Acute Renal Failure

Acute renal failure is a clinical syndrome which charcterised by decrease in renal function with progressive azotema [ excessive accumulation of BUN in body] and increase in serum creatinine level, and urine output is generally less than 40ml/hr. ARF can be further divided into per-renal, intra-renal, and post-renal causes. 

Causes of ARF--

1. Pre-Renal causes:-Consist of outside the kidney that reduces the renal blood flow, and lead to decrease glomerular filtration rate.

• hypovolemia- heamrrhage, dehydratition, vomiting, gestric suction, dibetic incipidus, cirrhosis, diaphorosis, burns ets are the causes of hypovolemia
• Decrease cardiac output- Cardiac Temponede myocardial infraction, cardiogenic shock
• Hypotention 
• Renal vascular obstruction;- Thrombosis in renal arteries, embolism 
• drugs like NSAIDS

2. Intra-Renal causes- it consist of inside the kidney difects

• Tubule damages:- Acute tubular nacrosis, Acute glomerunephritis, Acute pyelonephritis, 
• Vascular damages 
• Nephrotoxic injury- Allergy from antibiotics, ACE inhibitiors, heavy metals, furosemide rtc
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3. Post -Renal causes- It invole mechanical obstruction of urinary outflow,between the kidney and urethral.

• Calculi formation 
• benign prostatis hyperplasia
• Bladder cancer
• Strictures
• Spinal cord disease

Sign and symptom:- Sign and symptoms of ARF according to the body system are 

1. Urinary symptoms

• oligouria
• proteineuria
• increase urine sodium level 
• decrease specific gravity of urine
• decrease osmolality

2. Cardiovascular symptoms

• Arrhythamias
• Hypertention
• circulatory overload
• pericardial effusion
• congestive heart failure

3.  Respiratory symptoms

• Pulmonary edema
• Kussmauls respiration
• Plerural effusion

4. Gestrointestinal symptoms

• Anorexia
• stomatitis [Inflammation of mouth and lips]
• Bleeding
• Dirrhoea
• Constipation

5. Neuroloical symptoms

• Lethrgy
• Convulsions
• asterixis [ tremours in hand and wrist extension ]
• Memory impairment

6. blood finding changes

• Increase BUN
• Increase creatinine
• Increase potassium level
• Decrease pH level
• Decrease calcium level
• Increase phoaphate level 

 

Managment of ARF:-

Medical menagment :

1.To treat prerenal causes

• NSAIDS Drugs 
• ACE Inhibitors 

2. To treat Intra renal causes

• Iv fluids
• antibiotics for infections
• sodium sulfonate
• calcium infussion 

3. To treat post renal causes

• Allopurinol for treat renal calculi
• Tamsulosine, Alfuzosin etc. to treat BPH
• Doxorubidine, vinblastine to treat bladder cancer

NURSING MANAGMENET 

1.Nursing diagnosis

• Excess fluid volume R/T  Decrease filtration rate of the kidney 
• Risk of decrease cardiac output R/T Uremic effect on cardiac musscles
• Decrease nutrition level lesss than body requirment R/T  Increase metabolic needs, or anorexia
• Risk of infection R/T Invasive procedures [ like urinary catheter, iv cannulas etc]
• Knowledge level deficit R/T hospitalization or unknown about procedure