Acute Renal Failure

By Namra Khan
Definition
“Acute Renal Failure is a syndrome
characterized by rapid onset of renal
dysfunction, chiefle oligura and
anuria, and sudden increase in
metabolic waste products (urea and
creatinine) in the blood with
consequent development of uraemia.”
Etiopathogenesis
The causes may be
classified as
1. Pre-renal
2. Intra-renal
3. Post-renal
Pre-renal causes
These causes suddenly decrease the blood flow to the
nephron. These include:

• Dehydration- vomiting, diarrhea or blood loss

• Disruption of blood flow to the kidney
• Heart failure or heart attack causing low blood flow
• Flow obstruction to the kidneys like atherosclerosis
• Liver failure causing changes in hormones that affect
blood flow and pressure to the kidneys
Intra-renal Causes
Characterized by disease of renal tissue itself.
•Acute glomerulonephritis- Streptococcal
bacterial infection may damage the glomeruli
causing its inflammation
•Acute tubular necrosis- causes include
shock, drugs (mainly antibiotics) and
chemotherapy agents
Intra-renal Causes
• Accidental injuries
• Polycystic kidney
• Acute interstitial necrosis- caused by
• Medications such as antibiotics, anti- inflammatory
medicines(e.g. Aspirin , brufen)
• Infections and immune mediated diseases like
lupus, leukemia, lymphoma and sarcoidosis
• Vascular disease- of the arteries and arterioles
within the kidneys
Post- renal
Caused by obstruction to the flow of urine
anywhere along the renal tract distal to the
opening of collecting ducts.
These include-

 Kidney stone- usually only on one side

 Bladder injuries or tumors
 Bladder stone
 Medications
 Benign prostate hyperplasia
 Blood clot
Clinical features
Depend on the underlying cause and the stage of disease.

A. Syndrome of acute nephritis- associated with post- Streptococcal

glomerulonephritis , characteristic features are mild proteinuria, haematuria, oedema
and mild hypertension
B. Syndrome accompanying tubular pathology-when ARF is caused by destruction of
tubular cells, the disease typically progresses through three stages.

3 stages-
1. Oliguric phase-lasts from 7 to 10days Characterized by urine output of less than 400
ml/ day, which leads to accumulation of waste products of protein metabolism in blood
and resultant azotaemia, metabolic acidosis, hyperkalemia, hypernatremia and
hypervolaemia
2. Diuertic phase-improced urine output with the onset of healing of tubules
3. Phase of recovery - Full recovery with healing of tubular epithelial cells occurs in
about half the cases,while others terminate in death.
C. Pre- renal syndrome

• Disorders in which glomeruli and tubules are not affected,

seen in ischemia caused by renal arterial obstruction.

• Dutme to less rebal blood flow, there is decrease in GFR

causing oligura, azotaemia (elevation of BUN and
creatinine) and oedema
Risk Factors

 Advanced age
 Blockage in blood vessels
 Diabetes
 High blood pressure
 Heart failure
 Kidney diseases
 Liver disease
Symptoms Symptoms

•vomiting and diarrhoea causing dehydration • bone damage or non union in broken
•nausea bones

•nocturnal urination •muscle cramps and muscle paralysis

•pale urine •swelling of face, hands, feet

•less frequent urination , or in smaller amounts •shortness of breath due to extra fluid on
than usual, with dark coloured urine the lungs

•weight loss •dizziness

•haematuria • low blood pressure

•abnormal heart rhythms

Complications
o Infections
o Hyperkaemia
o Hyperphosphataemia
o Hyponatremia
o Pericarditis
o pulmonaty oedema
Diagnosis:
1. peripheral oedema
2. elevated right atrial pressure
3. serum creatinine and BUN level (normal
- 7 to 18mg/dl)
4. serim electrolytes
5. urine analysis
6. renal bladder ultrasound
7. CT scans and MRI
8. biopsy
Treatment
 correcting fluid and electrolyte balance
 correct dehydration
 Furosemide, torsemide, ethacrynic acid
 calcium gluconate, sodium bicarbonate
 dialysis
Thank you