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ARF & CRF

Dr Ankit SoniDNB Trainee ( Peds)

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Definition

Acute renal failure (ARF) is defined as asudden deterioration in kidney

functions resulting in inability tomaintain fluid & electrolyte balance.

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Prerenal Disease

Dehydration

Sepsis

Hypoalbuminemia

Cardiac failure

Hemorrhage

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Intrinsic Renal Failure

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GlomerulonephritisHUSAcute tubular necrosis

Cortical necrosisRenal vein thrombosisRhabdomyolysis

Acute interstitial nephritisTumour lysis syndrome

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Post-renal ARF

Posterior urethral valvesUreteropelvic junction obstruction

UreteroceleTumour

UrolithiasisHemorrhagic cystitis

Neurogenic bladder

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Symptoms of ARF Decrease urine output (70%)

Edema

Mental changes

Heart failure

Nausea, vomiting

Anemia

Tachypenic Cool, pale, moist skin

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Investigations

Hemogram

Electrolytes

KFTs S. phophate

S. calcium

ABG C3 levels

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ASO titre

Anti-nuclear/cytoplasmic antibodies

Urine RE Urine CS

CXR

Renal USG Renal biopsy

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r ne n ces

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prerenal

ARF

ATN

Urine specific gravity >1.020 500 20 40

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FeNa

Calculation of fractional excretion ofsodium (FeNa)

FeNa = (urine Na/plasma Na)/(urinecreatinine/plasma creatinine)

FeNa 1% = ATN

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Treatment

Fluid management

Management of hyperkalemia

Treatment of metabolic acidosis Hypocalcemia

Hyponatremia

Hypertension Anemia

Nutrition

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Indication of Dialysis

Volume overload with evidence of HT/Pul

edema refractory to diuretics

Persistent hyperkalemia Severe metabolic acidosis unresponsive to

medical management

Neurological symptoms BUN > 100-150

Ca/P imbalance, with hypocalcemic tetany

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Chronic kidney disease

It is defined as either renal injury(proteinuria)

and/or a GFR < 60ml/min/1.73m2 for > 3

months.

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Pathogenesis

Hyperfiltration injury

Proteinuria

hyperphosphatemia

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CHRONIC RENAL FAILURE:

Sodiumand Volume Balance

Sodium and water retention:

CHF, Hypertension, ascites, edema

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CHRONIC RENAL FAILURE:

Potassium Balance

Hyperkalemia

Renin-aldosterone-mediated K transport in the

DCT K-sparing diuretics, ACEis, beta-blockers impair

Aldosterone-mediated actions

Exacerbation of hyperkalenia:

Exogenous factors: K-rich diet, etc.

Endogenous factors: infection, trauma, etc.

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CHRONIC RENAL FAILURE:

Metabolic

Acidosis

Decreased acid excretion and ability to

maintain physiologic buffering capacity:

Treat with oral sodium bicarbonate

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CHRONIC RENAL FAILURE:

Mineral

and

Bone

Bone disease (Figure 16-6) from:

Decreased Ca absorption from the gut Over-production of PTH

AlteredVitamin D metabolism

Chronic metabolic acidosis Impaired production of 1,25D.

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CHRONIC RENAL FAILURE:

CardiovascularandPulmonary

Abnormalities

Volume and salt overload

CHF and pulmonary edema

Hypertension

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CHRONIC RENAL FAILURE:

Hematological

Abnormalities

Anemia: lack of erythropoietin production

diet

Lab Abnormalities: Prolonged bleeding time,abnormal platelet aggregation

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CHRONIC RENAL FAILURE:

Neuromuscular Abnormalites

CNS Abnormalities:

Mild-Moderate: Sleep disorders, impairedconcentration and memory, irritability

Severe: Asterixis, myoclonus, stupor, seizures andcoma

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CHRONIC RENAL FAILURE:

Gastrointestinal

Abnormalities

Peptic Ulcer disease: Secondaryhyperparathyrodism?

Uremic gastroenteritis: mucosal alterations

Non-Specific abnormalities:

anorexia, nausea, vomiting, hiccoughs

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CHRONIC RENAL FAILURE:

Endocrine

Abnormalities

Insulin: Prolonged half-life due to reduced

clearance (metabolism)

Amenorrhea and pregnancy failure: lowestrogen levels

Impotence, oligospermia and geminal cell

dysplasia: Low testosterone levels

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CHRONIC RENAL FAILURE:

Dermatologic

Abnormalities

Pallor: anemia

Skin color changes: accumulation of pigments

Ecchymoses and hematomas: clottingabnormalities

Pruritus and Excoriations: Ca deposits from

secondary hyperparathyroidism

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Growth retardation

Inadequate calorie intake

Renal osteodystrophy

Met acidosis anemia

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Hyperlipidemia

Pericarditis/cardiomyopathy

Glucose intolerance

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Thank you