Acuterenalfailure

DEFINITIONS
Acute renal failure is a sudden reduction in kidney

function that results in nitrogenous wastes accumulating in
the blood.
ETIOLOGY
Problems affecting the flow of blood before it
reaches the kidneys
1) Dehydration
vomiting, diarrhea, water pills, or blood
loss.
2) Disruption of blood flow to the kidneys .
*Major surgery with blood
loss, severe injury or burns, or infection
in the bloodstream.
* Blockage or narrowing of a blood vessel
carrying blood to the kidneys.
* Heart failure or heart attacks causing low blood flow.
* Liver failure causing changes in hormones that affect blood

flow and pressure to the kidney
Problems affecting the movement of urine out of the
kidneys.
a) Kidney stone: usually only on one side.

b) Cancer of the urinary tract organs or structures near
the urinary tract that may obstruct the outflow of
urine.
c) Medications.
d) Bladder stone.
e)Benign prostate hyper plasia (the most common cause in
men).
f) Blood clot.
g)Bladder cancer.
 Renal Problems with the kidney itself that prevent
proper filtration of blood or production of urine(25-
40%).
Blood vessel diseases
Blood clot in a vessel in the kidneys
Injury to kidney tissue and cells
Glomerulo nephritis
e.g, Streptococcal bacterial infections may
damage the glomeruli.
Acute interstitial nephritis
1)Medications such as antibiotics, anti-
inflammatory medicines (for example, aspirin, brufen), and
water pills .
2) infections and immune-related diseases such as
lupus
, leukemia, lymphoma, and sarcoidosis.
Acute tubular necrosis
Causes include shock (decreased blood supply to the
kidneys), drugs (especially antibiotics)
and chemotherapy agents, toxins and poisons, and
dyes used in certain kinds of x-rays.
Accidents, injuries
complications from surgeries (eg.Heart-bypass
surgery)
Polycystic kidney.
produce less erythropoietin
RISK FACTORS
Advanced age
Blockages in the blood vessels in your arms or legs
Diabetes
High blood pressure
Heart failure
Kidney diseases
Liver disease
Symptoms
Vomiting and/or diarrhea, which may lead to dehydration.
Nausea.
Weight loss.
Nocturnal urination.
pale urine.
Less frequent urination, or in smaller amounts than
usual, with dark coloured urine
Haematuria.
Pressure, or difficulty urinating.
Itching.
Bone damage.
Non-union in broken bones.
Muscle cramps (caused by low levels of calcium which
can cause hypocalcaemia).:
Abnormal heart rhythms.
Muscle paralysis.
Swelling of the legs, ankles, feet, face and/or
hands.
Shortness of breath due to extra fluid on the lungs
Pain in the back or side
Feeling tired and/or weak.
Memory problems.
Difficulty concentrating.
Dizziness.
Low blood pressure.
Other symptoms include
Anorexia
Pruritus
Seizures (if blood urea nitrogen level is very high)
Shortness of breath (if volume overload is present).
Decrease osmolality(A measurement of urine
concentration that depends on the number of particles
dissolved in it).
Increase urinary sodium.
Pericarditis.
Pericardial effusion.
Pleural effusion.
Decrease calcium and bicarbonate.
Defect in platelet functionings
PHASES OF
ARF
Initiating phase
Oliguric phase
Diuretic phase
Recovery phase
Diagnosis
History collection.
Physical examination.
1 Asterixis and myoclonus
2 Peripheral edema (if volume overload is present)
3 Pulmonary rales (if volume
overload is present)
4 Elevated right atrial pressure (if volume
overload is present)
Identification of precipitating cause.
Serum creatinine and BUN level .(n 7-18mg/dl)
Serum electrolytes.
Urine analysis.
Renal bladder ultra sound.
Renal scan.
CT scans and MRI scan (to identify lesion and masses)
The urine will be examined under a microscope.
biopsy
Medical and Pharmacological Treatment
 correcting fluid and electrolyte balance.
 Correct dehydration.
 Correct dehydration.
 Keeps other body systems working properly
 Furosemide, Torsemide, ethacrynic acid
 calcium gluconate
 Sodium bicarbonate
 dialysis
NUTRITIONAL THERAPY
Provide protein diet.
Calori requirements are met with high carbo-hydrate
meals (carbo-hydrates have a protein-sparing effect.
Foods and fluid containing potassium or
phosphorous (banana, coffee) are restricted.
Patient may require parenteral nutrition.
Prevention
A careful history(nephrotoxic antibiotic agent
aminoglycosides, gentamicin, tobramicine,
etc.)
blood tests and urinalysis
Drink enough fluids
Difficulties urinating or blood in the urine
should prompt a
visit
Treat hypotension promptly.
Prevent and treat infections promptly.
Pay special attention to wound, burns and other
precursors of
COMPLICATIONS
ARF can affect the entire body
Infection
Hyperkalaemia, Hyperphosphataemia,
hyponatraemia
water overload
Pericarditis
Pulmonary oedema.
Reduced level of consciousness.
Immune deficiency.
NURSING MANAGEMENT
 Excess fluid volume related to decreased Glomerular filtration

rate and sodium retention
 Risk for infection related to alterations in the immune
system and host defenses
 Imbalanced nutrition: less than body requirements
 Risk for injury related to GI bleeding
 Sleep pattern disturbances related to disease condition
 Providing skin care
 Providing support
Patient Teaching and Home Healthcare Guidelines

conclusion
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Acuterenalfailure

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DEFINITIONS

Acute renal failure is a sudden reduction in kidney

* Heart failure or heart attacks causing low blood flow.

* Liver failure causing changes in hormones that affect blood

a) Kidney stone: usually only on one side.

 Excess fluid volume related to decreased Glomerular filtration

Patient Teaching and Home Healthcare Guidelines

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