acute renal failure-ppt2

8/9/2019 Acute Renal Failure-ppt2

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ACUTE RENAL FAILURENARCISO A. CAIBAN


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P RERENAL ARF

In prerenal acute renalfailure, the problem isimpaired renal blood flow as

a result of true intravascular depletion, decreasedeffective circulating volumeto the kidneys or agents that

impair renal blood flow.


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CAUSES:1) Intravascular volume depletion

2. Decreased cardiac output

3)Renal sodium loss

4)Extrarenal sodium loss

5)Cutaneous loss

6)"Third-spacing " (low effectivearterial volume )

7)Drug effects: NSAIDs, ACEinhibitors, cyclosporine.

8)Hepatorenal syndrome:


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RISK FACTORS:

Atherosclerosis

Blood loss

Chronic liver disease

Heart disease


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IS IT REVERSIBLE

OR NOT???


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REVERSIBLE !!!


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INTRINSIC ARF

This type involvesdamage or injury within bothkidneys. Intrinsic ARF

accounts for approximately40% of the cases of acuterenal failure. The mostcommon cause is ATN or

acute tubular necrosis.


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1.Ischemia

2. Nephrotoxins: Antibiotics (aminoglycosides )Radiocontrast agentsEndogenous toxins (myoglobin,

hemoglobin, myeloma lightchains, uric acid )

3. Vascular events: Atheroembolic disease,

Renal artery stenosis/thrombosis,

Vasculitis4. Acute glomerulonephritis

5. Acute interstitial nephritis


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P OSTRENAL ARF

Postrenal ARF is causedby an acute obstruction thataffects the normal flow of

urine out of both kidneys.The blockage causespressure to build in all of therenal nephrons (tubular

filtering units that produceurine ). The excessive fluidpressure ultimately causesthe nephrons to shut down.


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U pper tract obstructiony intratubular: urate, myeloma lightchains, acyclovir, methotrexate (Cancrystallize and cause obstruction. )y intrapelvic: stones, clots, tumorsy intraureter: stones (unilateralusually )Female reproductive system:pregnancy (functional effect of fetuspushing on ureter ) , tumors(cervical, ovarian ).Gastrointestinal tract: diverticular disease , malignancy, abscessesRetroperitoneal processes: fibrosis,tumorsLower tract obstruction bladder:blood clots, stones, tumors,Neurogenic, BP H.


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PH ASES OF ARF

INITIATION

OLIGU RIC

DIU RESIS

RECOVERY


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The initiation phase beginswith onset of renal injury andcontinues through onset of oliguria


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Rise in the serum concentration of substances usually excreted by thekidneys :

urea, creatinine, uric acid, inorganicacids and the intracellular cations(potassium and magnesium )

Hyperkalemia develops

Minimum needed for elimination of metabolic waste products 400 ml /day

U remic symptoms appear

Nonoliguric forms are found after nephrotoxic antibiotics, burns,traumatic injury, halogenated

anesthetic agents


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Gradually the urinary outputincreases because theglomerular filtration hasstarted recovering

Laboratory values stop rising

U remic symptoms maycontinue

Watch for dehydration


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Improvement in renalfunction

May take 3 to 12 months

Lab values return to normalgradually


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IS PRERENAL ARFOLIG U RIC OR NOT?


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OLIG U RIC


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A client suffering from acute renal failurehas an unexpected increase in urinaryoutput to 150ml/hr. The nurse assessesthat the client has entered the third phaseof acute renal failure. Nursing actions

throughout this phase includeobservation for signs and symptoms of

a. Hypervolemia, hypokalemia, andhypernatremia.b. Hypervolemia, hyperkalemia, andhypernatremia.c. Hypovolemia, wide fluctuations in serumsodium and potassium levels.d. Hypovolemia, no fluctuation in serumsodium and potassium levels.

acute renal failure-ppt2

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