Acute Renal Failure

ARF is the sudden interruption of kidney function from obstruction, reduced circulation, or renal parenchymal disease.

• It is usually reversible with treatment.

• Otherwise, it can progress to end – stage renal disease, hemolytic uremic syndrome, and death.

Causes

• Prerenal failure is associated with diminished blood flow to the kidneys.

• Its causes include hypovolemia, shock, embolism, blood loss, sepsis, pooling of blood in ascites / burns, heart failure (HF), arrhythmias, and tamponade.

• Intrinsic renal failure may result from acute tubular necrosis (the most common cause), acute post streptococcal glomerulonephritis, systemic lupus erythematosus, periarteritis nodosa, vasculitis, sickle cell disease, bilateral renal vein thrombosis, the use of nephrotoxins, ischemia, renal myeloma, or acute pyelonephritis.

• Postrenal failure is associated with bilateral obstruction of urinary outflow.

• Its causes include renal calculi, blood clots, tumors, benign prostatic hyperplasia, strictures, urethral edema from catheterization, and papillae from papillary necrosis.

Signs and Symptoms• Oliguria (Usually the

earliest sign)• Anorexia• Nausea & Vomiting• Diarrhea or Constipation• Stomatitis• GI bleeding• Hematemesis• Dry mucous membranes

• Uremic breath• Headache• Drowsiness• Irritability• Confusion• Peripheral neuropathy• Convulsions• Coma• Skin dryness• Pruritus• Pallor and Purpura

• Hypotension appears early in the disease.

• Later assessment finding include Hypertension

Arrhythmias

Symptoms of fluid overload

Heart failure

Systemic edema

Anemia

Pulmonary edema

Kussmaul’s respirations also be evident.

Diagnostic Tests• Blood tests show

elevated BUN, creatinine, and potassium levels, and low pH, hematocrit, and bicarbonate and hemoglobin levels.

• Urine samples show

casts, cellular debris, decreased specific gravity.• Ultrasonography of the kidneys• Plain films of KUB• IVP• Renal scan• Retrograde pyelography• Nephrotomography

Treatment

• The major goals are to reestablish effective renal function, if possible, and to maintain the constancy of the internal environment despite transient renal failure.

• Supportive measures include a diet high in calories and low in protein, sodium, and potassium, with supplemental vitamins and restricted fluids.

• Meticulous electrolyte monitoring is essential to detect hyperkalemia.

• If these measures fail to control uremic symptoms, hemodialysis or perotoneal dialysis may be needed.

Nursing Interventions• Measure record intake & output.• Weigh the pt daily• Assess hematocrit hemoglobin level and

replace blood components as ordered. Don’t use whole blood if the pt is prone to HF

and can’t tolerate extra fluid volume. Packed red blood cells can be given.

• Monitor vital signs.• Watch for and report any signs / symptoms

of pericarditis,inadequate renal perfusion or acidosis.

Nursing Interventions…• Provide a high-calorie, low-protein, low-

sodium, and low-potassium diet, with vitamin supplements.

• Give the anorectic pt small, frequent meals.• Maintain electrolyte balance• Strictly monitor potassium levels.• Watch for symptoms of hyperkalemia

(malaise, anorexia, paresthesia, and muscle weakness) and ECG changes (tall, peaked T waves, widening QRS complex, and disappearing P waves) and report them immediately.

Nursing Interventions…• Avoid giving medications containing

potassium.

• Use aseptic technique, because the pt is highly susceptible to infection.

• Prevent complications of immobility.

• Provide good mouth care frequently.

• Use appropriate safety measures because the pt with central nervous system involvement may be dizzy.

• Monitor for GI bleeding by guaic testing all stools for blood.