Management of Acute Renal Failure

Posted by e-Medical PPT
Acute Renal Failure
Definition: Sudden deterioration in the ability of the kidneys to maintain fluid, solute or electrolyte homeostasis
Common in PICU patients (10-20%)
Greater than 50% mortality
ARF in PICU patients has an independent and significant impact on mortality

ARF: Causes and mortality
Primary renal disease: 33%
Hemolytic uremic syndrome: 88%
Obstructive uropathy
Renal vein/artery thrombosis
Primary glomerulonephritis (RPGN)

Overall mortality: 6%
Most primary renal diseases develop RF gradually and do not need emergent dialysis
Extrarenal causes of ARF: 67% of total

ARF: Risk factors for mortality
Multi-organ failure
Bacterial Sepsis
Fungal sepsis
Ventilatory support
Initiation of dialysis late in hospital course
Oliguria/anuria: with oliguric ARF, mortality is 50% compared to  20% with non-oliguric ARF

Best cure is to prevent
Have a high index of suspicion for reversible factors - volume depletion, decreasing cardiac function, sepsis, urinary tract obstruction
Be sure patient is well-hydrated when exposing patient to nephrotoxic drugs

Anticipate problems
Avoid worsening the ARF
Adjust medicines for renal insufficiency
Avoid nephrotoxins if possible
Avoid intravascular volume depletion (especially in third-spacing or edematous patients)

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