acute renal failure

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ACUTE

RENAL

FAILURE



Acute renal failure

• Is a sudden decline in renalfunction, usually marked byincreased concentrations of

blood urea nitrogen (BUN;azotemia) and creatinine;oliguria (less than 500 ml of

urine in 24 hours);hyperkalemia; and sodiumretention.



Acute renal failure are classified intofollowing:

• Prerenal failure – results from conditions thatinterrupt the renal blood supply; therebyreducing renal perfusion (hypovolemia, shock,

hemorrhage, burns impaired cardiac output,diuretic therapy).

• Postrenal failure – results from obstruction ofurine flow.

• Intrarenal failure – results from injury to thekidneys themselves (ischemia, toxins,immunologic processes, systemic and vascular

disorders).



• The disease progresses through three clinicallydistinct phase which is oliguric-anuric, diuretic,and recovery, distinguished primarily bychanges in urine volume and BUN andcreatinine levels.

• Complication of ARF include dysrhythmias,increased susceptibility to infection, electrolyte

abnormalities, GI bleeding due to stress ulcers,and multiple organ failure. Untreated ARF canalso progress to chronic renal failure, end-stagerenal disease, and death from uremia or related

causes.



Assessment:

• Oliguric-anuric phase: urine volume less than400 ml per 24 hours; increased in serumcreatinine, urea, uric acid, organic acids,

potassium, and magnesium; lasts 3 to 5 days ininfants and children, 10 to 14 days inadolescents and adults.

• Diuretic phase: begins when urine output

exceeds 500 ml per 24 hours, end when BUNand creatinine levels stop rising; length isavailabe.

http://nursingcrib.com/medical-laboratory-diagnostic-test/serum-creatinine/






• Recovery phase: asymptomatic; last

several months to 1 year; some scar

tissue may remain.• In prerenal disease: decreased

tissue turgor, dryness of mucous

membranes, weight loss, flat neckveins, hypotension, tachycardia



• In postrenal disease: difficulty in

voiding, changes in urine flow.

• In Intrarenal disease: presentationvaries; usually have edema, mayhave fever, skin rash.

• Nausea, vomiting, diarrhea, andlethargy may also occur.



Diagnostic Evaluation:

• Urinalysis shows proteinuria, hematuria,casts. Urine chemistry distinguishesvarious forms of ARF(prerenal, postrenal,

intrarenal).

• Serum creatinine and BUN levels areelevated; arterial blood gas (ABG) levels,

serum electrolytes may be abnormal.

• Renal untrasonography estimates renalsize and rules out treatable obstructive

uropathy.

http://nursingcrib.com/nursing-notes-reviewer/evaluation/

http://nursingcrib.com/nursing-notes-reviewer/evaluation/



Clinical featureSince ARF involves the acute retention ofnitrogenous waste products, salt, water, potassium and acid, the physicalsigns and symptoms encountered include:

• nausea and vomiting

• peripheral oedema

• breathlessness

• pulmonary oedema• itching

• pleural effusion

• weakness

• pericarditis

• depression of consciousness

• oliguria

• convulsion



CASESTUDY



Patient X

Sex :Male

Hometown : Baggao CagayanStatus : Married

Birthday : March 06, 1974

He is suffering from ARF (Acute RenalFailure). He was 65 years old whenadmitted in the hospital.



History of present illness

•5 days of fever, chills,

headache, musclepain, joint pain,

epigastric pain anddifficulty in urination.



Clinical Impression

•UTI

•APP

•Pro leptopirosis



Chief complaint

• Gastric pain

• Difficulty in urination

• Fever• Headache

• Weakness

• Joint pain

• Calf pain



DRUGS



Fortifer

• Ferrous + folate(Fortifer FA)

Classification:

• Vitamins &Minerals

Indication:• Prevention &treatment of Fe-deficiency anemia& folate

deficiency

Side effect:

• GI irritationNursing precaution:

• Should be taken on an empty stomach (Best takenbetween meals. May betaken w/ meals to reduce GI

discomfort.).



