DEFINITIONSudden reduction in renal functionKidneys are unable to excrete nitrogenous

waste productsPlus water and electrolyte balanceOliguric <400/m2/dayNon-oliguricARF in neonates<1ml/kg/hr

ClassificationsAcute versus chronicPre-renal, renal, post-renalAnuric, oliguric, polyuric

Acute Chronic

1. sudden onset.

2.Rapid reduction in urine output

3.Usually reversible

4.Tubular cell death and regeneration

1.Progressive2.Not reversible3.Nephron loss

4.75% of function can be lost before its noticeable

PATHOGENESISPRE-RENAL;HypovolemiaDecreased GFRIncreased ADH, increased aldosterone,

oliguria, increased blood urea and creatinineIf hypovolemia persists, ATN

RENAL;ATNRenal vasoconstriction, tubular obstruction

with debris, passive back diffusion of glomerular filterate

Acute AGN of various typesAcute interstitial nephritis

POST-RENAL;Obstruction of urinary tractATN and renal parenchymal damage

CLINICAL FEATURESOliguria, anuriaH/O vomiting, diarrhoea, feverSigns of dehydrationHemorrhage, nephrotoxic agent.Weight gainPeripheral oedemaHypertension.

Physical examinationRash; SLE, HSPFlank masses; renal vein thrombosisUremia; anorexia, nausea, hypertention, fits.Nausea/VomitingPulmonary edemaAscitesAsterixisEncephalopathy

INVESTIGATIONSCBCS/EBlood urea, s.creatinineUrine examinationUrine sodium>20mEq/L; intrinsic renal

failure, urine sodium<10mEq/L; pre-renalC3 levelMetabolic acidosis

X-ray abdIVPMCUGX-ray chestDTPA, DMSARenal biopsy

MANAGEMENTGENERAL MEASURES;IV lineSend investigationsBPIntake output recordEstablished renal failure; 400ml/m2/day10% dextrose initially300 calories/m2/day

Pre renal ARFFluid therapy; Severe dehydration;20ml/kg over ½ hrNo output, lasix 2mg/kgDopamine infusion to improve renal perfusionRenal failure with fluid overload;No IV fluid, only lasix, 2 dosesPeritoneal dialysis

MANAGEMENT OF COMPLICATIONS

Hyperkalemia;>6mEq/Li. CaLCIUMii. soda bicarb,iii. glucose plus inulin,iv. kayexalate

Acidosis; ARF, catabolism, inability to secrete hydrogen

and ammuniaSoda bicarbHypocalcemia;Calcium gluconateHyponatremia;Fluid overload, <120,3%NaCl

Hypertention; Nifedipine, IV nitroprussideSeizures;Uremia, hypertention, hypocalcemia,

hyponatremiaDiazepamInfection; cathetrization, dialysis,antibiotics

Anemia;Packed cellGI bleeding;CimetidineDIALYSIS;Peritoneal usuallyRecovery phase;diuresis

PROGNOSISCauseOliguria>3 wks, anuria, GAURDEDPRE-RENAL, HUS, ATN, goodB/L cortical necrosis, B/L renal vein

thrombosis, rapidly progressive GN; GAURDED