Acute Renal Failure

Acute Renal Failure (ARF): - the sudden interruption of kidney function from obstruction, reduced circulation, or renal parenchymal disease. If untreated, it can progress to end-stage renal disease, uremic syndrome, and even death. ARF is usually reversible with treatment.

Cause: Perenal failure is associated with diminished blood flow to the kidneys. The cause may be due to hypovolemia, shock, embolism, blood loss, sepsis, pooling of blood in ascites or burns, CHF, dysrhythmias, and tamponade.

Intrinsic renal failure- cause may include; acute poststreptococcal glomerulonephritis, acute tubular necrosis, systemic lupus erythematosus, periarteritis nodosa, vasculitis, sickle cell disease, bilateral renal vein thrombosis, acute pyelonephritis, ischemia, or renal myeloma.

Postrenal failure - is associated with bilateral obstruction of urinary outflow. The causes may include renal calculi, blood clots, tumors, benign prostatic hypertrophy, strictures, urethral edema from catherterization, and papillae from papillary necrosis.

Symptoms:

Oliguria (diminished urine secretion in relation to fluid intake)
Anuria (complete suppression of urine formation by the kidney) -Rarely seen
Anorexia
Nausea
Vomiting
Diarrhea or Constipation
Stomatitis
GI bleeding
Dry mucous membranes
Uremic breath
Headache
Drowsiness
Irritability
Confusion
Peripheral neuropathy
Convulsion
Skin dryness
Pruritus
Pallor
Purpura
Hypertension
Dysrhythmias
CHF
Systemic edema
Anemia
Coma

Treatment:

Goals: To reestablish effective renal function (if possible), and to maintain the constancy of the internal environment despite transient renal failure.

Supportive care: High in calories and low in protein, sodium and potassium diet, with supplemental vitamins and restricted fluids.

Electrolyte monitoring is essential to detect hyperkalemia.

Prevention of hyperkalemia: treatment may include - dialysis, sodium bicarbonate, and hypertonic glucose and insulin infusions.

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