2. Definition
🠶 It is critical condition where excretory function of kidney declines rapidly
over a period of hours/ days which is associated with accumulation of
metabolic waste products and water
3. Epidemiology
🠶 In the world, it affects 13.3 million cases every year
🠶 In India, half of the 13.3 million people are affected every year
4. Types
Pre renal failure
🠶 Responsible for 40-80% cases of acute kidney injury
🠶 Results due to decreased renal perfusion
Intra renal failure
🠶 Responsible for 10-50% cases of acute kidney injury
🠶 Results due to renal parenchymal injury
Post renal failure
🠶 Responsible for less than 10% cases of acute kidney injury
🠶 Results due to urinary tract obstruction
5. RIFLE Classification
Condition Serum
Creatinine(mg/dl)
GFR(ml/min) Urine
output(ml/hour)
Risk Increased Se.
Creatinine by 1.5
times
Decreased GFR by
greater than 25%
Less than
0.5ml/kg/hour in 6
hours
Injury Increased Se.
Creatinine by 2
times
Decreased GFR by
greater than 50%
Less than
0.5ml/kg/hour in 12
hours
Failure Increased Se.
Creatinine by 3
times
Decreased GFR by
greater than 75%
Less than
0.3ml/kg/hour in 24
hours
Loss Persistent renal failure for more than one month
End stage renal
disease
Persistent renal failure for more than three months
10. Pathogenesis of Intra renal failure
🠶 Hypoperfusion due to decreased oxygen and nutrient supply to kidney
🠶 Renal vasoconstriction due to radiocontrast media
🠶 Renal vasoconstriction due to hepatorenal syndrome
🠶 Direct renal cell damage due to Rhadmyolysis
🠶 Immune reactions due to renal transplantation
🠶 Direct cell damage, Disturbing renal tubular permeability of tubular cells and intra renal
vasoconstriction due to drugs (Aminoglycosides, Amphotericin B, Immunosupressants)
Damage of tubules of nephron
Decreased excretion of wastes
Accumulation of wastes
Damage to kidney
11. Pathogenesis of Post renal failure
🠶 Calculi or clots in Ureter
🠶 Excessive decompression of Ureter due to benign strictures
🠶 Retroperitoneal tumors
Urine obstruction
Accumulation of wastes in kidney
Damage of kidney
16. Diagnosis
🠶 Medical history
🠶 Family history
🠶 Clinical presentation
🠶 Renal function tests
🠶 Complete blood count
🠶 Urine microscopy
🠶 Renal biopsy
🠶 Computed Tomography of kidney
🠶 Magnetic Resonance imaging of kidney
🠶 Ultrasound of kidney
17. Diagnosis continued….
🠶Renal Immunology screening of :
Anti neutrophil cytoplasmic antibodies
🠶 Antiglomerular basement membrane antibodies
🠶Serum and urine electrophoresis
🠶Immunoglobulins
🠶Anti nuclear antibodies
18. Non Pharmacological Treatment
🠶 Oxygen therapy
🠶 Ventilation
🠶 Urinary catheterisation
🠶 Central line procedure
🠶 Water restriction –less than 1L per day
🠶 Sodium restriction- less than 2-3g/ day
🠶 Restriction of potassium rich diet
🠶 Dialysis
🠶 Renal transplantation
22. Drugs used in treatment of acute renal
failure
Drug Category Mode of action Dose Adverse effects
Furosemide Loop diuretic Inhibit reabsorption
of sodium and water
at proximal and
distal convoluted
tubule
100mg/hour-IF Hypokalemia
Hypocalcaemia
Hypomagnesaemia
Hypotension
Hyperurecemia
Metalazone Thiazide
diuretic
Inhibit reabsorption
of sodium and water
at distal convoluted
tubule
2.5-10mg-PO-OD Chest pain
Hyperurecemia
Hypocalcaemia
Hypomagnesaemia
Glucosuria
Calcium
Gluconate
(10%)
Antidote for
Hyperkalemia
Stabilises
myocardial
instability due to
high potassium levels
10-30ml-IF for 5-10
min
Bradycardia
Hypotension
Hypomagnesaemia
Hyperphosphatemia
GI disturbances
23. Drugs used in treatment of acute renal
failure continued…
Glucose (50%) Glucose elevating
agent
Stimulate intracellular
potassium uptake
50ml with 8-12
units of insulin –IF
for 10 minutes
Hyperosmolarity
Oedema
Venous thrombosis
Tachypnea
Phlebitis
Sodium
bicarbonate
Alkalinising
agent
Reacts with excess H+
ions and decreases
acidity
50MEQ-IV for 5
min
Aggravated Congestive heart
failure
Oedema
Hypernatremia
Metabolic alkalosis
Gastric distension
Calcium
carbonate
Mineral
supplement
balances negative
calcium ion levels in
the blood
1g-OD-PO Anorexia
Constipation
Flatulence
Hypercalcemia
Milk alkali syndrome
Vitamin D Vitamin
supplement
Stimulate calcium and
phosphorus absorption
from intestine,
stimulate calcium
secretion from bone in
to blood
600-IU-OD-PO Arrhythmias
Confusion
Constipation
Hypercalcemia
Dry mouth
24. Drugs used in treatment of acute renal
failure continued…
Calcium
acetate
Calcium
supplement
Balances negative
calcium ions levels
in the body
1334 mg-OD-
PO
Arrhythmias
Hypomagnesaemia
Hyperphosphatemia
Hypotension
Hypercalcemia