AMLODIPINE

• Classifications: cardiovascular

agent; calcium channelblocker; antihypertensive agent.

• Side effects of amlodipine: dizziness,

swelling, edema, heart palpitations,nausea, flushing (redness of the skin,especially the face, abdominal pain

(stomach pain and drowsiness.



Doxycycline

• Doxycycline is a tetracycline

antibiotic. It fights bacteria in the

body.• Doxycycline is used to treat many

different bacterial infections, such as

urinary tract infections, acne,gonorrhea, and chlamydia,

periodontitis (gum disease), and

others.



SIDE EFFECTS OF DOXYCYCLINE

• severe headache, dizziness, blurred

vision;

• fever, chills, body aches, flu symptoms,swollen glands, rash or itching, joint pain,

or general ill feeling;

• urinating less than usual or not at all;

• diarrhea that is watery or bloody

• pale or yellowed skin, dark colored urine,fever, confusion or weakness;



• severe pain in your upper stomach spreading toyour back, nausea and vomiting, fast heart rate;

• loss of appetite, jaundice (yellowing of the skinor eyes); or

• severe skin reaction -- fever, sore throat,swelling in your face or tongue, burning in your

eyes, skin pain, followed by a red or purple skinrash that spreads (especially in the face orupper body) and causes blistering and peeling.

• mild nausea, mild diarrhea;• upset stomach;

• mild skin rash or itching; or

• vaginal itching or discharge.



Aspilet EC

• Aspilets/Aspilets-EC helps to relieve pain andinflammation. It also helps to bring down a fever.

Aspilets/Aspilets-EC is also a blood-thinningmedicine. It prevents special cells in the blood --the platelets -- from sticking to each other. Thisreduces the risk of harmful blood clots forming.

Blood clots that form in a blood vessel inside theheart or brain can cause a heart attack or astroke.



Aspilets/Aspilets-EC may be used on its own or

together with other medicines to prevent heartattacks and strokes in people who are at risk.

Aspilets/Aspilets-EC is also used together with

other medicines to prevent blood clots in peoplewho have had stents inserted into their heartarteries. It can also be used to prevent harmfulblood clots in people who have an artificial heartvalve.

Aspilets/Aspilets-EC can also be used for other

medical conditions, as decided by your doctor.



Side effect

• Stomach discomfort, nausea and indigestion arecommon side effects of Aspilets/Aspilets-EC. TakeAspilets/Aspilets-EC with or immediately after food tominimise these side effects. Let your doctor know if

these side effects bother you or if they do not go away.

Aspilets/Aspilets-EC may cause dizziness. If you feeldizzy, do not drive or take part in any activity in which

you need to be alert. Let your doctor know if thedizziness persists.



• Less commonly, Aspilets/Aspilets-EC may cause some

side effects which can be serious. Alert your doctorquickly if you experience any of these:

- swelling of face, eyes or lips

- rashes- breathlessness- ringing in the ears- unusual bleeding, especially excessive bleeding orbleeding that takes a long time to stop

- unusual bruises, especially if the bruises appear bythemselves or if they cover a large area- black, sticky stools



Vidastat

• Indications:For the management of primaryhypercholesterolemia, heterozygous familialhypercholesterolemia, homozygous familial

hypercholesterolemia or combined (mixed)hyperlipidemia in patients who have notresponded adequately to diet and otherappropriate measures; prevention of coronary

events, need for revascularisation proceduresand to slow progression of coronary heartdisease.



• Contraindication:Acute liver disease orunexplained persistent elevations of serumtransaminases. Porphyria. Pregnancy and

lactation.• Precaution:Liver enzymes should be monitored

at the start and during simvastatin therapy. Usesimvastatin with caution in patients who

consume alcohol and/or have a history of liverdisease.



• Side Effect:Increase creatinine clearanceconc of at least 3 times the upper limit ofnormal, rhabdomyolysis with acute renal

failure secondary to myoglobinuria on rareoccasions, Other side effects: >1% - pain,asthenia, diarrhea, nausea/vomiting, and

headache; constipation; dyspepsia; andflatulence.



