ensure that the appropriate blood
is administered to the correct patient in order to avoid severe transfusion
reactions.

 Infections. Prevent and treat infections promptly because they can produce
progressive renal damage.

 Toxic drug effects. To prevent toxic drug effects, closely monitor dosage,
duration of use, and blood levels of all medications metabolized or excreted by
the kidneys.

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 Complications
Depending on the duration and severity of ARF, a wide
range of potentially life-threatening complications can
occur.

 Metabolic acidosis. Waste products could not be

eliminated by the kidneys and they can contribute to
metabolic acidosis.

 Fluid and electrolyte imbalances. Imbalances may

occur due to hemorrhage, renal losses, and
gastrointestinal losses.

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 diagnosis
 Urine output measurements. Measuring how much
you urinate in 24 hours may help your doctor determin
the cause of your kidney failure.

 Urine tests. Analyzing a sample of your urine

(urinalysis) may reveal abnormalities that suggest
kidney failure.
.

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 diagnosis

 Blood tests. A sample of your blood may reveal rapidly rising levels of urea
and creatinine — two substances used to measure kidney function.

 Imaging tests. Imaging tests such as ultrasound and computerized

tomography may be used to help your doctor see your kidneys.

 Removing a sample of kidney tissue for testing. In some situations, your

doctor may recommend a kidney biopsy to remove a small sample of kidney
tissue for lab testing. Your doctor inserts a needle through your skin and
into your kidney to remove the sample.
.

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 Medical Management
The objectives of treatment of ARF are to restore normal
chemical balance and prevent complications until repair of renal
tissue and restoration of renal function can occur.
 Pharmacologic therapy. Cation-exchange resins or
Kayexalate can reduce elevated potassium levels; IV dextrose
50%, insulin, and calcium replacement may be administered to
shift potassium back into cells; diuretic agents are often
administered to control fluid volume.

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 Medical Management
 Prerenal azotemia is treated by optimizing renal perfusion,
whereas postrenal failure is treated by relieving the
obstruction.

 Intrarenal azotemia is treated with supported supportive

therapy, with removal causative agents, aggressive
management of prerenal and postrenal failure, and avoidance
of associated risk factors.

 The patients lungs are auscultated for moist crackles.

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 Medical Management
 Adequate renal blood flow in patients with prerenal causes of
AKI may be restored by IV fluids or transfusions of blood
products.

 If AKI is caused by hypovolemia secondary to

hypoproteinemia, an infusion of albumin may be prescribed.
Dialysis may be initiated to prevent complications of AKI, such
as hyperkalemia, metabolic acidosis, pericarditis, and
pulmonary edema.

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 Medical Management

 Nutritional therapy. Replacement of dietary proteins is

individualized to provide the maximum benefit and minimize
uremic symptoms; likewise, caloric requirements are met with
high-carbohydrate meals, because carbohydrates have a
protein-sparing effect; foods and fluids containing potassium or
phosphorus are restricted; and after diuretic phase, the patient
is placed on a high-protein, high-calorie diet.

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 Nursing Management
 Monitors for complications, participates in emergency
treatment of fluid and electrolyte imbalances, assess the
patient’s progress and response to treatment, and provide
physical and emotional support.

 In addition, the nurse keeps family members informed about

the patient’s condition, helps them understand treatment and
provide psychological support.

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Assessment usually focuses on the characteristics of
the urine.

 Assess urine output. Urine output varies from

scanty to a normal volume.

 Assess blood in the urine. Hematuria may be

present in patients with ARF.

 Assess laboratory results. Laboratory results may

increase, decrease, or stabilize and these may
indicate each phase of ARF.
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Based on the assessment data, appropriate nursing
diagnoses for a patient with ARF include:

Electrolyte imbalance related to increased

potassium levels.

Risk for deficient volume related to increased in

urine output.

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The goals for a patient with ARF are:

 Improve nutritional intake.

 Restore fluid balance.
 Reduce metabolic rate.
 Promote pulmonary function.
 Prevent infection.

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 Monitor fluid and electrolyte balance.
 Reducing metabolic rate.
 Promoting pulmonary function.
 Preventing infection
 Providing skin care.
 Provide safety measures.

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Improved nutritional intake.

Restored fluid balance.

Reduced metabolic rate.

Promoted pulmonary function.

Prevented infection.
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Improved nutritional intake.

Restored fluid balance.

Reduced metabolic rate.

Promoted pulmonary function.

Prevented infection.
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The nurse plays an important role in teaching the patient and
family with ARF.

 Nutrition. A referral to the nutritionist is made because of the

dietary changes required.

 Problems to report. The patient and family must know what

problems to report to the healthcare provider.

 Follow-up examinations. The importance of follow-up

examinations and treatment is stressed to the patient and family
because of changing physical status and renal functions.
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.
The focus of documentation
in a patient with ARF include:
 Vital signs.
 Muscle strength and reflexes.
 Results of laboratory tests and
diagnostic studies.
 Degree of deficit and current
sources of fluid intake.
 I&O and fluid balance.
 Plan of care.
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 Teaching plan.
 Client’s responses to
treatment, teaching, and
actions performed.
 Attainment or progress
towards the desired
outcomes.
 Modifications to plan of care.
 Long term needs.
 Thanks!

REFERENCES:
Brunner & Suddarth’s textbook of medical-
surgical nursing, 14th ed., volume 2

https://nurseslabs.com/acute-renal-failure/

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