ACUTE RENAL FAILURE

NARCISO A. CAÑIBAN

CATEGORIES OF ACUTE RENAL FAILURE

‡ PRERENAL ARF

‡ INTRINSIC ARF

‡ POSTRENAL ARF

PRERENAL ARF ‡ In prerenal acute renal failure. the problem is impaired renal blood flow as a result of true intravascular depletion. decreased effective circulating volume to the kidneys or agents that impair renal blood flow. .

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ACE inhibitors. cyclosporine.CAUSES: 1) Intravascular volume depletion 2. 8)Hepatorenal syndrome: . Decreased cardiac output 3)Renal sodium loss 4)Extrarenal sodium loss 5)Cutaneous loss 6)"Third-spacing" (low effective arterial volume) 7)Drug effects: NSAIDs.

RISK FACTORS: ‡ Atherosclerosis ‡ Blood loss ‡ Chronic liver disease ‡ Heart disease .

IS IT REVERSIBLE OR NOT??? .

REVERSIBLE !!! .

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Intrinsic ARF accounts for approximately 40% of the cases of acute renal failure.INTRINSIC ARF This type involves damage or injury within both kidneys. The most common cause is ATN or acute tubular necrosis. .

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Acute glomerulonephritis 5. uric acid) 3. Renal artery stenosis /thrombosis. Nephrotoxins: Antibiotics (aminoglycosides) Radiocontrast agents Endogenous toxins (myoglobin. Vasculitis 4. Acute interstitial nephritis . Vascular events: Atheroembolic disease. hemoglobin.Ischemia 2.1. myeloma light chains.

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.POSTRENAL ARF Postrenal ARF is caused by an acute obstruction that affects the normal flow of urine out of both kidneys. The blockage causes pressure to build in all of the renal nephrons (tubular filtering units that produce urine). The excessive fluid pressure ultimately causes the nephrons to shut down.

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Neurogenic. clots. tumors (cervical. BPH. stones. ovarian). tumors Lower tract obstruction bladder: blood clots. tumors. acyclovir. . myeloma light chains. tumors y intraureter: stones (unilateral usually) Female reproductive system: pregnancy (functional effect of fetus pushing on ureter) . methotrexate (Can crystallize and cause obstruction. Gastrointestinal tract: diverticular disease .) y intrapelvic: stones.Upper tract obstruction y intratubular: urate. abscesses Retroperitoneal processes: fibrosis. malignancy.

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PHASES OF ARF ‡ INITIATION ‡ OLIGURIC ‡ DIURESIS ‡ RECOVERY .

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The initiation phase begins with onset of renal injury and continues through onset of oliguria .

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burns. traumatic injury. uric acid.Rise in the serum concentration of substances usually excreted by the kidneys : urea. halogenated anesthetic agents . inorganic acids and the intracellular cations (potassium and magnesium) Hyperkalemia develops Minimum needed for elimination of metabolic waste products 400 ml / day Uremic symptoms appear Nonoliguric forms are found after nephrotoxic antibiotics. creatinine.

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Gradually the urinary output increases because the glomerular filtration has started recovering Laboratory values stop rising Uremic symptoms may continue Watch for dehydration .

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Improvement in renal function May take 3 to 12 months Lab values return to normal gradually .

IS PRERENAL ARF OLIGURIC OR NOT? .

OLIGURIC .

Hypovolemia. b. Hypervolemia. d. wide fluctuations in serum sodium and potassium levels. c. no fluctuation in serum sodium and potassium levels. Nursing actions throughout this phase include observation for signs and symptoms of a. The nurse assesses that the client has entered the third phase of acute renal failure. Hypervolemia. and hypernatremia.A client suffering from acute renal failure has an unexpected increase in urinary output to 150ml/hr. hyperkalemia. hypokalemia. and hypernatremia. Hypovolemia. .

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