Approach to Acute renal failure

Posted by e-Medical PPT Friday, October 5, 2012
Acute renal failure (ARF) or acute kidney injury (AKI)
Deterioration of renal function over a period of hours to days, resulting in
the failure of the kidney to excrete nitrogenous waste products and
to maintain fluid and electrolyte homeostasis
ARF Rapid deterioration of renal function
(increase of creatinine of >0.5 mg/dl in <72hrs.)
“azotemia” (accumulation of nitrogenous wastes)
elevated BUN and Creatinine levels
decreased urine output (usually but not always)
Oliguria:  <400 ml urine output in 24 hours
Anuria: <100 ml urine output in 24 hours

It occurs in
5%of all hospitalized patients and
35% of those in intensive care units
Mortality is high:
up to 75–90% in patients with sepsis
35–45% in those without

Pre-renal AKI
Volume depletion
Renal losses (diuretics, polyuria)
GI losses (vomiting, diarrhea)
Cutaneous losses (burns, Stevens-Johnson syndrome)
Hemorrhage
Pancreatitis

Decreased cardiac output
Heart failure
Pulmonary embolus
Acute myocardial infarction
Severe valvular heart disease
Abdominal compartment syndrome (tense ascites)

Post-renal AKI
Ureteric obstruction
Stone disease,
Tumor,
Fibrosis,
Ligation during pelvic surgery

Bladder neck obstruction
Benign prostatic hypertrophy [BPH]
Cancer of the prostate
Neurogenic bladder
Drugs(Tricyclic antidepressants, ganglion blockers,
Bladder tumor,
Stone disease, hemorrhage/clot)

Urethral obstruction (strictures, tumor)

Acute Renal Failure_Diagnosis
Blood urea nitrogen and serum creatinine
CBC, peripheral smear, and serology
Urinalysis
Urine electrolytes
U/S kidneys
Serology: ANA,ANCA, Anti DNA, HBV, HCV, Anti GBM, cryoglobulin, CK, urinary Myoglobulin

Urinalysis
Unremarkable in pre and post renal causes
Differentiates ATN vs. AIN. vs.  AGN
Muddy brown casts in ATN
WBC casts in AIN
RBC casts in AGN
Hansel stain for Eosinophils
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