Acute Renal Failure (ARF) Causes Clinical Features TREATMENT of ARF

Acute Renal Failure (ARF)

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Acute renal failure (ARF) is defined as a sudden decrease of normal kidneyDiabetic Nephropathy and Renal complications of DM (Diabetes Mellitus). Read more ... » function that compromises the normal renal regulation of fluid, electrolyte, and acid–base homeostasis.

ARF (Acute renal failure) is characterized by :

  • · Decrease in GFR (reversible).
  • · Retention of nitrogenous wastes.
  • · Disturbance of balance of fluid volume, electrolytes and acid-base.
  • Oliguria: Urine output <0.5 mL/kg/h in infants or <500 mL/1.73 m2/d in older children
  • Anuria: Total cessation of urinary output
  • Polyuria: Urine output >2 L/m2/d in infants and children or 3 L/d in adults
  • ·Oliguria – i.e. urine output <400 ml/day.
  • Pre-renal and post-renal failure may be reversible by prompt and appropriate treatment.
  • ARF is usually asymptomatic. It is diagnosed by a recent increase in blood urea and creatinine.
Acute Renal Failure (ARF) 2

Acute Renal Failure (ARF) Causes Clinical Features TREATMENT of ARF

ARF may be of 3 types:


Hepatorenal syndrome


  • This may be due to :
  • 1. Disease of larger renal vessels
  • 2. Disease of glomeruli
  • 3. Ischemic and nephrotoxic ARF
  • 4. Tubulointerstitial disease.

Common causes of intrinsic ARF

  • · Ischemia (Acute tubular necrosis)
  • · Nephrotoxins.

Acute tubular necrosis


  • Post renal ARF is usually due to obstructive causes and are fully reversible with surgical treatment .


Renal Causes of ARF

  • Renal artery obstruction by thrombus, embolism Renal vein thrombosis
  • Glomerulonephritis
  • Vasculitis
  • Thrombotic thrombocytopeniac purpura Toxaemia of pregnancy
  • DIC (Disseminated intravascular coagulation) SLE (Systemic lupus erythematosus) Scleroderma
  • Acute tubular necrosis (Ischemia or hypoperfusi6n)
  • Toxins
  • PPH (Post Partum Haemorrhage) Abruptio placentae
  • Drugs  Cyclosporin
  •  Antibiotics
  • NSAIDs
  • Radiocontrast dye
  • Interstitial nephritis Infections.
  • Calculi CancerUses of Ayurveda for Improvement in Cancer Patients Treatment. Read more ... »
  • Clot
  •  Stricture Bladder neck obstruction
  • Urethral obstruction.


  • ARF is commonly precipitated by an ischemic or nephrotoxic event.
  • Initial vasodilatation is followed by intense vasoconstriction, with blood redistributed from the cortex to the juxtamedullary nephrons
  • Intratubular debris and cast formation develop.
  • Tubular fluid leaks backward across the injured tubular membrane, which, in addition to tubular obstruction, causes further hemodynamic changes.

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Clinical features of ARF

 Interstitial nephritis suggested by

Urinary obstruction suggested by -

  • Colicky pain
  • Suprapubic and flank pain
  • oFlank pain – loin tropain.

Prostate enlargement suggested by

  • Nocturia
  • Frequency
  • Hesitancy.


  • Oliguria or Anuria.

Prerenal ARF

  • · Urine is acellular
  • · Inactive sediments or hyaline casts present.

Post renal ARF

Acute tubular necrosis (ATN) i.e. Ischemic ARF, Nephrotoxic ARF

  • · Pigmented, muddy brown granular casts with tubule epithelial cells in urine.
  • · Mild proteinuria « 19/day

Glomerular involvement

  • Tubulointerstitial disease – RBC casts in urine.

Interstitial nephritis

  • · WBC casts in urine.
  • · Nonpigmented granular casts in urine.

Chronic renal disease

  • Broad granufar casts in urine.
  • Eosinophils -in urine – allergic interstitial nephritis. Uric a~id crystal~ in – acute urate nephropathy.

Proteinuria >1g/day suggests gIomerular disease.

Heavy proteinuria> 1 g/day also seen in patients on NSAIDs, ampicillin, rifampicinTuberculosis Treatment Complete DRUGS - ATT (ANTITUBERCULAR TREATMENT)with MDR. Read more ... », interferon alpha.

Bilirubin in urine in hepatorenal syndrome.

Fractional excretion of sodium

  • FE Na < 1 % in prerenal ARF
  • FE Na > 1 % in ischemic, nephrotoxic (tubular disease).


  • Serum creatinine: increases progressively in renal failure and is a very good indicator of renal failure.
  • Hyperkalemia
  • Hyperphosphatemia
  • Hypocalcemia
  • Hyperuricemia
  • Anaemia


  • Ultrasonography is useful for post renal ARF to diag­nose causes like – urinary tract obstruction, pelvicalyceal dilatation, retroperitoneal fibrosis, neo­plasia.



  • For nephrolithiasis.


retrograde, antegrade -

  • for lo­calization of site of obstruction.
  • For patency of renal arteries and veins.




Causes of Hypocalcemia in ARF

  • Metastatic deposition of calcium phosphate when the serum calcium X phosphate in mgjdl is > 70.
  • Tissue resistance to parathyroid hormone. Decreased 1,25 dihydroxyvitamin D.

Effects of hypocalcemia

  • Muscle cramps Seizures Hallucinations Confusion
  • Prolonged QT.


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