Acute Renal

Failure
Definition
Acute kidney injury, previously known as acute
renal failure, denotes a sudden and often
reversible reduction in kidney function, as
measured by increased creatinine or decreased
urine volume.

Etiology
The impetus for glomerular filtration is the
difference in the pressures between the
glomerulus and the Bowman space
-prerenal
-renal
-postrenal
Risk Factors

01 02 03
Being hospitalized Advance age Blockages in the
blood vessels in arms
or legs

04 05 06
Diabetes Heart failure
High blood pressure
Clinical Manifestation

diarrhea nausea vomitting NSAID or other

nefrotoxin meds

Chronic fatigue anorexia polyuria pruritis

Physical Examination

Skin livedo reticularis, digital ischemia, butterfly rash, and purpuras to suggest vasculitis.

jaundice in liver disease, band keratopathy in multiple myeloma, signs of diabetes

Eyes and ears mellitus, atheroemboli in retinopathy, and signs of hypertension

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Irregular rhythm may indicate electrolyte imbalance-related arrhythmias. Pericardial

Cardiovascular system friction rub in uremic pericarditis.
Evalution
Renal function test Basic metabolic panel Serum and urine
Increased of creatinine Urine protein, urine protein
osmolality, and urine
albumin to creatinine ratios
electrophoresis
(SPEP and UPEP)

Urine sediment
Renal Ultrasound CT non-contrast
examination
Obstruction Used to look for
nephrolithiasis or urolithiasis muddy brown casts seen in
acute tubular necrosis
Management
Non medicine:
● limit the dietary ingestion of potassium and phosphorus
● Insulin and IV dextrose
● Dialysis for nonresponsive hyperkalemia

Medicine:
● beta-agonists
● Calcium gluconate to stabilize the cardiac membrane
● IV furosemide
Complication
● Fluid buildup. Acute kidney failure may lead to a buildup of fluid in your lungs, which can cause
shortness of breath
● Chest pain. If the lining that covers your heart (pericardium) becomes inflamed, you may
experience chest pain
● Muscle weakness. When your body's fluids and electrolytes — your body's blood chemistry — are
out of balance, muscle weakness can result
● Permanent kidney damage. Occasionally, acute kidney failure causes permanent loss of kidney
function, or end-stage renal disease
● Death. Acute kidney failure can lead to loss of kidney function and, ultimately, death
Education
● Pay attention to the label when taking over-the-counter (OTC) pain relievers. Follow the
directions for over-the-counter pain relievers, such as aspirin, acetaminophen (Tylenol, others),
ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve, others). Taking too much of these
medications can increase the risk of kidney injury. This is especially true if you already have kidney
disease, diabetes, or high blood pressure

● Work with your doctor to manage kidney and other chronic conditions. If you have kidney
disease or another condition that increases your risk of acute kidney failure, such as diabetes or
high blood pressure, stay on track with treatment goals and follow your doctor's recommendations
to manage your condition.

● Make a healthy lifestyle a priority. Be active; eat a sensible, balanced diet; and drink alcohol only
in moderation — if at all
Resources
● Ferri FF. Acute kidney injury. In: Ferri's Clinical Advisor 2020.
Elsevier; 2020
● Goldman L, et al., eds. Acute kidney injury. In: Goldman-Cecil
Medicine. 26th ed. Elsevier; 2020
● Negi S, et al. Acute kidney injury: Epidemiology, outcomes,
complications, and therapeutic strategies. Seminars in
Dialysis. 2018
● Goyal A, Daneshpajouhnejad P, Hashmi MF, et al. Acute
Kidney Injury. [Updated 2023 Nov 14]. In: StatPearls
[Internet]. Treasure Island (FL): StatPearls Publishing; 2023