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    Acute Kidney Injury (ARF)

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    Aizaz Ahmad
    This document provides an overview of acute renal failure (ARF), also known as acute kidney injury (AKI). It discusses the prevalence, classification, etiology, stages, pathophysiology, symptoms, diagnosis, and management of ARF. ARF is defined as an abrupt decline in renal function and decrease in urine output. It can be classified as prerenal, intrinsic, or postrenal. Common causes include volume depletion, vascular disorders, toxic insults, and obstructions. ARF is staged based on increases in serum creatinine and decreases in urine output. Treatment focuses on supportive care, fluid management, and potentially renal replacement therapy to prevent progression of injury and support organ functions.

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    Acute Kidney Injury (ARF)

    Uploaded by

    Aizaz Ahmad
    70 views23 pages
    This document provides an overview of acute renal failure (ARF), also known as acute kidney injury (AKI). It discusses the prevalence, classification, etiology, stages, pathophysiology, symptoms, diagnosis, and management of ARF. ARF is defined as an abrupt decline in renal function and decrease in urine output. It can be classified as prerenal, intrinsic, or postrenal. Common causes include volume depletion, vascular disorders, toxic insults, and obstructions. ARF is staged based on increases in serum creatinine and decreases in urine output. Treatment focuses on supportive care, fluid management, and potentially renal replacement therapy to prevent progression of injury and support organ functions.

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    Acute Kidney Injury

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    This document provides an overview of acute renal failure (ARF), also known as acute kidney injury (AKI). It discusses the prevalence, classification, etiology, stages, pathophysiology, symptoms, diagnosis, and management of ARF. ARF is defined as an abrupt decline in renal function and decrease in urine output. It can be classified as prerenal, intrinsic, or postrenal. Common causes include volume depletion, vascular disorders, toxic insults, and obstructions. ARF is staged based on increases in serum creatinine and decreases in urine output. Treatment focuses on supportive care, fluid management, and potentially renal replacement therapy to prevent progression of injury and support organ functions.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    70 views23 pages

    Acute Kidney Injury (ARF)

    Uploaded by

    Aizaz Ahmad
    This document provides an overview of acute renal failure (ARF), also known as acute kidney injury (AKI). It discusses the prevalence, classification, etiology, stages, pathophysiology, symptoms, diagnosis, and management of ARF. ARF is defined as an abrupt decline in renal function and decrease in urine output. It can be classified as prerenal, intrinsic, or postrenal. Common causes include volume depletion, vascular disorders, toxic insults, and obstructions. ARF is staged based on increases in serum creatinine and decreases in urine output. Treatment focuses on supportive care, fluid management, and potentially renal replacement therapy to prevent progression of injury and support organ functions.

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    of 23

    Acute Renal Failure

    Chap 10. Unit IX Nephrology


    Clinical Pharmacy II
    Abuzar Khan PhD.
    Contents
    ✓ARF
    ✓Prevalence
    ✓Clinical classification
    ✓Etiology
    ✓Stages ARF
    ✓Pathophysiology
    ✓Symptoms
    ✓Diagnosis
    ✓Management
    ✓STGs
    Acute Renal Failure
    ✓ARF or AKI is abrupt or rapid decline in renal filtration
    function.
    ✓Decrease urine output
    ✓Rise in Scr or BUN
    ✓Reversible if managed earlier
    ✓High mortality and morbidity if diagnosis is delayed.
    ✓Affecting 5 % of all hospitalized patient
    ✓High prevalence in critical care units, and multiorgan failure
    patients
    ✓AKI mortality is 46.5 %
    ✓200 pt/million in USA
    ARF Classification

    1.Prerenal 55% 2.Intrinsic 40 % 3. Postrenal 5%


    • As an adaptive response • In response to • Obstruction to the
    to cytotoxic, ischemic, passage of urine
    • Severe volume or inflammatory
    depletion and insults to the
    • Hypotension kidney, with
    structural and
    • Structurally intact
    functional damage
    nephrons
    ARF classification
    ARF Classification

