Acute Renal Failure .

Ms. Yasmeen M K
2nd year BSc Nursing
BBC College of Nursing
Gangavathi

1. Acute Renal failure PRESENTED BY : Ms. Yasmeen M K 2 nd year B.Sc. Nursing BBC College of Nursing Gangavathi SUPERVISED BY: Mr. George. D. Honnalli M.Sc.[N] HOD, Dept of Medical Surgical Nursing BBC College of Nursing Gangavathi

2. introduction Kidney failure or renal failure is a situation in which the Kidneys are fail to function adequately

3. Definition Acute Renal Failure (ARF), also known as Acute Kidney Injury (AKI), is a sudden loss of kidney function that occurs over hours to days. It results in the kidneys being unable to filter waste products, balance fluids, electrolytes, and maintain acid-base homeostasis. This leads to an accumulation of waste products in the blood and disturbances in fluid and electrolyte balance.

4. Acute kidney failure a sudden decline in renal function, usually marked by decreased glomerular filtration rate (GFR), Increased concentrations of blood urea nitrogen and creatinine the urine output is less than 400 ml per day and Hyperkalemia and sodium retention

5. Causes Prerenal causes: Decreased blood flow to the kidneys (e.g., dehydration, heart failure, sepsis) Intrinsic causes: Direct damage to the kidneys (e.g., acute tubular necrosis, glomerulonephritis, ischemia) postrenal causes: Obstruction of urine outflow (e.g., kidney stones, tumors, enlarged prostate)

6. Risk factors Age High blood pressure Diabetes mellitus Peripheral artery disease Kidney Disease liver disease heart failure

7. pathophysiology Prerenal , Intrarenal , Post renal causes ⬇️ Hypoperfusion of the kidneys ⬇️ Alteration in kidney function ⬇️ Decreased glomerular filtration rate ⬇️ Retention of fluids and urinary sediments ⬇️ Increased in serum concentration of renal substances ⬇️ Kidney damage

8. Phases of acute renal failure Initiation Phase : The Tubular necrosis occurs, and kidney function begins to decline. This phase is often asymptomatic but leads to a reduction in urine output and impaired renal function Oliguric (Maintenance) Phase : Urine output significantly decreases (oliguria) or stops (anuria), leading to fluid retention, electrolyte imbalances (hyperkalemia), metabolic acidosis, and uremia. This phase can last from days to weeks. Diuretic Phase: The kidneys begin to recover, and urine output increases. However, the kidneys may not fully concentrate urine, leading to potential dehydration, electrolyte imbalances, and a need for close monitoring. Recovery Phase : Kidney function gradually returns to normal or near normal. Urine output stabilizes, and electrolyte levels balance, but full recovery may take weeks or months, depending on the severity of the injury.

9. Clinical manifestations 1 Decreased Urine Output (Oliguria/Anuria) 2. Fluid Retention 3. Electrolyte Imbalances - Hyperkalemia - Hyponatremia - Hypocalcemia 4. Metabolic Acidosis 5. Uremia (Buildup of Waste Products) 6. Hypertension 7. Fatigue and Weakness 8. Chest Pain 9. Azotemia 10. Tachycardia, dysrhythmias

10. Clinical manifestations

11. Diagnostic evaluation Blood Test: Increased BUN and serum creatinine Hyperkalemia decreased bicarbonate level Decreased hematocrit and hemoglobin level Low PH Electrolytes imbalance

12. Diagnostic evaluation Urine Test : Urine studies shows Casts Proteinuria Hematuria decreased specific gravity hyponetremia Increased potassium level

13. Diagnostic evaluation 3. ECG: Normal ECG

14. Diagnostic evaluation 4. Imaging studies: Ultrasonography plain films of abdomen KUB radiography Excretory urography Renal scan Retrograde Pyelography CT Nephrotomography

15. Plain films of abdomen KUB Radiography Excretory urography

16. Ultrasonography Computerized tomography

17. Diagnostic evaluation 5. Kidney biopsy

18. management Pharmacological management: Furosemide (Lasix) Dose : 20-80 mg IV, can be increased based on response. Action: A loop diuretic that helps increase urine output and reduce fluid overload. 2. Dopamine (Low-dose) Dose : 1-5 mcg/kg/min IV infusion. Action : Increases renal blood flow and enhances urine output by stimulating dopaminergic receptors.

19. 3. Mannitol Dose : 0.25-2 g/kg IV over 30-60 minutes. Action : An osmotic diuretic used to promote diuresis and reduce intracranial pressure in some cases of ARF. 4. Calcium Gluconate Dose : 1-2 g IV over 2-5 minutes. Action : Stabilizes cardiac membranes in hyperkalemia, a common complication of ARF.

20. 5. Sodium Bicarbonate : Dose : 1 mEq /kg IV bolus. Action : Corrects metabolic acidosis, which can occur due to ARF. 6. Kayexalate (Sodium Polystyrene Sulfonate): Dose : 15-30 g orally or rectally Action : Binds potassium in the gut to lower high potassium levels .

21. Fluid and electrolyte replacement Fluid Management : Fluid restriction : if oliguria (low urine output) or fluid overload Fluid replacement : ( IV fluids) if dehydration or hypovolemia Electrolyte Imbalances: Hyperkalemia (high potassium): Treatment: calcium gluconate, insulin + glucose, sodium bicarbonate, or dialysis Hyponatremia (low sodium):Restrict water intake or use hypertonic saline in severe cases Metabolic acidosis: Treatment: sodium bicarbonate if severe Monitoring: Daily weight ,Strict input and output charting, Serum electrolyte levels (potassium, sodium, calcium, bicarbonate)

22. Nutritional therapy Protein : Restricted to 0.6-1.5g/kg/day to limit urea buildup , Calories : 25-35 kcal/kg/day, mainly from carbs and fats to preserve muscle mass. Electrolytes : Sodium: Restricted to prevent fluid retention. Potassium & Phosphorus: Limited if elevated levels are present. Fluids : Based on urine output plus 500-1000 mL to avoid overload. Vitamins : Supplement water-soluble vitamins (B, C) and iron if anemic.

23. Fluid volume excess related to decreased Glomerular filtration rate as evidenced by edema Imbalanced nutritional status less than body requirement related to protein catabolism as evidence by weakness and weight changes Risk for decreased cardiac output related to fluid deficit and fluid shift Nursing Diagnosis

24. Thank you