Acute Renal Failure
Terms
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- Acute Renal Failure
- ARF is a rapid deterioration or cessation in kidney function demonstrated by progressive azotemia and serum creatinine. Anuria, oliguria, or polyuria may exist.
- ARF: review renal function
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*regulate fluid volume(edematous, ^wt, CHF, SOB, rales)
*regulate electrolyte balance (^K, <Ca, ^Phos)
*Regluate acid-base balance (lungs ^ or <R 1 hr)(kidneys ^<UO 24hrs)
*regluate BP (renin-angio: vasoconstriction=<BP)(aldosterone ^NA, ^H2O, ^Bl vol)
*excrete nitrogenous waste products (^BUN)
*produce erythropoietin (anemic <dec RBC)
*Metabolism of vitD (bones) - ARF: risks for development
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*Hx DM, HTN, CV disease, calculi
*Family hx calculi, HTN
*drugs with potential for nephrotoxicity (gentomycin, amphoteracin, NSAIDS, chemo)
*major trauma, crushing injuries, severe allergic reactions - ARF: hyperkalemia
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*Kalexalate enema, po
*sorbitol retention enema
*D50W with Humulin R insulin
*Soium Bicarbonate IV
*IV calcium gluconate
*dialysis - ARF: dietary changes
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*restrict protein
*high CHO, fat
*restrict fluids
*restrict Na
*restrict K - ARF: medications
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*diuretics: lasix, bumex, mannitol
*Aluminum hydroxide preparations (AlternaGel) binds with Phosphate
*Calcium replacement
*epogen/iron supplements - Causes of ARF
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*prerenal: <blood flow to the kidney
*intrarenal: direct damage to the kidney parenchyma
*postrenal: obstruction to the flow of urine which may cause hydronephrosis - Causes of Prerenal ARF
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*inadequate intravascular volume (fluid loss from N/V; hemorrhage, excessive diuresis)
*Redistribution of blood volume (peripheral vasodilation, third spacing)
*reduced CO (acute MI--> cardiogenic shock)
*renal artery thrombosis - Causes of Intrarenal ARF
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*ATN most common form
*prolonged ischemic damage
*nephrotoxic damage (radiographic contrast dye, drugs: antibiotics, NSAIDS, heavy metals)
*glomerulonephritis - Causes of Postrenal ARF
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*Obstruction due to
-calculi
-blood clots
-BPH
-Obstruction of indwelling catheter
-tumors - ARF: Onset
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*begins with insult and ends with oliguria
*the key is prevention
*monitor BP (if low for them, kidney perfusion <, CR^)
*monitor vol status: (I&O)
*monitor cardiac func: (If pulse <, < function)
*monitor labs: (BUN,Cr^= not a good sign)
*identify potential nephotoxins (NSAIDS) - ARF: Oliguric phase
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*can last up to 8 weeks
*vol overloaded pt: edema, crackles, rales, ^HR, SOB (d/t <UO)
*lab values altered (^BUN,Cr, ^K, dilutional hyponatremia, <Ca, ^Phos, <H&H)
*Acidosis (metabolic-kidney can't get rid of bicarb)
*diet changes (restrict proteins, ^CHO, ^fats
*Tx: low dose dopamine (^perfusion, ^BP, ^vasodilation) - ARF: Diuresis Phase
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*^UOn (^out d/t lasix, bumex or renal cocktail)
*FVD (I&O)
*Labs: (<Cr, <K, ^H&H, ^Ca, <Phos
- ARF: Recovery phase
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*lasts about six months
*Primary concerns: maintain UO, Monitor I&O, BP, drugs they are on - S/S of ARF
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*CNS (lethargy, confusion, tremors, seizures, coma)
*CV: EKG changes, tachycardia, edema (caused by ^K, bradycardia to asystole)
*PULM: SOB, rales, frothy sputum with CHF, rapid resp (too much vol = ^rr/acidosis)
*GI: n/v/d (build up of waste)
*GU: urine scant, cloudy, sediment - ARF: Laboratory Data
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*^BUN
*^Cr
*ABG: <CO2, <ph, <HCO3, <PO2
*^K
*^Phos
*<Ca
*<RBC & Hgb - ARF: Treatment
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*correct cause
*manage volume status (^vol=^wt, but still <BP= give albumin, then lasix)
*correct elec. imbal.
*correct acidosis (can give bicarb)
*treat azotemia: dialysis
*nutritional requirements (<proteins, ^CHO, fat)
*stimulate kidneys: drugs