    3. Non oliguria
    1. Anuria 2. Oliguria
    Urine output
    Urine output of <50 Urine output is
    >450 ml/day
    ml/day 50-450 ml/day
    Good Prognosis
    High mortality High mortality
    No worries about
    Less reversible Less reversible
    fluid overload
    Etiology ARF
    1.Prerenal 2.Intrinsic 3. Postrenal
    • Volume depletion • Vascular • Tubular obstruction
    • Diuretics Renal Artery obstruction Crystals – E.g
    • GI Renal vein Obstruction Uric acid
    • Burns Transplant rejection Calcium oxalate
    • Hemorrhages Malignant HTN • Ureteral obstruction
    • Heart Failure • Glomerular Stone
    • Liver Failure Glomerulonephritis Tumor
    • Sepsis Autoimmunity Fibrosis
    • Tubular • Urethral obstruction
    Aminoglycoside Benign prostatic
    Rhabdomyolysis hypertrophy
    • Interstitial Neurogenic bladder
    Stone/ Hematoma
    JPMA 55:526;2005
    ARF Etiology
    Stages of ARF
    Stage SCr Urine output

    Stage I 1.5–1.9 times baseline, or <0.5 mL/kg/h for 6–12 h


    >0.3 mg/dL increase

    Stage 2 2.0–2.9 times baseline <0.5 mL/kg/h for >12 h

    Stage 3 3.0 times baseline, or <0.3 mL/kg/h for >24 h, or


    Increase in SCr to >4.0 Anuria for >12 h
    mg/dL
    ARF Pathophysiology
    Endothelial
    dysfunction
    Microcirculatory
    Coagulation
    failure
    Hypoxia

    Ischemia Inflammation
    Cytokines
    leukocytes
    activation

    ROS
    Mitochondrial
    Dysfunction Toxic Injury
    Apoptosis Direct tubular
    injury
    Antibiotics/
    Doi Journal of Intensive Care (2016) 4:17DOI 10.1186/s40560-016-0146-3 Contrasts
    ARF pathophysiology septic conditions
    ARF pathophysiology vasculature
    ARF signs and symptoms

    Prerenal Intrinsic Postrenal


    symptoms Hypertension BPH
    related to Edema Urgency,
    Vary from hypovolemia,
    patient to Fever Frequency,
    patient
    thirst, and hesitancy
    Stage and decreased Rash
    etiological urine output, Flank pain
    factors dizziness, Muscular and
    orthostatic pain hematuria
    hypotension Seizures
    Altered
    mental status
    Diagnosis of ARF

    History

    Diagnosis CBC and


    biochemistry
    Urine analysis and
    electrolytes
    Radiological
    exams
    Diagnosis
    MANAGEMENT OF ARF
    Goals of treatment

    ARF Prevent ARF and its progression


    Theophylline acetylcysteine, insulin, hydration (Na Loading) glycemic control

    Supportive management

    Fluid management
    General management approach
    ✓Blood pressure monitoring
    ✓Cardiac output monitoring
    ✓Tissue perfusion
    ✓Electrolytes management
    ✓Management of edema
    ✓RRT
    ✓Continuous and intermittent
    ✓Acid base & electrolytes imbalance, intoxication, fluid
    overload
    ARF ATN ICU Algorithm
    Rifle criteria for AKI
    Further Readings
    1. Joseph, D., Pharmacotherapy: A pathophysiologic
    approach. 2008: McGraw-Hill Medical.
    2. Workeneh, B.T., Acute Kidney Injury. 2018.
    eMedicine by Medscape
    3. Bokhari, S.R.A., et al., Characteristics and Outcome
    of Obstetric Acute Kidney Injury in Pakistan: A Single-
    center Prospective Observational Study. 2018. 10(9).
    ✓Thanks

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