1. MEDICAL-SURGICAL
Practice Teaching1
Topic – Acute Renal Failure
Presented By –
Mr. Simon Raju
BSc 2nd` year

2. Introduction
ARF is a syndrome of varying
causation that results in a sudden
decline in renal function.
Associated with :
 Increase in BUN & creatinine
 Oliguria (less than 500ml urine /24h)
 Hyperkalemia
 Sodium retention

3. Anatomy & Physiology

4. Pathophysiology & Etiology
1. Pre renal cause - result from
hypovolemia
, shock,hemorrhage,burns,impaired
cardiac outut,diuretic therapy.
2. Post renal cause – arise from
obstruction or disruption to urine flow
anywhere along urinary tract.
3. Intra renal cause – results from injury to
renal tissue & associated with intra
renal ishemia , toxins , immunologic
processes ,systemic and vascular
disorders

5. Contd….

6. Contd…

7. Clinical Course
 Onset - lasts from hours to days
 Oliguric phase – anuric phase ( urine
less than 400 to 500ml/24h)
a)Accompanied in rise in serum
concn.which are excreted by kidneys
b) There can be decrease in renal
function with increase in N2 retention
even when the pt.is excreting more
than 2 to 3 L of urine daily – called
non oliguric or high output renal
failure.

8. Contd…
 Diuretic phase – begins when the 24hr
urine vol.exceeds 500ml and when
BUN & serum creatinine levels stop
rising.
 Recovery phase -
a) Several months to 1 yr
b) Probably some scar tissue remains

9. Clinical Manifestations
 Pre renal – decreased tissue turgor ,
dryness of mucous membrane , weight
loss , hypotension , oliguria or anuria ,
tachycardia
 Post renal – obstruction to urine flow,
nephrolithiasis , obstructive symptoms of
BPH
 Intra renal – edema , presentation
based on cause
 Changes in urine vol. and serum conc. of
BUN , creatinine , potassium and so
forth…

10. Contd….
 Objective
symptoms
◦ Oliguric phase –
 vomiting
 disorientation,
 edema,
 ^K+
 decrease Na
 ^ BUN and creatinine
 Acidosis
 uremic breath
 CHF and pulmonary
edema
 hypertension caused
by
hypovolemia, anorexia
 sudden drop in UOP
 convulsions, coma
 changes in bowels

11. Diagnostic Evaluation
1. Urinalysis – reveals proteinuria
, hematuria
2. Rising serum creatinine and BUN
levels; 41:1
3. Urine chemistry examinations
4. Renal ultrasonography

12. Contd…
 Diagnostic tests
◦ H&P
◦ BUN, creatinine, sodium, potassium.
pH, Hgb
◦ Urine studies
◦ US of kidneys
◦ KUB
◦ Renal CT/MRI
◦ Retrograde pyloegram

13. Treatment
 Treat underlying cause
 Blood pressure
 Infections
 Stop inciting medications
 Nephrostomy tubes/ureteral stents if
obstruction
 Hydration
 Diuresis (Lasix)
 Dialysis
 Renal Transplant

14. Acute Renal Failure
 Medical treatment
◦ Fluid and dietary restrictions
◦ Maintain E-lytes
◦ May need dialysis to jump start renal
function
◦ May need to stimulate production of urine
with IV fluids, Dopamine, diuretics, etc.

15. Contd…
 Medical treatment
◦ Hemodialysis
 Subclavian approach
 Femoral approach
◦ Peritoneal dialysis
◦ Continous renal replacement therapy
(CRRT)
 Can be done continuously
 Does not require dialysate

16. Contd..
 Spl. Attention to draining wounds
, burns ,
 Avoid infections
 Care while administering blood

17. Complications
1. Infection
2. Arrhythmias
3. Electrolyte abnormalities
4. GI bleeding
5. Multiple organ systems failure

18. Nursing diagnosis
 Fluid volume excess r/t decreased glomerular
filtration rate & sodium retention
 Risk for infection r/t alterations in immune
system & host system
 Altered nutrition: less than body requirements
r/t catabolic state ,anorexia ,malnutrition
associated with ARF
 Risk for injury r/t GI bleeding

19. Acute Renal Failure
 Nursing interventions
◦ Monitor
I/O, including all
body fluids
◦ Monitor lab results
◦ Watch hyperkalemia
symptoms:
malaise, anorexia, p
arenthesia, or
muscle
weakness, ECG
changes
◦ watch for
hyperglycemia or
hypoglycemia if
receiving TPN or
insulin infusions
◦ Maintain nutrition
◦ Safety measures
◦ Mouth care
◦ Daily weights
◦ Assess for signs of heart
failure
◦ Skin integrity problems

20. Nursing management
 Stay focused on the primary
disorder, and monitor all complications.
 Assist in emergency treatment of fluid
and electrolyte imbalances.
 Assess progress and response to
treatment; provide physical and
emotional support.
 Keep family informed about condition
and provide support.

21. Nursing Management
 Monitoring Fluid and Electrolyte levels
 Reducing Metabolic Rate
 promoting pulmonary Function
 Avoiding Infection
 Providing Skin Care
 Providing Support During Dialysis

22. Summary & Conclusion

23. Thank you