Acute renal failure (ARF) refers to the abrupt loss of kidney function.

Over a period of hours to a few days, the GRF falls, accompanied by concomitant rise in serum creatinine and urea nitrogen. A healthy adult eating a normal diet needs a minimum daily urine output of approximately 400 ml to excrete the bodys waste products through the kidneys. An amount lower than this indicates a decreased GFR. ARF affects approximately 1% of patients on admission to the hospital, 2% to 5% during the hospital stay, 4% to 15% after cardiopulmonary bypass surgery and 10% of cases acute renal failure occurs in isolation (i.e. single organ failure).

Causes

Contents [hide] 1 Causes 2 Manifestations 3 Diagnostic Procedures 4 Medical Management

Prerenal Hypovolemia Heart failure Hemorrhage Excessive diarrhea Vomiting Diuresis

Intrarenal Acute tubular necrosis Postrenal Kidney stones Tumor Spinal cord injury

Benign Prostatic Hypertrophy

Manifestations
Anemia decreased in erythropoietin and bleeding Bleeding result from hypocalcemia and altered pH function because of increase in BUN Pruritus accumulation of waste products in the blood excreted in the skin. Neurologic manifestations because of uremic encephalopathy, hypocalcemia and elevated BUN Constipation because of the use of phosphate binders, immobility, fluid restrictions Fatigue because of anemia Pathologic fractures because of hypocalcemia and hyperparathyroidism

Diagnostic Procedures
Urine tests Urinalysis: Analysis of the urine affords enormous insight into the function of the kidneys. Twentyfourhour urine tests: This test requires you to collect all of your urine for 24 consecutive hours. The urine may be analyzed for protein and waste products (urea nitrogen and creatinine). The presence of protein in the urine indicates kidney damage. The amount of creatinine and urea excreted in the urine can be used to calculate the level of kidney function and the glomerular filtration rate (GFR). Glomerular filtration rate (GFR): The GFR is a standard means of expressing overall kidney function. As kidney disease progresses, GFR falls. The normal GFR is about 100140 mL/min in men and 85115 mL/min in women. It decreases in most people with age. The GFR may be calculated from the amount of waste products in the 24hour urine or by using special markers administered intravenously. Patients are divided into five stages of chronic kidney disease based on their GFR. Urine Specific Gravity This is a measure of how concentrated a urine sample is. A concentrated urine sample would have a specific gravity over 1.030 or 1.040 Blood tests Creatinine and urea (BUN) in the blood: Blood urea nitrogen and serum creatinine are the most commonly used blood tests to screen for, and monitor renal disease. Creatinine is a breakdown product of normal muscle breakdown. Urea is the waste product of breakdown of protein. The level of these substances rises in the blood as kidney function worsens.

Electrolyte levels and acidbase balance: Kidney dysfunction causes imbalances in electrolytes, especially potassium, phosphorus, and calcium. High potassium (hyperkalemia) is a particular concern. The acidbase balance of the blood is usually disrupted as well.

Decreased production of the active form of vitamin D can cause low levels of calcium in the blood. Inability to excrete phosphorus by failing kidneys causes its levels in the blood to rise. Blood cell counts: Because kidney disease disrupts blood cell production and shortens the survival of red cells, the red blood cell count and hemoglobin may be low (anemia). Some patients may also have iron deficiency due to blood loss in their gastrointestinal system. Other nutritional deficiencies may also impair the production of red cells. Other tests Ultrasound: Ultrasound is often used in the diagnosis of kidney disease. An ultrasound is a noninvasive type of test.

In general, kidneys are shrunken in size in chronic kidney disease, although they may be normal or even large in size in cases caused by adult polycystic kidney disease, diabetic nephropathy, and amyloidosis. Biopsy: A sample of the kidney tissue (biopsy) is sometimes required in cases in which the cause of the kidney disease is unclear. Usually, a biopsy can be collected with local anesthesia only by introducing a needle through the skin into the kidney.

Medical Management
I. Promote Fluid and Electrolyte and Acid Base Balance A. Fluid Balance Monitor fluid volume status Weight most accurate indicator (daily) Input and Output monitoring Assessment of skin turgor and mucous membrane Fluid restrictions Amount of fluids to be taken per day (400 ml (insensible fluid loss) + previous days urine output. Moisten the lips, give ice chips Diuretic therapy Furosemide and Mannitol are often use

B. Electrolyte Balance 1. Hyperkalemia impaired potassium excretion; indication for dialysis; result from metabolic acidosis If there is Emergency Hyperkalemia give 50% dextrose and regular insulin Can give sodium bicarbonate for acidosis Client can be given with Sodium Polystyrene Sulfonate (Kayexalate) can be given with Sorbitol to promote evacuation; can be given orally or rectally Avoid salt substitutes

2. Hyponatremia restriction of fluids Fluid restrictions 3. Hypocalcemia decreased activation of Vit. D; hyperphosphatemia Calcium Carbonate, Calcium Lactate and Vitamin D Emergency Hypocalcemia give Calcium Gluconate IV 4. Hyperphosphatemia impaired excretion of Phosphate by the kidneys in the urine Phosphate binders they bind phosphate in the GI tract for excretion Aluminum hydroxide cause constipation so stool softener maybe given Aluminum Carbonate if use for a long period, this can caused dementia Calcium base phosphate binders excrete phosphorus but increased Ca. Calcium Carbonate Calcium Acetate

5. Hypermagnesemia impaired excretion of Magnesium by the kidneys Magnesium mainly excreted in the urine; seen in antacids or enemas Diuretic therapy Avoid magnesium containing antacids or enemas

Emergence Hypermagnesemia Give Calcium Gluconate

C. Acid Base Balance Metabolic Acidosis Impaired hydrogen ion excretion Increased excretion of bicarbonate Accumulation of urea, creatinine and uric acid Hyperkalemia Give Sodium Bicarbonate alkalinic meds Give Sodium Lactate alkalinic meds Give Shohls solution treatment of metabolic acidosis; caused stomatitis

II. Reserve Renal Function Dopamine Hydrochloride to dilate renal arteries promoting renal perfusion Control of hypertension with the use of ACE inhibitors, diet and weight control

III. Optimal Nutrition High CHO diet to spare CHON metabolism Low CHON diet but with essential amino acids (50 proteins); 50 mg/day Serve foods in small amount because of nausea, anorexia and stomatitis

IV. Improve Body Chemistry Dialysis Hemodialysis Peritoneal dialysis

Kidney Transplantation

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