ACUTE AND CHRONIC RENAL

FAILURE

Mrs.V. Stephina Immaculate

INTRODUCTION

 Acute renal failure (ARF) is uncommon in childhood but its

incidence may be increasing and modalities of treatment changing

with an increasing number of children being treated in the intensive

care unit (ICU) with multiorgan failure. Traditionally children with

ARF with renal involvement were only treated with peritoneal

dialysis but extracorporeal techniques are being increasingly used in

ICUs
DEFINITION

 Acute kidney failure (AKF) occurs when there is a sudden

reduction in kidney function that results in nitrogenous wastes

accumulating in the blood (azotemia).

 Jane Ball and Blinder ,2009

CAUSES OF RENAL FAILURE

Causes of acute kidney failure fall into one of the following categories:

 Prerenal: Problems affecting the flow of blood before it reaches the

kidneys

 Post renal: Problems affecting the movement of urine out of the

kidneys

 Renal: Problems with the kidney itself that prevent proper filtration

of blood or production of urine

CAUSES OF RENAL FAILURE
PRE RENAL CAUSES

Prerenal failure

 Prerenal failure is the most common type of acute renal failure

(60%-70% of all cases). The kidneys do not receive enough blood

to filter. Prerenal failure can be caused by the following conditions:

 Dehydration: - From vomiting, diarrhea, water pills, or blood loss.

PRE RENAL CAUSES
 Disruption of blood flow to the kidneys from a variety of
causes:
 Drastic drop in blood pressure from major surgery with
blood loss, severe injury or burns, or infection in the
bloodstream (sepsis) causing blood vessels to
inappropriately relax
 Blockage or narrowing of a blood vessel carrying blood to
the kidneys
 Heart failure or heart attacks causing low blood flow
 Liver failure causing changes in hormones that affect blood
flow and pressure to the kidney
POST RENAL CAUSES

Obstruction of one or both ureters can be caused by the following:

 Kidney stone: usually only on one side

 Cancer of the urinary tract organs or structures near the urinary tract

that may obstruct the outflow of urine

 Medications
POST RENAL CAUSES

Obstruction at the bladder level can be caused by the following:

 Bladder stone

 Enlarged prostate (the most common cause in men)

 Blood clot

 Bladder cancer

 Neurologic disorders of the bladder impairing its ability to contract

RENAL CAUSES

Some kidney problems that can cause kidney failure include:

 Blood vessel diseases

 Blood clot in a vessel in the kidneys

 Injury to kidney tissue and cells

 Glomerulonephritis

 Acute interstitial nephritis

 Acute tubular necrosis

PHASES OF ACUTE RENAL
FAILURE

The Four Phases of Acute Renal Failure

 Onset Phase – this period represents the time from the onset of
injury through the cell death period. This phase can last from hours
to days and is characterized by:
 Renal flow at 25% of normal
 Oxygenation to the tissue at 25% of normal
 Urine output at 30 ml (or less) per hour
 Urine sodium excretion greater than 40 meq/L.
 In this phase only 50% of the patients are noted to be oliguric
PHASES OF ACUTE RENAL
FAILURE

Oliguric/Anuric Phase – this phase usually lasts between 8-14 days

and is characterized by further damage to the renal tubular wall and
membranes. Other characteristics in the oliguric-anuric phase
include:
 Great reduction in the glomerular filtration rate (GFR)
 Increased BUN/Creatinine
 Electrolyte abnormalities (hyperkalemia, hyperphosphatemia and
hypocalcemia)
 Metabolic acidosis
PHASES OF ACUTE RENAL
FAILURE

Diuretic Phase – this phase occurs when the source of obstruction has been

removed but the residual scarring and edema of the renal tubules remains.

This phase usually lasts and additional 7-14 days and is characterized by:

 Increase in glomerular filtration rate (GFR)

 Urine output as high as 2-4 L/day

 Urine that flows through renal tubules

 Renal cells that cannot concentrate urine

PHASES OF ACUTE RENAL
FAILURE

Recovery Period Phase – The recovery phase can last from several

months to over a year. During this phase, edema decreases, the renal

tubules begin to function adequately and fluid and electrolyte

balance are restored (if damage was significant, BUN and

Creatinine may never return to normal levels). At this point the

GFR has usually returned to 70% to 80% of normal

PATHOPHYSIOLOGY
CLINICAL MANIFESTATION

 Anemia.

 Bad breath or bad taste in mouth

 Bone and joint problems

 Edema. Puffiness or swelling in the arms, hands, feet, and

around the eyes.

CLINICAL MANIFESTATION

 Frequent urination.

 Foamy or bloody urine

 Cola-colored urine followed by oliguria (decreased urine output) or

anuria (no urine output)

 Headaches. High blood pressure may trigger headaches.

CLINICAL MANIFESTATION

 Hypertension, or high blood pressure

 Increased fatigue

 Itching

 Lower back pain

 Nausea
DIAGNOSTIC PROCEDURES

Lab Test Prerenal Value Intrarenal Value

Urine Specific Greater than 1.020 1.010 to 1.020
Gravity
BUN/Creatinine ratio Greater than 20:1 10-20:1
Urine Osmolality Greater than 500 300-500 mOsm/kg
mOsm/kg
Urine Sodium 10 mEq/L or less 20 mEq/L or more
Urine Sediment Hyaline casts Granular casts
(urinalysis)
Fractional excretion Less than 1% Greater than 1%
of sodium percent
(FENa)
DIAGNOSTIC PROCEDURES

 Creatinine clearance test

 Ultrasound
 Doppler studies
 Nuclear studies
 Renal biopsy
MEDICAL MANAGEMENT

DIALYSIS

PERITONIAL

HEMODIALYSIS