FOR LIBYA

1. 1 DR MAGDI AWAD SASI 2014 ARF SUMMARY SHEET
SUMMARY SHEET OF ACUTE SENA FAILUR ((ARF))
CRITERIA OF ARF DIAGNOSIS:
I. Raising plasma urea and creatinine concentration.
II. Rising plasma potassium ,sulphate & falling calcium and bicarbonate
III. A fall in urine volume to 400ml/day( 25% non oliguric)
AETIOLOGY OF ARF:
1.PRE-RENAL ----------–HYPOPERFUSION-----75%
2.RENAL -------------------RENAL PARENCHYMA DAMAGE OR DYSFUNCTION -10-20%
3.POST-RENAL------------ACUTE OBSTRUCTION OF THE URINE FLOW ---2-15%
WHAT ARE THE PRE-RENA CAUSES?
1. Hypovolemia
2. Decreased cardiac out put
3. Septicemic shock
4. Renal artery occlusion
5. Drugs causing reduction in renal blood flow
WHAT ARE THE RENAL CAUSES?
1. Vascular—HHS,TTP,DIC , vasculitis ,scleroderma ,malignant HTN ,eclampsia
2. Glomerular ---rapidly progressive glomerulonephritis
3. Acute interstitial nephritis—
A. Drugs
B. Infections –bacterial interstitial nephritis -----streptococal ,leptospiral ,EB virus,
Mycoplasma pneumonias ,legionella pneumophilia pneumonia
4. ATN------ A. Ischemia---prolonged pre-renal insult
B.Toxins-------myoglobinuria ,haemoglobinuria ,bens jones myeloma
WHAT ARE THE CAUSES OF POST-RENAL ARF?
A. Prostate hyperatrophy, urinary bladder tumor, pelvic tumor
B. Drugs and crystals

2. 2 DR MAGDI AWAD SASI 2014 ARF SUMMARY SHEET
NATURAL HISTORY OF ARF:
1. Incidence: 50 cases annually / million population(UK)
1% OF all population
2—5% major surgery
5—15% intensive care units
2. Three phases:
A. Initiating phase=precipitating factors
˂ 24 hours
B. Established oliguric phase (ATN)
Few days 60 days
C. Recovery =diuretic phase
1.Gradual increase in GFT and urine volume
2.Gradual increase in tubular concentration ability
3.Follow up of ARF cases (RFT never return to normal as before )
4.Increased mortality rate=50% (up to 90% of patients with severe
trauma ,sepsis ,multiple organ failure). Only 105 die as a result of ARF
due to HYPERKALEMIA
HISTORY AND EXAMINATION OF A PATIENT WITH ARF:
1. ARF/CRF---- ARF AND stigma of CRF e.g.:
I. Pigmentation and anemia
II. Pruritis and hypocalcemia
III. Bone diseases
2. ARF due to 3 main causes:
I. Pre –renal : compatable history
1. Check input/output
2. Signs of dehydration----decreased CVP is the most important sign
3. Body weight---- over loaded or dehydrated

3. 3 DR MAGDI AWAD SASI 2014 ARF SUMMARY SHEET
4. Change in the urine characters which differentiate it from
established ATN
5. Effect of fluid challenge and diuretic :
A. Diuresis---prerenal
B. Pulmonary oedema-----ATN
II. Renal(ATN)
History of precipitating factors
Clinical S&S of precipitating cause and acute uremia
Complication of ARF
III. Post –renal:
History of renal symptoms---renal colic ,haematuria
Anurea (˂50 ml/day)
Full urinary bladder (abdomen palpation and USS adomen)
Palpable kidney’s tumor
CLINICAL POINTS TO BE REMMEBERED:
1. ATN is the commonest histology in ARF secondary to pre-renal
causes or nephrotoxic drugs.
2. A urine output ˂25-30ml/hour in adult should be investigated and
urgently corrected. If oliguria persists ˃2-3 hour, it may be irreversible
3. The simplest screening test for RF in ICU patients are :
I. Hourly urine output ( at least 0.5ml/kg/hour)
II. Accurate I/O fluid chart
III. Daily serum creatinine assessment
4.Rhabdomyolysis-----myoglobinuria---it is a cause of hypercatabolic
ARF and hypocalcemia and hyperphosphatemia ( hypercalcemia
occur in recovery phase).
SUMMARY OF ARF MANAGEMENT
Initial assessment
Resuscitation
Management of emergencies

4. 4 DR MAGDI AWAD SASI 2014 ARF SUMMARY SHEET
Exclude prerenal element
Renal ultrasound
Dilated pelvicalyceal system normal sized kidneys small kidneys /PCKD
OBSTRUCTION HISTORY COMPATIBLE ATN H/O NOT COMBATIPLE ATN ACUTE ON CRF
OR HISTORY AND EXAMINATION
SUGGESTIVE OF 1RY PARENCHYMAL DISEASE
SURGERY RENAL BIOPSY
MANAGEMENT OF ESTABLISHED ACUTE RENAL FAILURE
RECOVERY---MANAGEMENT OF RECOVERY PHASE NON RECOVERY IN 3—4WEEKS
FURTHER INVESTIGATIONS INCLUDING
RENAL BIOPSY TO EXCLUDE OTHER DX