ACUTE RENAL FAILURE

DEFINITION: Acute renal failure (a.k.a. acute kidney injury) is the abrupt loss of
kidney function, resulting in the retention of urea and other nitrogenous waste
products and in the dysregulation of extracellular volume and electrolytes. The term
AKI has largely replaced acute renal failure (ARF), reflecting the recognition that
smaller decrements in kidney function that do not result in overt organ failure are of
substantial clinical relevance and are associated with increased morbidity and
mortality. The term ARF is now reserved for severe AKI, usually implying the need
for renal replacement therapy.
The loss of kidney function that defines AKI is most easily detected by measurement
of the serum creatinine, which is used to estimate the glomerular filtration rate
(GFR). Three problems are associated with the use of serum creatinine to
quantitatively define AKI:
Serum creatinine does not accurately reflect the GFR in a patient in whom it is not
in steady state. In the early stages of AKI, the serum creatinine may be low, even
though the actual (not estimated) GFR is markedly reduced, since there may not
have been sufficient time for the creatinine to accumulate (see "Assessment of
kidney function"). When the serum creatinine is rising, estimates of GFR based on
creatinine values will overestimate the true GFR; conversely, estimates of GFR will
underestimate the true GFR during recovery of kidney function, when the serum
creatinine concentration is declining.
Creatinine is removed by dialysis. As a result, it is usually not possible to assess
kidney function by measuring the serum creatinine once dialysis is initiated. One
exception is when the serum creatinine continues to fall on days when hemodialysis
is not performed, indicating recovery of renal function.
Numerous epidemiologic studies and clinical trials have used different cut-off
values for serum creatinine to quantitatively define AKI
CAUSES: Acute kidney failure can occur when:

You have a condition that slows blood flow to your kidneys

You experience direct damage to your kidneys
Your kidneys' urine drainage tubes (ureters) become blocked and wastes
can't leave your body through your urine

Impaired blood flow to the kidneys

Diseases and conditions that may slow blood flow to the kidneys and lead to kidney
failure include:
o
o
o
o
o
o

Blood or fluid loss

Blood pressure medications
Heart attack
Heart disease
Infection
Liver failure

o
o
o
o

Use of aspirin, ibuprofen (Advil, Motrin IB, others), naproxen (Aleve, others),
or related drugs
Severe allergic reaction (anaphylaxis)
Severe burns
Severe dehydration

Damage to the kidneys

These diseases, conditions and agents may damage the kidneys and lead to acute
kidney failure:
o
o
o
o
o
o
o

o
o
o
o
o

Blood clots in the veins and arteries in and around the kidneys
Cholesterol deposits that block blood flow in the kidneys
Glomerulonephritis (gloe-mer-u-loe-nuh-FRY-tis), inflammation of the tiny
filters in the kidneys (glomeruli)
Hemolytic uremic syndrome, a condition that results from premature
destruction of red blood cells
Infection
Lupus, an immune system disorder causing glomerulonephritis
Medications, such as certain chemotherapy drugs, antibiotics, dyes used
during imaging tests and zoledronic acid (Reclast, Zometa), used to treat
osteoporosis and high blood calcium levels (hypercalcemia)
Multiple myeloma, a cancer of the plasma cells
Scleroderma, a group of rare diseases affecting the skin and connective
tissues
Thrombotic thrombocytopenic purpura (TTP), a rare blood disorder
Toxins, such as alcohol, heavy metals and cocaine
Vasculitis, an inflammation of blood vessels

Urine blockage in the kidneys

Diseases and conditions that block the passage of urine out of the body (urinary
obstructions) and can lead to acute kidney failure include:
o
o
o
o
o
o
o
o

Bladder cancer
Blood clots in the urinary tract
Cervical cancer
Colon cancer
Enlarged prostate
Kidney stones
Nerve damage involving the nerves that control the bladder
Prostate cancer

PATHOPHYSIOLOGY:

Predisposing Factors
Age
DM
Heredity/Genes
Primary
hypertension
Cardio and
peripheral vascular
diseases
SLE
AIDS

Precipitating Factors
Prerenal causes (~55%)
Intrerenal causes (~40%)
Postrenal causes (~5%)

Legend:

Phenomen
Manifestation/
on
s
Direction of Pathogenesis (P)

Abrupt
deterioration of
renal structural
Renal
function
compromise
Major
manifestations
show:

Sustained
renal damages
or destruction

Total GFR
decreased

Renal
damage
advances

Possible Direction of P

- Fluid and Electrolyte imbalances

- Impaired wound healing
- Increased susceptibility to
infections
- Acidosis
- Gastrointestinal complications
- Anemia
- Increased incidence of
pericarditis
- Uremic encephalopathy
- Platelet dysfunction

End Stage
renal
Disease

Serious inability of
the kidneys to rid
body of all waste

Multisyste
m
involveme

Stages

- Fluid and Electrolyte imbalances

- Metabolic changes
- Hematologic changes
- Gastrointestinal changes
- Immunologic changes
- Changes in medication
metabolism
- Cardiovascular changes
- Respiratory changes
- Musculoskeletal changes
- Integumentary changes
- Neurologic changes
- Reproductive chnges
- Endocrine changes
- Psychosocial changes

MANIFESTATION/S:

Little or no urine when you try to urinate.

Swelling, especially in your legs and feet.
Not feeling like eating.
Nausea and vomiting.
Feeling confused, anxious and restless, or sleepy.
Pain in the back just below the rib cage. This is called flank pain.

HOME MANAGEMENT:
A. MEDICAL
B. SURGICAL