ACUTE RENAL FAILURE.

ARF

It is the sudden decrease in the kidney

functions leading to retention of
nitrogenous waste products ,disturbance
of water excretion and acid-base
disturbance.

;ETIOLOGY

PRE-RENAL CAUSES -1
;Causes leading to decrease renal perfusion

A-Hypovolemia ; Hge , severe dehydration

.,burns ,and nephrotic syndrome
B-Hypoxia ;neonatal asphyxia ,severe chest
.infection and post cardiac surgery
C-Hypotension ;cardiomyopathy ,long standing
.heart failure , and septicemia

;Renal-2

;The lesions in the kidney

APSGN .HUS ,HSP ,PYLONEPHRITIS and

.NEPHROTOXINS

;Post-renal-3

;It is due obstruction of urine flow

in the kidney due to heavy crystalluria-

.PUJ-
.MEGAURETER-
.URETERIC STENOSI-
.BLADDER NECK OBSTRUCTION-
.POSTERIOR URETHERAL VALVE-
.SPINA BIFIDA

;PATHOGENESIS

Fluid disturbance-1
fluid depletion and hypovolemia as in -
.pre-renal
fluid overload in renal and post-renal -

;Biochemical disturbances-2

.Hyperkalemia-
.Hyponatremia-
.Metabolic acidosis-
.Hypocalcemia-
;Retention of waste products-3
More than 100 toxic waste products are
retended urea,creatinine ,phenol,sulphoric
.acid

;CLINICAL PRESENTATIONS
;General manifestations-1
Fatigability ,drowsiness ,nausea ,vomiting headache
,furred tongue ,hiccough ,and lately convulsions
.and coma
;Specific manifestations-2
dehydration,hypotesion,and shock in pre-renal-
.type

.Oliguria and even anuria-

.Hypertension-
.Manifestations of metabolic acidosis-
Manifestations of hyponatremia ,hypocalcemia,and-
.hyperkalemia
;Investigations-3
.Increase BUN ,and serum creatinine

TREATMENT

;Treatment of the pre-renal type-1

.Hge ------blood transfusion-
.dehydration -------I,V fluid-
burns & nephrotic syndrome ---I,V albumin-
control infections by proper antibiotics .in cases-
.of septicemia
Fluid intake in renal type should be calculated-2
;as

Insensible water loss(400 c.c /m2) +volume of urine

of previous day +ongoing losses( vomiting ,diarrhea ,
or fluid of nasogastric tube or chest tube.)

Hyperkalemia-3
+Elimination of any diet or drugs containing K -
I.V ca.gluconate10% dose o.5 c,c/kg over 1o-
.minutes
.Sod.bicarbonate 8.4% dose 1-2 c.c/kg-
,Glucose & regular insulin glucose 0.5 gm/kg-
.Regular insulin 0.1 unit /kg
Ion exchange resin (ca.resonium) 1.0 gm/kg-
.Orally or per rectum
.Dialysis-

Hyponatremia; fluid containing sodium -4

.
,dialysis

.Metabolic acidosis ; sod.bicarbonate-5

.dialysis
;Indication of dialysis
.circulatory overload and pulmonary edema-1
Hyperkalemia more than 7 mEq/L or intactable-2
.Hyperkalemia
.Intractable metabolic acidosis-3
.intractable hyponatremia-4
Severe heart failure and intractable hypertension-5

.High BUN and high serum creatinine-6

.DIALYSIS
;Dialysis may be
.Peritoneal dialysis-1
.Hemodialysis-2

.PERITONEAL DIALYSIS

.HEMODIALYSIS