Acute Renal FailureAcute Renal Failure

Dr. Rawi Ramadan

Dept. of Nephrology Rambam Medical Center

Definition

A Clinical syndrome characterized by:

• Rapid decline (hours- weeks) in GFR

• Perturbation of ECF volume

• Perturbation of electrolytes + a-b

• Accumulation of nitrogenous waste products from protein catabolism, such as BUN + Creatinine

• ARF - 5% of hospital admissions

- up to 30% of ICU admissions

• ARF- is usually asymptomatic.

• ARF is associated with high morbidity + mortality.

• ARF- can be prevented in many settings.

Causes of ARF

• Prerenal

• Renal

• Post renal

Heme Pigment Nephropathy

• 10-15% of hospitalized patients with ARF

• Rhabdomyolysis - symptomatic

- asymptomatic

• CPK > 10000.

Correspond purely with severity of ARF

• Treatment - I.V. saline

- NaHCO3

Radiocontrast Nephropathy

• 20-50% is patients with cr. > 2

5 - respectively

• Diabetics, CHF, Vol. Depletion, M.M, NSAID, ACE-I.

• Begins 24-48h, peak 4-5 days, resolve 7-10 day

NSAID

• Cox-2, Cox-1

• Impaired renal autoregulation

• Atx1, AIN, papillary necrosis

• Reversible 2-7 days after stop NSAID

Aminoglycosides

• Nonoliguric ARF

• Following 5-10 days of treat

• Hypokalemia hypomagnesemia