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ARF
ARF
INTERN EMERGENCY
LECTURE SERIES 2005
DEFINITION
ABRUPT DECREASE IN RENAL
FUNCTION RESULTING IN THE
ACCUMULATION OF
NITROGENOUS COMPOUNDS
SUCH AS UREA AND
CREATININE
A
Acute vs Chronic Renal
Failure
History
» Known Chronic
» Recent Toxic Exposure
» Recent Hypoxic Insult
» Recent Trauma
» Known Diseases Associated with ARF
» Prev. Abnormal Lab Results Suggesting
Chronic
Acute vs Chronic Renal
Failure
PRE-RENAL 55-60%
RENAL 35-40%
PRE-RENAL ACUTE RENAL
FAILURE
VASCULAR DISEASE
» VASCULITIS (SLE, POLYARTERITIS
ETC.)
» SCLERODERMA
» THROMBOEMBOLIC DISEASE
» MALIGNANT HYPERTENSION
RENAL--ACUTE RENAL
FAILURE
GLOMERULAR DISEASE
» ACUTE GLOMERULONEPHRITIS
–POST INFECTIOUS GN
–CRESCENTIC GN
ANCA POSITIVE DISEASES
–GOODPASTURE’S DIS.
ANTI- GLOMERULAR BASEMENT
ANTIBODY
RBC CAST
ACUTE INTERSTITIAL NEPHRITIS
DRUG INDUCED
PENICILLINS NSAID
SULFONAMIDES (FENOPROFEN)
CEPHALOSPORIN ALLOPURINOL
RIFAMPIN ( 2ND PHENYTOIN
TIME) THIAZIDES
QUINOLONES FUROSEMIDE
CIMETIDINE
Acute Interstitial Nephritis
Fever
Rash
Eosinophilia
Pyuria
Eosinophiluria
WBC Casts
WBC Cast
RENAL --ACUTE RENAL FAILURE
MYOBLOBINURIA (RHABDOMYOLYSIS)
ENDOTOXEMIA
RENAL-- ACUTE RENAL FAILURE
CLINICAL SETTING
FREQUENCY
GEN.MED. --SURG. 3-5%
INTENSIVE CARE 5-25%
OPEN HEART SURG 5-20%
AMINOGLYCOSIDE 10-30%
BURNS 20-60%
RHABDOMYOLYSIS 20-30%
CIS-PLATIN 15-25%
ATN SEDIMENT
DIAGNOSTIC APPROACH TO ARF
HISTORY
PHYSICAL EXAMINATION
ASSMENT OF URINE VOLUME
URINE ANALYSIS
BLOOD CHEMISTRY
BLOOD AND URINE INDICES
RADIOLOGIC STUDIES
Treatment of ARF
Hyperkalemia
Urgency
Role of the EKG in making the decision
Clinical setting in which it occurs
» Acute renal failure
» Chronic renal failure
Table 5-3. Treatment of hyperkalemia
PERICARDITIS
NEUROPATHY
MENTAL STATUS CHANGE
SEIZURES
BLEEDING
TOXINS----ETHYLENE GLYCOL,
METHANOL
PROPHYLACTIC
~recent studies fail to document benefit
MORTALITY ASSOCIATED WITH
SETTING OF ATN