Acute Renal Failure1
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Transcript of Acute Renal Failure1
- 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%.
- 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.
- 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
- Excessive diuresis
- Redistribution of blood volume
- Peripheral vasodilation with sepsis
- Third spacing
17. ARF PRERENAL CAUSES
- Reduced cardiac output
- Acute MI -> cardiogenic shock
- 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