Xatral

• Xatral tablets contain the active ingredientalfuzosin, which is a type of medicinecalled an alpha-blocker. It works by

blocking alpha receptors that are found inthe muscle in the prostate gland. (NB.Alfuzosin is also available without a brand

name, ie as the generic medicine.)

http://www.netdoctor.co.uk/medicines/brand_generic.htm

http://www.netdoctor.co.uk/medicines/brand_generic.htm



• The prostate gland, which is found only inmen, lies at the top of the tube connectingthe bladder to the outside (urethra). The

prostate gland often enlarges withadvancing age (benign prostatichyperplasia), pressing on the urethra and

obstructing the flow of urine from thebladder. This can cause various urinarysymptoms, such as difficulty passing urine.



• Alfuzosin blocks alpha receptors in

the muscle of the prostate gland,

which causes the muscle in theprostate to relax. This allows urine toflow freely past the prostate and

relieves the urinary symptoms.



Side effect

• Dizziness.

• Feeling faint.

• Headache.

• Spinning sensation (vertigo).

• A drop in blood pressure that occurs when going from lying down tositting or standing, which results in dizziness and lightheadedness(postural hypotension).

• Nausea.

• Abdominal pain.

• Diarrhoea.

• Dry mouth.

• Weakness or loss of strength (asthenia).

• General feeling of being unwell (malaise).



Hytaz

• Indications:In the treatment of edemaassociated with heart failure and with renaland hepatic disorders; also used in

hypertension.

• Contraindication:Anuria, renal impairmentand sulfonamide allergy.

• Precaution:Renal and hepatic disease.Gout or hyperuricemia. History ofpancreatitis.



• Side Effect:Weakness. Orthostatic hypotension.Pancreatitis, jaundice, diarrhea, vomiting, sialadenitis,

cramping, constipation, gastric irritation, nausea,anorexia. Aplastic anemia, agranulocytosis, leukopenia,hemolytic anemia, thrombocytopenia. Anaphylacticreactions, necrotizing angiitis, respiratory distress,

including pneumonitis and pulmonary edema,photosensitivity, fever, urticaria, rash, purpura.Electrolyte imbalance, hyperglycemia, glycosuria,hyperuricemia. Muscle spasm. Vertigo, paresthesias,dizziness, headache, restlessness. Renal failure and

dysfunction, interstitial nephritis. Erythema multiformeincluding Stevens-Johnson syndrome, exfoliativedermatitis including toxic epidermal necrolysis, alopecia.Impotence



Pentoprazole

• Pantoprazole is in a group of drugs

called proton pump inhibitors. It

decreases the amount of acidproduced in the stomach

• Side effects: nausea, vomiting;

• gas, stomach pain;• diarrhea; or

• headache.

http://www.emedicinehealth.com/script/main/art.asp?ArticleKey=59276






Folic acid

• Folic acid is a type of B vitamin that isnormally found in foods such as driedbeans, peas, lentils, oranges, whole-wheat

products, liver, asparagus, beets, broccoli,brussels sprouts, and spinach.

• Folic acid helps your body produce and

maintain new cells, and also helps preventchanges to DNA that may lead to cancer



• As a medication, folic acid is used to treat folicacid deficiency and certain types of anemia (lackof red blood cells) caused by folic acid

deficiency.• Folic acid is sometimes used in combination with

other medications to treat pernicious anemia.However it will not treat Vitamin B12 deficiency

and will not prevent possible damage to thespinal cord. Take all of your medications asdirected.



• How should I take folic acid?

• Take folic acid exactly as prescribed by your doctor. Donot take it in larger amounts or for longer thanrecommended. Follow the directions on your prescriptionlabel.

• Take folic acid with a full glass of water.• Your doctor may occasionally change your dose to make

sure you get the best results from this medication.

• Store folic acid at room temperature away from moisture

and heat.



