Acute Renal Failure

ACUTE RENAL FAILURE Presented by….. Lt Ritu Dagur

Definition 

Acute renal failure (ARF) is defined as a precipitous and significant (>50%) decrease in glomerular filtration rate (GFR) over a period of hours to days, with an accompanying accumulation of nitrogenous wastes in the body.

Pathophysilogy 

It manifests with oliguria,anuria or normal urine volume

CATEGORIES OF ARF 

PRERENAL

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INTRARENAL

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POSTRENAL

CAUSES 

PRERENAL  Volume

depletion resulting from Hemorrahage  Renal loss(diuretic,osmotic diuresis)  Gastrintestinal losses (vomiting,diarrhae,nasogastric suction)

Impaired cardic efficency resulting from: Myocardial infarction  Heart failure  Dyshythmias  Cardiogenic shock 

Vasodilation resulting from: Sepasis  Anaphylaxis  Antihypertensive medication or other mediction that causes vasodilation 

INTRARENAL FAILURE      

Prolonged renal ischemia resulting :Pigment nephrophy Myoglobinuria(trauma,crush injuries,burns) Hemoglobinuria(trauma,crush injuries,burns) Nephrotoxic agents such as:Aminoglycoside antibiotics(gentamicin,tobramycin)

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Radiopaque contrast agents Heavy metals (lead, mercury) Solvents and chemical(etylnene glycol,carbon tetrachloride,arsenic) Nonsteroidal anti inflammatory drugs(NSAIDs) Angiotensin-converting enzyme inhibitors(ACE inhibitors)

CLINICAL MANIFESTATION       

Changes in urine Changes in kidney contour Incresed bun and cretinine levels(Azotenia) Hyperkalemia Metabolic acidosis Calcium and phoshorus abnormalites Anemia

MEDICAL MANAGEMENT

NUTRITIONAL THERAPY