ACUTE AND CHRONIC RENAL Failure

ACUTE AND CHRONIC
RENAL
FAILURE
Mimi, Connie and Pat
Acute renal failure (ARF): is the sudden and
severe reduction in previously normal renal function,

may result from primary renal disease but is more
frequently associated with other organ failure. Failure is
often reversible, but should the kidneys fail to recover,
permanent treatment will be required.
( Alexander et al, 2000).
Chronic renal failure (CRF) is the gradual and

progressive reduction in renal function. Failure may
occur over weeks, months or even years. (Alexander et
al, 2000).
Causes
Renal failure, whether chronic or acute, is usually

categorised according to pre-renal, renal and post-renal
causes. Researchers also report finding a significant
association between smoking, heavy alcohol intake and
chronic kidney disease.
Pre-renal (causes in the blood supply):
hypotension (decreased blood supply), usually from
shock or dehydration and fluid loss.
hepatorenal syndrome in which renal perfusion is
compromised in liver failure
vascular problems, such as atheroembolic disease and
renal vein thrombosis (which can occur as a
complication of the nephrotic syndrome)
Renal (damage to the kidney itself):

infection usually sepsis (systemic inflammation due to
infection),rarely of the kidney itself, termed
pyelonephritis
toxins or medication (e.g. some NSAIDs,
aminoglycoside antibiotics, iodinated contrast, lithium)
rhabdomyolysis (breakdown of muscle tissue) - the
resultant release of myoglobin in the blood affects the
kidney; it can be caused by injury (especially crush
injury and extensive blunt trauma), statins, MDMA
(ecstasy) and some other drugs
hemolysis (breakdown of red blood cells) - the
hemoglobin damages the tubules; it may be caused
by various conditions such as sickle-cell disease, and
lupus erythematosus
multiple myeloma, either due to hypercalcemia or
"cast nephropathy" (multiple myeloma can also cause
chronic renal failure by a different mechanism)
Acute glomerulonephritis which may due to a variety of

causes, such as anti glomerular basement membrane
disease/Goodpasture's syndrome, Wegener's
granulomatosis or acute lupus nephritis with systemic
lupus erythematosus
Post-renal (obstructive causes in the urinary tract) due to:

medication interfering with normal bladder emptying.
benign prostatic hypertrophy or prostate cancer.
kidney stones.
due to abdominal malignancy (e.g. ovarian cancer,
colorectal cancer).
obstructed urinary catheter.
RENAL FAILURE SIGNS &

SYMPTOMS
Decreased urine output.

Weight gain
Uraemic symptoms of anorexia, nausea &
vomiting, fatigue, itchy skin, metallic taste in the
mouth, halitosis(bad breath).
Thirsty/dry mouth.
Breathlessness.
Fever & ankle swelling.
Congestive cardiac failure.
Confusion, twitching, irritability and convulsions.
Signs
Anuria or oluguria<400ml/day, raised urea & creatinine.

Peripheral or systemic oedema.
Weight loss, poor diet intake, dry flay skin, pale yellow
skin colour.
Raised blood pressure.
Lowered blood pressure.
Abnormal, irregular pulse.
Increased respirations.
Raised temperature.
Depressed level of consciousness or seizures.
Electrolyte imbalance.
Contd.
Initially it is without specific symptoms and can only be

detected as an increase in serum creatinine and as kidney
function decreases
Blood pressure is increased due to fluid overload and

production of vasoactive hormones leading to
hypertension and congestive heart failure.
Potassium accumulates in the blood.
Erythropoietin synthesis is decreased.
Fluid volume overload.
Hyperphosphatemia.
Metabolic acidosis.
Diagnosis.
Blood test - to find out if waste substances have been

filtered out
Urine test - to see if there is blood or protein in the urine.
Kidney scans such as MRI scan, CT scan or ultrasound to find if there are any unusual blockages in urine flow.
When kidney disease is advanced, the kidneys are
shrunken, have an uneven shape and are firm to touch.
Kidney biopsy - taking a small sample of tissue to test the
cells and look for damage
Calculating the glomerular filtration rate (GFR) - to check
how efficiently the kidneys are filtering waste, in particular
a substance called creatinine.
Treatment.
Treatment focuses on controlling the symptoms,

minimizing complications, and slowing the progression of
the disease
Three basic stages in treatment
Preserve remaining nephrons
Conservative treatment of uraemic syndrome
Renal dialysis and transplantation
Preserve remaining nephron function

Control of hypertension and heart failure
Treatment of superimposed urinary tract infection
Correction of salt and water depletion
Careful prescribing of drugs that are potentially
nephrotoxic
Dietary protein restriction
Conservative management of uraemic syndrome
Reduce protein intake
Aluminium hydroxide to reduce intestinal phosphate
absorption
Vitamin D and calcium supplements to increase serum
calcium
Allopurinol to reduce serum uric acid
Erythropoietin to correct anaemia
Dialysis is the option for ongoing treatment, often used

while waiting for a suitable transplant opportunity
Kidney transplant, in which a functioning kidney from a
donor is surgically grafted into the patient, has a good
rate of success
Differencies
Acute renal failure
Most causes of acute renal failure can be treated and the

kidney function will return to normal with time.
Replacement of the kidney function by dialysis (artificial
kidney) may be necessary until kidney function has
returned.
Chronic renal failure
Chronic kidney damage is usually not reversible and if
extensive, the kidneys may eventually fail completely.
Dialysis or kidney transplantation will then become
necessary
Another diagnostic clue that helps differentiate CRF and

ARF is gradual rise in serum creatinine (over several
months or years) as opposed to a sudden increase in the
serum creatinine (several days to weeks).
References
Alexander, M.F, Fawcett, J.N. and Ruciman, P.J.

(2000) Nursing practice Hospital & Homes. The
Adult. 2nd Edition Edinburgh. Harcourt
Publishers Limited.
Acute Renal Failure (online), Available from
www.patient.co.uk/showdoc/400006 accesses
on 07|11|2006
Redmond et al (2004): Acute renal failure:
recognition and treatment in ward patients.
Nursing Standard 18, 22, 46-53.

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ACUTE AND CHRONIC

Mimi, Connie and Pat

Acute renal failure (ARF): is the sudden and

severe reduction in previously normal renal function,

Chronic renal failure (CRF) is the gradual and

Renal failure, whether chronic or acute, is usually

Renal (damage to the kidney itself):

Acute glomerulonephritis which may due to a variety of

Post-renal (obstructive causes in the urinary tract) due to:

RENAL FAILURE SIGNS &

Decreased urine output.

Anuria or oluguria<400ml/day, raised urea & creatinine.

Initially it is without specific symptoms and can only be

Blood pressure is increased due to fluid overload and

Blood test - to find out if waste substances have been

Treatment focuses on controlling the symptoms,

Preserve remaining nephron function

Dialysis is the option for ongoing treatment, often used

Acute renal failure

Most causes of acute renal failure can be treated and the

Another diagnostic clue that helps differentiate CRF and

Alexander, M.F, Fawcett, J.N. and Ruciman, P.J.

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