1.

Prerenal failure – results from conditions that interrupt the renal blood supply;
thereby reducing renal perfusion (hypovolemia, shock, hemorrhage, burns
impaired cardiac output, diuretic therapy).
2. Postrenal failure – results from obstruction of urine flow.

Intrarenal failure – results from injury to the kidneys themselves (ischemia, toxins,
immunologic processes, systemic and vascular disorders).

Diagnostic Evaluation:

1. Urinalysis shows proteinuria, hematuria, casts. Urine chemistry distinguishes

various forms of ARF(prerenal, postrenal, intrarenal).
2. Serum creatinine and BUN levels are elevated; arterial blood gas (ABG) levels,
serum electrolytes may be abnormal.
3. Renal untrasonography estimates renal size and rules out treatable obstructive
uropathy.

Therapeutic and Pharmacologic Interventions:

1. Surgical relief of obstruction may be necessary.

2. Correction of underlying fluid excesses or deficits.
3. Correction and control of biochemical imbalances.
4. Restoration and maintenance of blood pressure through I.V. fluids and
vasopressors.
5. Maintenance of adequate nutrition: Low protein diet with supplemental amino
acids and vitamins.
 6. Initiation of hemodialysis, peritoneal dialysis, or continuous renal replacement
therapy for patients with progressive azotemia and other life-threatening
complications.

Nursing Interventions:

1. Monitor 24-hour urine volume to follow clinical course of the disease.

2. Monitor BUN, creatinine, and electrolyte.
3. Monitor ABG levels as necessary to evaluate acid-base balance.
4. Weigh the patient to provide an index of fluid balance.
5. Measure blood pressure at various times during the day with patients in supine,
sitting, and standing positions.
6. Adjust fluid intake to avoid volume overload and dehydration.
7. Watch for cardiac dysrhythmias and heart failure from hyperkalemia, electrolyte
imbalance, or fluid overload. Have resuscitation equipment available in case of
cardiac arrest.
8. Watch for urinary tract infection, and remove bladder catheter as soon as possible.
9. Employ intensive pulmonary hygiene because incidence of pulmonary edema and
infection is high.
10. Provide meticulous wound care.
11. Offer high-carbohydrate feedings because carbohydrates have a greater protein-
sparing power and provide additional calories.
12. Institute seizure precautions. Provide padded side rails and have airway and
suction equipment at the bedside.
13. Encourage and assist the patient to turn and move because drowsiness and
lethargy may reduce activity.
14. Explain that the patient may experience residual defects in kidney function for a
long time after acute illness.
15. Encourage the patient to report routine urinalysis and follow-up examinations.
16. Recommend resuming activity gradually because muscle weakness will be
present from excessive catabolism.

3. toxins, immunologic processes, systemic and vascular disorders).

Three Causes
1. Prerenal azotemia (decrease of renal blood flow)
2. Renal azotemia (intrinsic renal parenchymal disease)
3. Postrenal azotemia (obstruction of urine flow)