Acute Renal Failure

2. Renal failure results when the
kidneys cannot remove the body’s
metabolic wastes or perform their
regulatory functions.
The substances normally
eliminated in the urine accumulate
in the body
fluids as a result of impaired renal
excretion, leading to a disruption
in endocrine and metabolic
functions as well as fluid,
electrolyte,
and acid–base disturbances.

3. Renal failure is a systemic disease and is a
final common pathway of many different
kidney and urinary tract diseases.
ARF is A condition in which the kidneys
suddenly can't filter waste from the blood.
Acute renal failure develops rapidly over a
few hours or days. It may be fatal.
Chronic kidney disease (CKD) is a type of kidney
disease in which there is gradual loss of kidney
function over a period of months to years. Initially
there are generally no symptoms; later, symptoms
may include leg swelling, feeling tired, vomiting,
loss of appetite, and confusion.

5. ARF is A condition in which the kidneys
suddenly can't filter waste from the blood.
Acute renal failure develops rapidly over a
few hours or days. It may be fatal.
Acute renal failure (ARF) is a sudden and
almost complete loss of kidney function
(decreased GFR) over a period of hours to
days.

6.  Incidence of acute renal
failure was 3.1%. There were
118 (87.4%) males and average
length of stay was 9 (1, 83)
days.

9. Initiation
Oliguria
Diuresis
Recovery
 Initiation
 The initiation period begins with the initial insult and ends
when oliguria develops.
 The oliguria period is accompanied by a rise in the serum
concentration of substances usually excreted by the kidneys
(urea, creatinine, uric acid, organic acids, and the
intracellular cations [potassium and magnesium]).
 The minimum amount of urine needed to rid the body of
normal metabolic waste products is 400 mL.
 In this phase uremic symptoms first appear and life
threatening conditions such as hyperkalemia develop

10.  Oliguria
Oliguric (anuric) phase: Urine output decreases
from renal tubule damage
 Diuresis
 In the diuresis period the third phase, the patient experiences
gradually increasing urine output, which signals that glomerular
filtration has started to recover.
 Laboratory values stop rising and eventually decrease.
 Although the volume of urinary output may reach normal or
elevated levels, renal function may still be markedly abnormal.
Because uremic symptoms may still be present,
 the need for expert medical and nursing management continues.
 The patient must be observed closely for dehydration
 during this phase; if dehydration occurs, the uremic symptoms
 are likely to increase

11.  Recovery
 The recovery period signals the improvement of renal function
and may take 3 to 12 months.
 Laboratory values return to
 the patient’s normal level.
 Although a permanent 1% to 3% reduction in the GFR is
common, it is not clinically significant.

13.  Patient may
 Appear critically ill
 Lethargic
 Persistent nausea
 Vomiting,
 Diarrhea
 The skin and mucous membranes are dry
 From dehydration
 The breath may have the odor of urine
 (Uremic fetor)
 Central nervous system signs and symptoms
include
 Drowsiness
 Headache
 Muscle twitching
 Seizures.

15.  HISTORY TAKING
 PHYSICAL EXAMINATION
 Urine output measurements. Measuring how much you urinate in 24
hours may help your doctor determine the cause of your kidney failure.
 Urine tests. Analyzing a sample of your urine (urinalysis) may reveal
abnormalities that suggest kidney failure.
 Blood tests. A sample of your blood may reveal rapidly rising levels of
urea and creatinine — two substances used to measure kidney function.
 Imaging tests. Imaging tests such as ultrasound and computerized
tomography may be used to help your doctor see your kidneys.
 Removing a sample of kidney tissue for testing. In some situations,
your doctor may recommend a kidney biopsy to remove a small sample
of kidney tissue for lab testing. Your doctor inserts a needle through your
skin and into your kidney to remove the sample.

17. Goal
 Preserve kidney function
 Treating the effects
 Prevent the complications
promptly
 Restoration of kidney function

18. Maintain fluid & Electrolytes
 It’s the Key to survival
 Fluid replacement shoud be done carefully to
avoid the fluid over load
 Fluid therapy – Output+ amount (400 ml )
 0.2-0.5 kg Weight loss is success indicator for
fluid therapy
 Diuretic therapy- Furosemide
 Electrolyte balance related to the electrolyte
concentration – K+, Mg
 Metabolic acidosis – Dialysis

19. Renal replacement therapy
 Dialysis – Hyperkalaemia, acidosis Uraemia,
Altered CNS Function

20. Prevent infections
 Monitor infectious process closely
 Catheter associated infections

21.  Treatments to balance the amount of fluids in your blood. If your acute kidney
failure is caused by a lack of fluids in your blood, your doctor may recommend
intravenous (IV) fluids. In other cases, acute kidney failure may cause you to have
too much fluid, leading to swelling in your arms and legs. In these cases, your
doctor may recommend medications (diuretics) to cause your body to expel extra
fluids.
 Medications to control blood potassium. If your kidneys aren't properly filtering
potassium from your blood, your doctor may prescribe calcium, glucose or sodium
polystyrene sulfonate (Kionex) to prevent the accumulation of high levels of
potassium in your blood. Too much potassium in the blood can cause dangerous
irregular heartbeats (arrhythmias) and muscle weakness.
 Medications to restore blood calcium levels. If the levels of calcium in your blood
drop too low, your doctor may recommend an infusion of calcium.
Pharmacological management
Dialysis

22. The prognosis is poor. At least 80% of people
who are not treated develop end-stage kidney
failure within 6 months. The prognosis is
better for people younger than 60 years

24.  Ineffective breathing pattern related to the inflammatory process.
 Altered urinary elimination related to decreased bladder capacity
or irritation secondary to infection.
 Excess fluid volume related to a decrease in regulatory
mechanisms (renal failure) with the potential of water.
 Risk for infection related to a decrease in the immunological
defense.
 Imbalanced nutrition less than body requirements related
to anorexia, nausea, vomiting.
 Risk for impaired skin integrity related to edema and pruritus.
 Hyperthermia related to the ineffectiveness of thermoregulation
secondary to infection.

26. The prognosis is poor. At least 80% of people
who are not treated develop end-stage kidney
failure within 6 months. The prognosis is
better for people younger than 60 years

27.  Renal failure
 Encephalopathy,
 Heart failure
 Pulmonary
edema

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