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Clinical Manifestations with diagnostics

The initiation/Onset phase begins with the initial insult and ends when oliguria develops.
o Begins at time of renal insult
o Continues until S & S are apparent
o Duration: hours to days
Prerenal Failure

Hemorrhage
Renal losses
Gastrointestinal losses
Myocardial infarction
Heart failure
Dysrhythmias
Cardiogenic shock
Vasodilation resulting
from:
Sepsis
Anaphylaxis

Intrarenal Failure

Myoglobinuria
Hemoglobinuria Nephrotoxic
agents such as:
Aminoglycoside antibiotics
Radiopaque contrast agents
Heavy metals
Solvents and chemicals
(NSAIDs)
(ACE inhibitors)
Infectious processes such as:
Acute pyelonephritis
Acute glomerulonephritis

Postrenal Failure

Urinary tract
obstruction,
including: Calculi
(stones)
Tumors
Benign prostatic
hyperplasia
Strictures
Blood clots

Causes

The Oliguric phase is accompanied by an increase in the serum concentration of substances


usually excreted by the kidneys (urea, creatinine, uric acid, organic acids, and the intracellular
cations [potassium and magnesium]).
o Urine production of < 400 ml in 24 hours
o Oliguria is often the initial manifestation of ARF caused by reduction in GFR
o Occurs within 1 to 7 days of precipitating event
o Duration: 10 to 14 days, but can last months
o The longer this phase, the poorer the prognosis of regaining renal function
o Some patients have decreased renal function with increasing nitrogen retention, yet
actually excrete normal amounts of urine (2 L/day or more). This is the nonoliguric form
of renal failure and occurs predominantly after exposure of the patient to nephrotoxic
agents, burns, traumatic injury, and the use of halogenated anesthetic agents.
Manifestation
^Elevated blood urea nitrogen and serum creatinine levels
^Decreased urine spec. gravity (prerenal causes) OR normal levels (intrarenal causes)
^Decreased glomerular filtration rate and creatinine clearance
^Hyperkalemia
^Normal or decreased serum sodium level
^hypervolemia

^hypocalcemia
^hyperphosphatemia

The Diuretic phase is marked by a gradual increase in urine output, which signals that glomerular
filtration has started to recover.
o Urine production occurs
o Osmotic diuresis from high urea levels and kidneys inability to concentrate urine
o Initial urine output of 1-3 liters/day and may increase to 3-5 liters/day
o Duration: 1 to 3 weeks
o Acid-base, electrolyte, BUN and creatinine values begin to normalize as phase ends
Manifestation
^Gradual decline in blood urea nitrogen and serum creatinine levlles, but still
elevated
^Continued low creatinine clearance with improving glomerular filtration rate
^Hypokalemia
^Hyponatremia
^hypovolemia
The Recovery phase signals the improvement of renal function.
o Begins when the GFR increases, lthough a permanent 1% to 3% reduction in the GFR is
common, it is not clinically significant.
o BUN and creatinine levels plateau and then decrease
o Duration: lasts up to 12 months
o Some patients never reach this phase and progress to chronic renal failure
Manifestation
^Increased glomerular filtration rate
^Stabilization or continual decline in blood urea nitrogen and serum creatinine levels
toward normal
^Complete recovery (may take 1 to 2 years)