Acute Renal Failure

Stephanie White, DO Graeme Reed, MD Jaimeet Chhabra, OMSIII

Criteria for acute renal failure

Serum Creatinine rises >0.3 on 2 contiguous days or Serum Creatinine rises >0.5 mg/dl or Serum Creatinine rises >50% above baseline or Calculated GFR falls >50% below baseline

Patients Labs Serum Creatinine

Baseline: 1.5 (02/09) On admission: 4.0

Baseline: 44 (02/09) On admission: 12

Calculated GFR

Epidemiology / Pathogenesis

Epidemiology

Acute Tubular Necrosis accounts for 20-30% of ARF

Pathogenesis

Prerenal Failure Postrenal Failure Intrarenal Conditions

Vascular Injury Glomerulonephritis Acute Interstitial Nephritis Tubular Injury and Acute Tubular Necrosis

Laboratory Examination

Labs

Fractionial Excretion of Sodium (FENa) Complete Blood Count Urinalysis Autoimmune Testing for Glomerular Disease Percutaneous Renal Biopsy

Acute Tubular Necrosis

Mechanism

Tubule Injury Obstruction Back-leak

Course

Initiation Maintenance

Recovery (weeks to months)

ARF Management

Volume Status Potassium Acid-Base Status Nutritional Intake Uremia Dialysis Indications Medications