Acute Renal Failure1

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  • 1.ACUTE RENAL FAILURE Trish Keresztes, PhD, RN, CCRN

2. ARF: REVIEW RENAL FUNCTION

  • Regulate fluid volume.
  • Regulate electrolyte balance.
  • Regulate acid-base balance.
  • Regulate blood pressure.
  • Excrete nitrogenous waste products.
  • Produce erythropoietin.
  • Metabolism of vitamin D.

3. 4. ACUTE RENAL FAILURE

  • Precipitous and significant (>50%) decrease in glomerular filtration rate (GFR) over a period of hours to days with an accompanying accumulation of nitrogenous wastes in the body.

5. ACUTE RENAL FAILURE

  • Glomerulus: tuft of capillaries. The wall of the glomerular capillary serves as a filtration membrane with three layers
    • Inner capillary endothelium
    • Middle basement membrane
    • Outer layer of capillary epithelium

6. ACUTE RENAL FAILURE

  • The glomerular filtrate passes through the three layers of the glomerular membrane and forms the primary urine.
  • GFR: the filtration of the plasma per unit of time. Directly related to the perfusion pressure in the glomerular capillaries.

7. ACUTE RENAL FAILURE

  • Process of urine formation:
    • Glomerular filtration-> tubular reabsorption->tubular secetion->excretion.
    • Proximal tubules reabsorbs 60-70%sodium and water and 90% other electrolytes.
    • Distal tubules reabsorb sodium, secrete potassium and hydrogen ions (regulate acid base balance.

8. ACUTE RENAL FAILURE 9. ACUTE RENAL FAILURE 10. ACUTE RENAL FAILURE 11. ARF: RISKS FOR DEVELOPMENT

  • Hx DM, HTN, CV disease, calculi.
  • Family history calculi, HTN.
  • Hypotensive episodes.
  • Drugs with potential for nephrotoxicity.
  • Major trauma, crushing injuries, severe allergic reactions.

12. Acute Renal Failure

  • Occurs in 4% of all hospital admissions.
  • Occurs in 20% of those admitted into critical care units.
  • Mortality rate 50% overall.
  • Mortality rate for hospital acquired ARF is 70%.

13. Pathophysiology

  • Glomerular pressure is primarily dependant upon renal blood flow.
  • Depressed renal blood flow eventually leads to ischemia and tubular cell death.
  • As tubular cells die, they slough off into the tubules and form obstructing casts which further decrease GFR and lead to oliguria.

14. ACUTE RENAL FAILURE

  • Azotemia: refers to an abnormally high level of nitrogenous wastes (urea nitrogen, uric acid, creatinine) in the blood related to a decrease in the GFR.
  • Uremia: a clinical syndrome that comprises the signs and symptoms associated with end stage renal disease.

15. ARFCAUSES

  • Prerenal: decreased blood flow to the kidney.
  • Intrarenal: Direct damage to the kidney parenchyma.
  • Postrenal: Obstruction to the flow of urine which may cause hyronephrosis.
  • Before-within-after the kidney.

16. ARF PRERENAL CAUSES

  • Inadequate intravascular volume:hypovolemia
    • Fluid loss from N/V
    • Hemorrhage
    • Excessive diuresis
  • Redistribution of blood volume
    • Peripheral vasodilation with sepsis
    • Third spacing

17. ARF PRERENAL CAUSES

  • Reduced cardiac output
    • Acute MI -> cardiogenic shock
    • CHF
    • Cardiac tamponade
  • Renal artery thrombosis
  • Interruption of blood flow during surgery

18. ARF INTRARENAL CAUSES

  • Acute Tubular Necrosis most common form
  • ATN: Prolonged ischemic damage: MAP