• Folic acid side effects

• Get emergency medical help if you have any of thesesigns of an allergic reaction to folic acid: hives; difficult

breathing; swelling of your face, lips, tongue, or throat.• Less serious side effects are more likely, but may

include:

• nausea, loss of appetite;

• bloating, gas;

• bitter or unpleasant taste in your mouth;

• sleep problems;

• depression; or

• feeling excited or irritable.

• This is not a complete list of side effects and others mayoccur. Call your doctor for medical advice about sideeffects.



Ceftriaxone

• Treating bacterial infections.

• Ceftriaxone is a cephalosporin

antibiotic. It works by interfering withthe formation of the bacteria's cellwall so that the wall ruptures,

resulting in the death of the bacteria.



Side effect

• Mild diarrhea; mild pain,swelling, or redness at the

injection site; nausea;vomiting.



hydrocortisone

• Enters target cells and binds tocytoplasmic receptors; initiates many

complex reactions that are responsible forits anti-inflammatory, immunosuppressive(glucocorticoid), and salt-retaining

(mineralocorticoid) actions. Some actionsmay be undesirable, depending on druguse.



• Drug Interactions:

• · Increased steroid blood levels with hormonalcontraceptives, troleandomycin

• · Decreased steroid blood levels with phenytoin,phenobarbital, rifampin, cholestyramine

• · Decreased serum level of salicylates

• · Decreased effectiveness of anticholinesterases(ambenonium, edrophonium, neostigmine,pyridostigmine)



Side effect

• Difficulty sleeping; dizziness orlightheadedness; headache;

increased appetite; increasedsweating; indigestion;

nervousness.



Arcoxia

• Arcoxia is used for the following:

• acute and chronic treatment of the signsand symptoms of osteoarthritis andrheumatoid arthritis

• management of ankylosing spondylitis

• relief of chronic musculoskeletal pain

• relief of acute pain

• to treat acute gouty arthritis



Side effects

• feeling sick (nausea), vomiting

• heartburn, indigestion, uncomfortablefeeling or pain in the stomach

• diarrhoea

• swelling of the legs, ankles or feet

• high blood pressure• dizziness

• headache



Hytrin

• alpha 1-blockers

• is used to treat high blood

pressure. It relaxes blood vessels,allowing blood to flow through

them more easily.



Side effects

•Dizziness;

drowsiness;lightheadedness;

nasal congestion;nausea; weakness.



Cephalexine

• DRUG CLASS AND MECHANISM: Cephalexin belongsto a class of antibiotics called cephalosporins. They aresimilar to penicillin in action and side effects. They stopor slow the growth of bacterial cells by preventing

bacteria from forming the cell wall that surrounds eachcell. The cell wall protects bacteria from the externalenvironment and keeps the contents of the cell together.Without a cell wall, bacteria are not able to survive.

Bacteria that are susceptible to cephalexininclude Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, E. coli andseveral others.



• SIDE EFFECTS: The most common

side effects of cephalexin

are diarrhea,nausea, abdominalpain, vomiting, headaches, dizziness,skin rash, fever,abnormal liver

tests and vaginitis. Individuals whoare allergic to penicillin may also beallergic to cephalexin.

•

http://www.medicinenet.com/script/main/art.asp?articlekey=1900


























Metoclopramide

• Metoclopramide increases the

movements or contractions of the

muscles in the stomach andintestines. This decreases the amountof time it takes for the stomach

contents to move through thedigestive tract. Metoclopramide canbe used alone or with other medicine.



• Side Effects

• Metoclopramide does not cause as many sideeffects as many other medicines used to prevent

nausea and vomiting. Possible side effectsinclude:

• Sleepiness or confusion.

• Twitching or muscle spasms.

• Decreased blood pressure (hypotension).

