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    Acute Renal Failure-1-1

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    Acute Renal Failure-1-1

    Uploaded by

    dekexom965
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    Acute Renal Failure-1-1 (1)

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    3 views6 pages

    Acute Renal Failure-1-1

    Uploaded by

    dekexom965

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    © All Rights Reserved
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    of 6

    Acute kidney injury

    Definition:
    Acute renal failure is defined as the rapid decrease in renal function which is
    reversible.
    Signs and symptoms
    Clinical
    Nausea and vomiting
    Dyspnea
    Reduced urine output, characterized by <0.5 ml/kg/hour for more than 6
    hours.
    Biochemical
    Elevated serum creatinine level
    Metabolic acidosis
    Pulmonary edema
    Hyperkalemia
    Classification:
    Based upon the causes AKI can be classified into
    1. Pre renal
    2. Intrinsic
    3. Post renal
    1. Pre renal:
    It is an adaptive response to severe volume depletion and hypotension, with
    structurally intact nephrons
    1. Hypotension
    2. Hemorrhage
    3. Volume Depletion
    4. Congestive heart failure
    5. Renal artery occlusion (Stenosis, Thrombosis)
    6. Trauma with hypovolemia,
    7. Low cardiac output
    8. Cardiac or major vascular surgery
    9. Shock of any type (anaphylactic, hemorrhagic, Septic shock or
    hypovolemic)
    10. And rhabdomyolysis
    2. Intrinsic
     It is caused in response to cytotoxic, ischemic, or inflammatory insults to the
    kidney, with structural and functional damage of one or more of the
    following
     Glomeruli
     Blood vessels
     Tubules
     Interstitium
     Glomerular Damage
    1. Poststreptococcal glomerulonephritis
    2. Idiopathic rapidly progressive glomerulonephritis
     Blood Vessels damage
    1. Vasculitis
    2. Thrombocytic thrombopenic purpura
     Damage of Interstitium
    1. Acute allergic interstitial nephritis
    2. Infections
    3. NSAIDs
    4. Penicillins
     Damage of Tubules
    1. Hypotension
    2. Drugs (aminoglycoside)
    3. Multiple myeloma
    4. Radio-contrast agents
    3. Post renal
     Post renal is due to obstruction of urine flow in the urinary tract.
     Urinary tract obstruction can be because of the following reasons
    1. Nephrolithiasis (Renal stone disease)
    2. Benign prosthetic hyperplasia
    3. Obstructed urinary catheter
    4. Narrowing of ureter (Ureteral stricture)
    5. Prostate cancer
    Acute renal failure classification by urine volume:
    1. Non oliguric: >500 mL/24 Hrs
    2. Oliguric: <400 mL/ 24 Hrs
    3. Anuric: <100 mL/24 Hrs
    Diagnosis
     Serum Creatinine
     Blood Urea Nirtogen
     Urine Output
     Urine analysis
     Dysmorphic RBCs or RBC casts is diagnostic of glomerulonephritis or
    vasculitis
     Heavy proteinuria suggests glomerular disease
     The finding of WBC casts can suggest either interstitial nephropathy or
    infection
     A urinalysis that yields no abnormal findings can also provide important
    diagnostic information, suggesting that ARF is prerenal or obstructive
     Ultra-Sound is a rapid, noninvasive imaging study to look for obstruction,
    stones, cysts, masses, or renovascular disease.
    Biomarkers
    1. Neutrophil gelatinase-associated lipocalin (NGAL)
    2. Kidney injury molecule 1 (KIM-1)
    3. Interleukin 18 (IL-18)
    4. β-trace protein (BTP)
    5. Serum cystatin C
    Prevention:
    ⚫ Maintain BP and Volume
    ⚫ Avoid Urinary catheter where ever possible
    ⚫ Avoid nephro-toxic drugs
    ⚫ Using alternative imaging techniques such as MRI scanning should be
    considered in patients at high risk for contrast.
    Treatment:
    ⚫ Treat / Remove the Cause
    ⚫ Restore adequate circulating Volume
    ⚫ Restore adequate blood pressure
    ⚫ Control fluid intake
    ⚫ Correct prerenal/postrenal factors
    ⚫ Optimise Renal Blood Flow
    ⚫ Nutritional support
    ⚫ Treat infection, bleeding
    ⚫ Start dialysis before uremic complications.
    ⚫ Renal Replacement therapy in case of Hyperkalemia/ Metabolic acidosis/
    signs of uremia.
    Indications of Renal Replacement therapy in AKI:
    1. Acidosis
    2. Electrolyte imbalance
    3. Intoxication
    4. Overload of volume
    5. Uremia

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