ACUTE RENAL FAILURE

IN SURGICAL PATIENTS

DAGMAWI TESFAYE
DAGMAWI TSEGAYE
DAGNACHEW TAMRAT
DAMTEW ASFAW
Objectives
• Anatomy and physiology
• Definition
• Causes
• Clinical manifestation
• Diagnosis
• Management
• Complications
ANATOMY AND PHYSIOLOGY

BY DAGMAWI TSEGAYE
Anatomy
 Physiology
• Receive high CO(20%)
• GFR is about 125ml/min
• GFR is a reflection of over all kidney
function
• 1-2 L of urine per day
 Physio…
• The primary function of the kidneys is:
• Excretion- excess water, excess electrolytes, urea,
creatinine, toxins, drugs….
• Retention- glucose, amino acids, bicarbonates,
electrolytes
• Synthesis- ammonia, bicarbonate, prostaglandins
• Activation of vit-D
• Regulation of arterial blood pressure- RAAS
• Endocrine function -erythropoietin, renin
• Metabolism -Gluconeogenesis
Definition
• Acute renal failure is a clinical syndrome
characterized by an abrupt decline in GFR
which may or may not be accompanied by
oliguria and results in the accumulation of
nitrogenous waste products.
• Rapid deterioration of ability to eliminate
waste products, regulate extracellular
volume, and maintain electrolyte and acid-
base homeostasis.
• Accounts for about 7% hospital
admissions
• 30% of admissions to ICU
Causes
• Pre-renal
• Intrinsic Renal
• Post-renal
Pre-renal

Pre-renal ARF

Disordered Auto
Hypovolemia
regulation

Hemorrhage
Low CO
GI loss
Cirrhosis NSAID
Skin loss
Sepsis ACEI/ARBs
Renal loss
3rd spacing
Anesthesia
• Pathogenesis

Hypovolemia & Hypotension

Renal Hypotension

Activation of compensatory systemic

& renal responses

↑ tubular reabsorption of Na & water

FUNCTIONAL RENAL FAILURE

Renal
Renal azotemia or renal cause of ARF is due to insults to
the renal parenchyma itself.

• Renovascular obstruction
• Diseases of the glomeruli or vasculature
• ATN
• AIN
Post-renal
• Is due to urinary tract obstruction.
• Accounts for 5% of ARF cases.
• More common in ambulatory than hospitalized patients.
• ARF from obstruction may occur if:
- external urethral meatus and neck
- bilateral ureteric obstruction
- unilateral ureteric obstruction in a pt. with one
functioning kidney/preexisting chronic renal insufficiency.
• Obstruction: upper vs. lower urinary tract
• Intraluminal, wall defect, external compression

• Pathogenesis
Renal obstruction
• Congenital:polycystic kidney
• Neoplastic:renal cell carcinoma, transitional cell
carcinoma
• Inflammatory:TB,echinococcus,
• Metablic:calculi
• Others:trauma,renal aa. aneurysm
Ureter
• Congenital: ureteral valve, prune belly
syndrome,ureterovesical reflux
• Neoplastic: primary carcinoma of ureter,
metastatic carcinoma
• Inflammatory: TB,schistosomiasis,endometriosis
• Others: retro peritoneal fibrosis,pelvic
lipomatosis,trauma,radiation therapy,ureteral
calculi
Bladder and Urethra
• Congenital: posterior urethral
valve,phimosis,hypospadias,epispadias
• Neoplastic : bladder ca,prostate
ca,carcinoma of urethra,penis
• Inflammatory: prostatitis,parauretheral
abscess
• Others: BPH,neurogenic bladder
Reference
• Harrison’s Internal medicine 17th edit.
• Campbell-Walsh urology 9th edit.
THANK YOU