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    Add as FriendAcute Renal Failure

    by: jai

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    1 : Acute Renal Failure (Acute Kidney Injury) By;Dr.Jaiveer Singh Army College Of Dental Sciences, Secunderabad(Andhra Pradesh) INDIA
    2 : ARF - definition An abrupt fall in GFR over a period of minutes to days with rapid & sustained rise in nitrogenous waste products in blood. (Rate of production of metabolic waste exceeds the rate of renal excretion)
    3 : 3 MANIFFESTATIONS of ARF Decrease in glomerular filtration rate Increase in BUN Increase in creatinine Oliguria(< 400 –500 ml/day)
    4 : 4 ARF Classification Prerenal Renal Postrenal
    5 : Prerenal ARF 1. Systemic Heart failure Blood or fluid loss 2. Local Renal artery occlusion/stenosis Diseases affecting Arteriols
    6 : ARF Intrinsic (Renal) Acute Tubular Necrosis (ATN) Ischaemia Toxin Tubular factors Acute Interstitial Necrosis (AIN) Inflammation Oedema Amyloidosis (deposition of proteins in kidney tissues) Glomerulonephritis (GN) Damage to filtering mechanisms
    7 : ATN Sepsis - 48% Hemodynamic (excluding sepsis) - 32% Toxic – 20% NSAIDS Radiocontrast media ACEI Antibiotics (Gentamicin, Amphotericin)
    8 : Pathophysiology of ATN: Tubular Epithelial Cell Injury and Repair
    9 : Acute Interstitial Nephritis Causes Allergic interstitial nephritis Drugs Infections Bacterial Viral Sarcoidosis
    10 : Post Renal ARF Obstruction - Stones - Tumour -Prostatic Enlargement
    11 : ARF Signs and Symptoms Fever, rash, arthralgia (joint pain)—associated with allergic interstitial nephritis Flank pain—associated with renal artery or vein obstruction, severe glomerulonephritis Headache, dizziness, confusion, seizure—associated with malignant hypertension Oliguria (reduced urination), edema (swelling), hypertension—associated with glomerulonephritis, vasculitis Papilledema (swollen optic disk)—associated with malignant hypertension
    12 : Acute Kidney Injury Network (AKIN- 2005) Continuum of the renal injury STAGE I RISK (R) STAGE II INJURY (I) STAGE V ESRD (E) STAGE III FAILURE (F) STAGE IV LOSS (L) Severity Outcome
    13 : – RIFLE criteria/staging system
    14 : Acute Renal Failure Diagnostic Tools Levels of urea (blood urea nitrogen[BUN]) and creatinine are high in kidney failure of prerenal origin. This is called azotemia. Electrolyte levels in the blood may be abnormally high or low because of improper filtering. When the duration and severity of kidney failure is severe, the red blood cell count may be low. This is called anemia.
    15 : Acute Renal Failure Diagnostic Tools contd…. Urinary sediment Urinary indices Urine volume Urine electrolytes Radiologic studies
    16 : RBCs Dysmorphic red blood cells suggest glomerular injury.
    17 : Red blood cell cast Marker of glomerular injury Granular cast
    18 : Pigmented granular (“muddy brown”) casts Marker of acute tubular necrosis
    19 : May- Grünwald - Giemsa staining Marker of acute interstitial nephritis.
    20 : ARF: Life threatening consequences Volume overload Hyperkalaemia Uremia: Pericarditis Encephalopathy Platelet dysfunction Metabolic acidosis
    21 : Management principles in ARF Identify and correct pre-renal and post-renal factors Optimise cardiac output and RBF- Review drugs: Stop ACEI, ARBs, NSAIDs Adjust doses / monitor drug concentrations (where appropriate)
    22 : Management principles.... Accurately monitor fluid balance and daily body weight Identify and treat acute complications Hyperkalaemia, Acidosis, Pulmonary oedema
    23 : Management principles…. Identify and aggressively treat infection; Minimise indwelling lines Remove bladder catheter if anuric. Identify and treat bleeding tendency: Prophylaxis - proton pump inhibitor or H2 antagonist, avoid aspirin transfuse if required
    24 : Initiate dialysis before uraemic complications set in.
    25 : Thank YOU

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