This PPT is regarding acute renal failure

1. Dr. V. S. Swathi
Assistant Professor

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

6. Risk factors
🠶 Advanced age
🠶 Peripheral artery disease
🠶 Hypertension
🠶 Diabetes
🠶 Previous kidney injury
🠶 Liver disease
🠶 Cancer
🠶 Morbid obesity

7. Etiology
🠶 Hypoperfusion of kidney
🠶 Renal parenchymal damage
🠶 Urinary tract obstruction

9. Pathogenesis
Pre renal failure

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

12. Clinical Presentation
Volume loss signs and symptoms
🠶 Thirst
🠶 Vomiting
🠶 Diarrhea
🠶 Dry mucosa
🠶 Decreased elasticity of skin
🠶 Tachycardia
🠶 Decreased blood pressure
🠶 Decreased jugular venous pressure

13. Clinical Presentation continued…
Volume over load signs and symptoms
🠶 Weight gain
🠶 Orthopnea
🠶 Nocturnal dyspnoea
🠶 Ankle swelling
🠶 Oedema
🠶 Jugular venous distension
🠶 Pulmonary crackles
🠶 Shortness of breath

15. Complications
🠶 Hyperkalemia
🠶 Metabolic acidosis
🠶 Hypocalcaemia
🠶 Hyperphosphatemia
🠶 Infections
🠶 Uraemic gastro intestinal erosions
🠶 Pleural effusion
🠶 Heart failure
🠶 Bleeding problems

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

20. Treatment Algorithm
Acute kidney injury
🠶 Loop diuretics+ Thiazide diuretics
Hyperkalemia
🠶 Restriction of potassium rich food
🠶 Calcium Gluconate
🠶 Glucose + Insulin
🠶 Nebulised Salbutamol
Uraemia
🠶 Parentral nutrition
Volume overload
🠶 Water and sodium restriction
🠶 Dialysis

21. Treatment Algorithm continued…
Metabolic acidosis
🠶 Sodium bicarbonate
🠶 Dialysis
Hypocalcaemia
🠶 Calcium carbonate
🠶 Vitamin D
Hyperphosphatemia
🠶 Calcium carbonate
🠶 Calcium acetate
Infections
🠶 Broad spectrum antibiotics
Gastric erosions
🠶 Proton pump inhibitors
🠶 H2 receptor antagonists

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

25. Resources
🠶 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6322747/pdf/pone.0210360.pd
f
🠶 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6303942/pdf/12882_2018_Arti
cle_1169.pdf
🠶 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5915682/pdf/pone.0196088.pd
f
🠶 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6096658/pdf/11255_2018_Arti
cle_1836.pdf
🠶 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5827600/?report=printable