WHAT IS

ACUTE RENAL FAILURE

KIDNEYS

URETERS

BLADDER

URETHRA
 KIDNEYS

• Two bean-shaped organs

• Four Components: cortex, medulla, renal pelvis, and
nephron
• Cortex
- outer layer; contains glomeruli, proximal tubules,
and distal tubules
• Medulla
- inner layer; contains loop of Henle and collecting
tubules
• Renal Pelvis
- collects urine from the calices
• Nephron
- functional unit; contains Bowman’s capsule,
glomerulus, and renal tubule
 URETERS

• This tubule extends from

the renal pelvis to the
bladder floor
• Transports urine from the
kidney to the bladder
 BLADDER

• Muscular, distendible sac

that stores urine
• Total capacity of
approximately 1 Liter
 URETHRA

• This tubule extends from the

bladder to the urinary meatus
• Transports urine from the
bladder to the urinary meatus
 Urine Formation

• Blood from the renal artery is filtered across the

glomerular capillary membrane in the Bowman’s
capsule
• Filtration requires adequate intravascular volume
and adequate cardiac output
• Composition of formed filtrate is similar to blood
plasma without proteins
• Formed filtrate moves through the tubules of the
nephron, which reabsorb and secrete electrolytes,
water, glucose, amino acids, ammonia, and bicarbonate
• Antidiuretic hormone and aldosterone control the
reabsorption of water and electrolytes
 RENAL FAILURE

Sudden inability of the kidneys

to regulate fluid and electrolyte balance

and remove
and remove toxic
toxic products
products from the from
body
the body
 ACUTE KIDNEY INJURY

Rapid loss of renal function

due to damage of the kidneys.

and remove toxic products from
the body
 ACCEPTED CRITERION FOR AKI

• 50% or greater increase in creatinine

above baseline

(NORMAL CREATININE = less than 1 mg/ dL)

POSSIBLE CHANGES IN URINE VOLUME

• OLIGURIA
less than 0.5 mL/kg/hr

• ANURIA
less than 50 mL/day
 PATHOPHYSIOLOGY

• Pathogenesis is not always known

• BUT, many times there is a specific cause

1) hypovolemia
2) hypotension
3) Reduced cardiac output
4) Obstruction of the kidney or lower urinary tract by tumor
5) bilateral obstruction of the renal arteries or veins
CLASSIFICATIONS OF AKI

RIFLE
 CATEGORIES AND CAUSES

PRERENAL FAILURE

• Occurs in 60-70% of cases

• result of impaired blood flow that leads
to hypoperfusion of kidney
 PRERENAL FAILURE CAUSES

• Volume depletion
• Impaired cardiac efficiency
• Vasodilation
 INTRARENAL FAILURE

• result of actual parenchymal to the

glomeruli or kidney tubules
• most common intrarenal cause is ACUTE
TUBULAR NECROSIS which accounts for
about 75% of cases
INTRARENAL FAILURE CAUSES

• Prolonged renal ischemia

• Nephrotoxic agents
• Infectious processes
 POSTRENAL FAILURE

• results from obstruction distal to the

kidney
 POSTRENAL FAILURE CAUSES

• Renal Calculi
• Tumors
• Strictures
• Blood clots
• Benign prostatic hyperplasia
 PHASES

Initiation, oliguria, diuresis and recovery

 INITIATION PERIOD

• Begins with the initial insult and ends

when oliguria develops
 OLIGURIA PERIOD

• Accompanied by an increase in the serum

concentration of substances usually
excreted by the kidneys and the
intracellular cations
 DIURESIS PERIOD

• Marked by a gradual increase in urine

output, which signals that glomerular
filtration has started to recover.
• Urine output of 3-5 L/ day.
 RECOVERY PERIOD

• Signals the improvement of renal function

and may take 3 to 12 months.
 CLINICAL MANIFESTATIONS

• Patient may appear critically ill and lethargic

• Skin and mucous membranes are dry from
dehydration
• CNS S/S: drowsiness, headache, muscle
twitching, seizures
• Urine output less than 400 mL/day for 1 to 2
weeks followed by diuresis (3-5 L/day) for 2 to 3
weeks
 DIAGNOSTIC EXAMS

• Renal Ultrasonography • Blood Chemistry:

BUN, Creatinine,
• Renal Sonogram
Potassium,
• CT Scan Phosphorus,
Magnesium, Uric Acid
• MRI Scan
• ABG
• Urinalysis
 MEDICAL MANAGEMENT

• I.V Therapy: electrolyte replacement, hypertonic

glucose and insulin to treat hyperkalemias,
saline lock
• Hemodialysis
• Continuous Renal Replacement Therapies
(CRRTS)
 PHARMACOLOGIC THERAPY

• HYPERKALEMIA may be reduced by

administering cation-exchange resins (sodium
polystyrene sulfonate ( Kayexalate)
• Kayexalate may be administered in comnibation
with Sorbitol
• Insulin and calcium replacement
• Antibiotic
• Diuretic agents
 NUTRITIONAL THERAPY

• DIET: low protein, increased carbohydrate,

moderate fat, and moderate- calorie, with
potassium, sodium, phosphorus intake
regulated according to serum levels
• Fluids: restrict intake to amount needed to
replace fluid loss
 NURSING MANAGEMENT

• Monitor Fluid and Electrolyte Balance

• Reduce Metabolic Rate
• Promote Pulmonary Function
• Prevent Infection
• Provide Skin Care
• Provide Psychosocial Support
THANK
YOU