ACUTE RENAL FAILURE OR ACUTE KIDNEY INJURY

Complications of Acute Renal Failure (ARF)

Potential complications of acute renal failure include:

 Fluid buildup: Acute renal failure may lead to a buildup in the lungs, which can cause shortness
of breath.
 Chest pain: If the lining that covers the heart (pericardium) becomes inflamed, they may
experience chest pain.
 Muscle weakness: When the body’s fluids and electrolytes- the body’s blood chemistry-are out of
balance, muscle weakness can result. Elevated levels of potassium in the blood are particularly
dangerous.
 Permanent kidney damage: Occasionally, acute kidney failure causes permanent loss of kidney
function, or end-stage renal disease. People with end-stage renal disease require permanent
dialysis- a mechanical filtration process used to remove toxins and waste from the body-or a
kidney transplant to survive.
 Death: Acute renal failure can lead to loss of kidney function and, ultimately, death. The risk of
death is higher in people with kidney problems before acute renal failure.
 Electrolyte disturbance:
 Hyperkalemia:(serum K+ >5.5mEq/L): decreased renal excretion combined with tissue
necrosis or hemolysis.
 Hyponatremia:(serum Na+<135mEq/L): excessive water intake in the face of excretory
failure.
 Hyperphosphatemia:(serum phosphate concentration of >5.5mg/dl): failure of excretion
or tissue necrosis.
 Hypocalcemia:(serum Ca2+ <8.5mg/dl): results from decreased Active Vit-D,
hyperphosphatemia, or hypoalbuminemia.
 Hypercalcemia:(serum Ca2+ > 10.5mg/dl): may occur during the recovery phase
following rhabdomyolysis included acute renal failure.
 Metabolic acidosis:(arterial blood ph <7.35): is associated with sepsis or severe heart
failure.
 Hyperuricemia: due to decreased uric acid excretion.
 Bleedind tendency: may occur due to platelet dysfunction and coagulopathy associated
with sepsis.
 Seizure: may occur related to uremia.

Classification of Acute Renal Failure (ARF)

Acute renal failure is classified under three categories:

 RIFLE criteria
 Acute Kidney Injury Network (AKIN)
 KDIGO Clinical Practice Guidelines

RIFLE criteria
Stage GFR Urine output
Risk ↑SCr×1.5 or ↓GRF >25% <0.5ml/kg/hr×6hour
Injury ↑SCr×2 or ↓GRF >50% <0.5ml/kg/hr×12hour
Failure ↑SCr×3 or ↓GFR >75% or <0.3ml/kg/hr×24hour or
baseline SCr ≥353.6µmol/L anuria×12hour
(≥4mg/dl) ↑SCr > 44.2µmol/L
(>0.5mg/dl)
Loss Complete loss of kidney function > 4 weeks
ESRD Complete loss of kidney function > 3 months

Acute Kidney Injury Network (AKIN) criteria:

 Abrupt (within 48h) reduction in kidney function currently defined as an absolute increase in
serum creatinine of 0.3mg/dl or more (≥26.4µmol/L) OR
 A percentage increase in serum creatinine of 50% or more (1.5 fold from baseline) OR
 A reduction in urine output (documented oliguria of <0.5ml/kg/hr for >6hr).

KDIGO Clinical Practice Guidelines:

 Increase in serum creatinine by 0.3mg/dl or more within 48 hours OR

 Increase in serum creatinine to 1.5 times baseline or more within the last 7days OR
 Urine output less than 0.5ml/kg/hr for 6 hours.

Drugs causing Acute Kidney Injury

Pre-renal Intrinsic Post-renal

Diuretics Indinavir
ACE inhibitors Acyclovir
ARBs Sulfonamides
NSAIDs
Cyclosporins
Interferon
Interleukin-2
Tacrolimus