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Acute Renal Failure PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Acute Renal Failure” by Marcela Ramirez, MD.

This medical PowerPoint presentation is about acute renal failure, also known as acute kidney injury. Acute renal failure is a sudden loss of kidney function that occurs over a period of hours to days. This condition can occur due to various reasons, including dehydration, sepsis, medication toxicity, urinary tract obstruction, or any condition that leads to reduced blood flow to the kidneys.

Tags : Acute Renal Failure, acute kidney injury, Nephrology, Nephrology PowerPoint presentation

Published on : Jun 07, 2023 | Views : 1613 | Downloads : 3

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Acute Renal Failure Marcela Ramirez, MD
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Acute Renal Failure Abrupt ( hours or days) deterioration of renal function with decrease in GFR or tubular injury compromising the kidney ability to maintain fluid or electrolyte homeostasis
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Acute Renal Failure
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Acute Renal Failure The Acute Dialysis Quality Initiative Group proposed the RIFLE system classification : - Three severity categories: Risk Injury Failure - 2 clinical outcomes categories: Loss ESRD
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Acute Renal Failure
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Acute Renal Failure An increase in BUN and creatinine >/50% over baseline in 24h Acute Azotemia Intrinsic RF Pre-renal Post renal Reversible
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Acute Renal Failure
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Acute Renal Failure
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Acute Renal Failure Renal ischemia central contributor in at least half of the cases of ARF. Causes: - Absolute loss of IV volume ( hemorrhage) - Decreased effective IV volume (sepsis) - Diminished CO - Meds ( NSAIDS, ACE-I, contrast)
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Renal perfusion pressure
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Pathophysiology Pre Renal circulating volume MAP renal blood flow GFR Aldosterone and ADH (retain Na & H2O) Concentrated urine with low Na ( u/o) BUN reabsorbed tubules Azotemia
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Post Renal or Obstructive Blockage of both urethers or urethra Obstruction of urine flow renal basal vascular tone renal blood flow Reversible atrophy CRF
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Acute Intrinsic RF
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Diagnosis Sudden drop U/O (< 0.5ml/Kg/h in 4h) or daily Cr level (≥0.25mg/dl from baseline) Cr 1.5mg/dl (represent a 50% in GFR R/O obstruction (foley, US) R/O prerenal dysfunction
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Acute Renal Failure Surgical patients Renal perfusion (mcc of oliguria) Renal work + Renal perfusion ( O2 Consumption) ( O2 delivery) ATN Hypovolemia is the most common cause
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Serum BUN increases more quickly than Cr. A ratio BUN: Cr ≥ 15 Renal hypoperfusion BUN is influenced by the patients metabolic state. BUN can also be : - Excesive protein intake (nl renal Function) - Steroids
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Lab indices of Intrinsic Renal Dysfunction and Prerenal Azotemia / Oliguria
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Acute Renal Failure FENa: U Na x P Cr P Na x U Cr Accuracy decreases: Pre-existing renal insufficiency Recent diuretic use Eldderly patients
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Diagnosis and Treatment of Oliguria and Azotemia Increased Cr Oliguria R/O Obstruction Prerenal? Fluid Challenge Cr > 0.25g/dl in 24h Insert Foley Flush foley US BUN Cr >20 TC, Low filling preasure yes Intrarenal Injury/ Dysfunction No response No
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Intrarenal Injury/ Dysfunction U Na >20 U osm <300-400 FENa >1 Cast in urine Increased DO2I Transfuse Optimize preload MAP >80 Diuretic trial Requires renal replacement Nonoliguric renal injury Hemodymically stable IHD Continues renal replacement yes no
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Acute Renal Failure