This document summarizes acute and chronic kidney failure. For acute failure, it discusses causes like pre-renal issues and acute tubular necrosis, investigations, management focusing on treating underlying causes and symptoms like hyperkalemia, and indications for dialysis. Chronic kidney failure is defined by decreased glomerular filtration rate over 3 months and stages are described. Causes and management target complications like fluid balance, blood pressure control, removing toxins and planning for long term renal replacement therapy if needed.
4. Significant reduction in renal failure in hours or days.
Maybe no symptoms, oliguria is common
(<400ml/24hrs)
Biochemically detected by increasing Urea &
Creatinine.
Can occur in isolation but usually secondary to other
pathology.
Pre Renal and acute tubular necrosis account for 80%
of acute renal failure.
5. Systemic cause that reduce perfusion of the
kidney
◦ Hypovolemia
◦ Sepsis
◦ Post Surgery
◦ Shock
◦ Hepatic Failure
◦ Drugs – NSAIDs, ACEi
◦ Renal artery/vein occlusion
13. Causes
◦ Pre-renal
◦ Renal
◦ Post-renal
Pre Renal and acute tubular necrosis account for 80% of
acute renal failure.
Rapid diagnosis and treatment of underlying pathology
crucial.
Symptomatic management and empirical treatment vital.
Always be aware of hyperkalaemia
14.
15. Defined as kidney damage or a decreased
kidney glomerular filtration rate (GFR) of less
than 60 for 3 or more months
ESRD aged >65, increases mortality 6x
Usually asymptomatic in stage 1-3
CRF alter the dose of certain drugs and
contraindicate others depending on the GFR
20. Is it truly chronic?
Treat any reversible causes or acute
exacerbations
Treatment of consequences of chronic renal
failure
Long term planning esp renal replacement
therapy
21. Review medication during progression of
renal failure.
Symptoms can reflect failure of any the action
of the kidneys.
Treat any reversible causes promptly
Plan long term therapy early
95% of the body's potassium is intracellular
Aggressive Rx due to risk of arrhythmias
http://upload.wikimedia.org/wikipedia/commons/4/49/ECG_in_hyperkalemia.png
1) calcium gluconate - heart membrane stabiliser, protects against arrhythmias
2) Insulin & Dextrose- Insulin moves K+ into cells thus decreasing intravasc lvls
3) Calcium resonium – Binds K+ in the gut and stops absorption
Renovascular disease – NB vasculitides - wegners
The deteriation in CRF is relatively predictable so long term planning can begin early to make sure that the best quality of life is maintained, esp when beginning to plan renal replacement therapy.