• Rapid or uncontrolled movements of lipsand tongue.

http://www.webmd.com/brain/tic-disorders-and_twitches

http://www.webmd.com/pain-management/muscle-spasms-cramps-charley-horse

http://www.webmd.com/hypertension-high-blood-pressure/guide/blood-pressure-causes

http://www.webmd.com/oral-health/picture-of-the-tongue

http://www.webmd.com/oral-health/picture-of-the-tongue

http://www.webmd.com/hypertension-high-blood-pressure/guide/blood-pressure-causes

http://www.webmd.com/pain-management/muscle-spasms-cramps-charley-horse

http://www.webmd.com/brain/tic-disorders-and_twitches



Pharmacort

• Indications: Primary &secondary adrenocortical insufficiency;endocrine, hematologic, rheumatic &

collagen disorders; severe shock, bilateraladrenalectomy, acute hypersensitivityreactions, severe lupus erythematosus in

relapse; other conditions requiringimmediate metabolic & anti-inflammatoryactions of hydrocortisone.

http://www.mims.com/Philippines/diagnoses/info/2678











Side effects:

• tinging, burning, irritation,

dryness, or redness at the

application site may occur. Acne,unusual hair growth, "hair bumps"(folliculitis), skin

thinning/discoloration, or stretchmarks may also occur.



Metodopramide IV

• its mechanism of

action in the treatmentof migraine headache.

FOODS TO EAT FOR ACUTE RENAL



FOODS TO EAT FOR ACUTE RENALFAILURE

• Acute renal failure occurs when your kidneyssuddenly lose the ability to clean waste productsand other impurities from your blood. This type

of renal failure usually happens over a few hoursto a few days; it may be a temporary condition orit could lead to chronic kidney problems.Because your kidneys are unable to perform

their normal functions, you will need to adjustyour diet to limit the work that your kidneys haveto do.



FEWER PROTEIN FOODS

• You will need to eat less protein if you have acute renalfailure, reports Drugs.com. When the body breaks downprotein, the kidneys get rid of the waste products. Toprotect your kidneys and prevent a buildup of waste

products in the blood during acute renal failure, you needto lower your protein intake. High-protein foods includemeats, poultry, dairy products and eggs. Your renaldietitian will educate you about the protein in foods and

about how much protein you should eat each day. Youmay be instructed to eat more healthy carbohydratefoods or healthy fats to obtain nutrition and calories,notes the kidney care company DaVita.



LOW-SODIUM FOODS

• High levels of sodium can increase fluid retention in yourbody. Fluid retention can lead to swelling in the body oreven high blood pressure, according to DaVita. Highblood pressure can further hamper kidney function in

acute renal failure, and kidneys in failure may not beable to clear fluids effectively. You should avoid foodslike processed meats, salty chips and crackers, cannedsoup and vegetables, reports the Mayo Clinic. You can

also control your salt intake by cooking your own mealsand using herbs and spices to season food instead ofsalt.

O O SS OO S



LOW-POTASSIUM FOODS

• One of the functions of the kidneys is to maintain theproper balance of potassium in the body. Too muchpotassium in the body can lead to heart problems anddeath, notes the Kidney Patient Guide. You will need to

monitor your intake of high-potassium foods likebananas, oranges, potatoes and tomatoes. Eatingapples, grapes, cabbage and strawberries are betterchoices if you have acute renal failure. If your potassium

level becomes too high, you may have to undergodialysis treatments to clean your blood because highpotassium can be life threatening.

LOW PHOSPHORUS FOODS



LOW-PHOSPHORUS FOODS

• The kidneys also clear excess phosphorusfrom the body. In acute renal failure,phosphorus levels may become too high

and cause bone problems, notesDrugs.com. Limiting high-phosphate foodslike dairy products, peas and nuts can

lower your phosphate levels and protectyour bones. Your dietitian can tell you howmuch phosphorus you can eat each day.



• Given below are the nutrients that need to be eaten inlimited quantities or preferably avoided as far aspossible:Protein: Eggs, dairy products, beans, meat,chicken and turkey

• Phosphorus: Nuts, nut butters, peas, beans, milk,cheese, yogurt and colas

• Potassium: Bananas, avocado, pears, raisins,cantaloupe, potatoes, broccoli, spinach and tomatoes

• Sodium: Table salt, chips, crackers, pretzels, commercialsauces and other salty snacks

acute renal failure

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