Acute renal failure

Definition

• Acute reduction in kidney function (GFR)

• Usually in hours
• Usually reversible
• The commonest cause is an acute tubular
necrosis
 ARF is due to…

• Tubular damage
• Intestitial damage
• Blood vessel damage (vasculitis)
• Glomerular damage

• Only 1 (and perhaps 2, 3) are fully

reversible
Causes of Acute Renal Failure
Pre renal failure –
Systemic – Heart failure
Blood or fluid loss
Local - Renal artery occlusion / stenosis
Intrinsic failure – Multiple factors are
often involved
Acute tubular necrosis
Glomerular disease
Interstitial disease
Post-renal failure –
Obstruction – prostatic enlargement
 Acute renal failure

creatinine Serum K+
Urine output Serum H+

Oliguric phase Polyuric phase Time

 Polyuric ARF

• Majority of ARF is of this group

• Not detected in the majority of cases
• Usually does not require dialysis
• (20%) do require dialysis
• Due to transient tubular damage
 Fluid challenge

• In pre-renal failure
• To correct a fluid deficit
• To prevent ATN
• With or without a diuretic

• If deficit remains uncorrected ATN will occur

 Acute renal failure

creatinine Serum K+
Urine output Serum H+

Oliguric phase Polyuric phase Time

 Oliguric phase

• Fluid overload
• Acidosis
• Increased potassium
• Increased blood urea/ creatinine
– uraemia
 Indications for urgent dialysis

• Acidosis
• Hyperkalaemia
• Fluid overload with pulmonary oedema
• Rapidly rising serum creatinine
• A high absolute value of serum creatinine
• Presence of uraemic encephalopathy
 Polyuric phase

• Hypovolaemia
• Hypokalaemia
• Hyponatraemia

– Treatment is symptomatic
 Prognosis of ARF

• Variable
• Depends on number of organs involved
• Also depends on pre-morbid function of the
kidneys
Acute renal failure
Chronic renal failure
Acute on chronic renal failure