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    Cute Enal Ailure: Dr. Shumaila Rafi Assistant Professor Medicine

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    Muhammad Makki
    The most likely cause of renal failure in this case is acute interstitial nephritis based on history of recent antibiotic use and presence of RBC and WBC casts on urine examination. Additional finding of eosinophilia on complete blood count further supports the diagnosis of acute interstitial nephritis.

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    Cute Enal Ailure: Dr. Shumaila Rafi Assistant Professor Medicine

    Uploaded by

    Muhammad Makki
    66 views27 pages
    The most likely cause of renal failure in this case is acute interstitial nephritis based on history of recent antibiotic use and presence of RBC and WBC casts on urine examination. Additional finding of eosinophilia on complete blood count further supports the diagnosis of acute interstitial nephritis.

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    Kindney failure

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    The most likely cause of renal failure in this case is acute interstitial nephritis based on history of recent antibiotic use and presence of RBC and WBC casts on urine examination. Additional finding of eosinophilia on complete blood count further supports the diagnosis of acute interstitial nephritis.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    66 views27 pages

    Cute Enal Ailure: Dr. Shumaila Rafi Assistant Professor Medicine

    Uploaded by

    Muhammad Makki
    The most likely cause of renal failure in this case is acute interstitial nephritis based on history of recent antibiotic use and presence of RBC and WBC casts on urine examination. Additional finding of eosinophilia on complete blood count further supports the diagnosis of acute interstitial nephritis.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 27

    ACUTE RENAL FAILURE

    Dr. Shumaila Rafi


    Assistant Professor Medicine
    LEARNING OBJECTIVES
     At the end of session final year students will be
    able to:
     Define acute renal failure

     Classify renal failure on the basis of RIFLE


    strata
     Discuss all the causes of acute renal failure

     Explain all the clinical features of acute renal


    failure
     Justify an outline for the management of acute
    renal failure
    DEFINITION
    A sudden and usually reversible loss
    of renal function, which develops
    over days or weeks and is usually
    accompanied by a reduction in urine
    volume.
    RIFLE
    STRATA
    CLASSIFICATION

    Reversible acute renal failure

    Established acute renal failure


    HISTORY
    Volume restriction

    Nephrotoxic drug ingestion

    Exposure to iodinated contrast agent


    Trauma or unaccustomed exertion

    Blood loss or transfusions

    Exposure to toxic substances, such as


    ethyl alcohol or ethylene glycol

    Access for co –morbid conditions


    SYMPTOMS
    Oliguria --- Urine output < 500ml/day

    Anuria ---- Complete absesnce of


    urine

    Non oliguric renal failure --- urine


    volume is increased
    OTHER FEATURES

     'Uraemic' features include:


     initial anorexia, nausea and vomiting
    followed by
     drowsiness, apathy, confusion,
    muscle-twitching,
     hiccups, fits and coma.
    PHYSICAL EXAMINATION
    BLOOD LOSS CARDIAC FAILURE

     Tachycardia  Raised JVP


     Orthostatic  S3 gallop
    hypotension  Pulmonary
     Poor skin turgor crepts
    CONTD.
    Periorbital edema

    Maculopapular rash Acute


    interstitial
    nephritis
    Wheezing
    INVESTIGATIONS
     CBC

     S. Urea and Creatinine

     S. Sodium &S. Potassium

     S. Calcium &S. Phosphate

    S. Albumin
     ABGS

     Urinalysis &Cultures

    Renal ultrasound

    Renal biopsy

    Systemic disorders investigations


    CXR
    ECG
    MANAGEMENT OF REVERSIBLE
    PRE -RF
     Establish and correct the underlying
    cause

     Treat hypovolumia

     Optimise systemic haemodynamics

     Correct metabolic acidosis by sodium


    carbonate
    MANAGEMENT OF ESTABLISHED RF
    Treatment of Hyperkalaemia

     Immediate fluid management

    Dietary restriction

    Control of infection

    Renal repalacement therapy


    ACUTE INTERSTITIAL NEPHRITIS

    Acute inflammation within the


    tubulo-interstitium.
    Drugs:
    CAUSES
    Infections:  Penicillins
     NSAIDs

     Acute bacterial  Proton pump


    pyelonephritis inhibitors
     Leptospirosis
     Tuberculosis Toxic
     Hantavirus
     Myeloma light
    chains
     Mushrooms
    MANAGEMENT
    Treat the underlying cause
    Withdrawal of the drug alone
    Corticosteroids (e.g. prednisolone 1
    mg/kg/day)
    Dialysis is sometimes necessary but is
    usually only short-term
    ACUTE TUBULAR NECROSIS (ATN)

    Acute necrosis of renal tubular cells


    may result from ischaemia or
    nephrotoxicity .
    1. 20 years old male came in emergency with complaints of decrease
    urine output for last 48 hrs. On further inquiry history of taking
    some antibiotics from GP few days back. Urine DR shows RBC cast
    and WBC cast. What is the most likely cause of renal failure?
    a. Acute interstitial nephritis
    b. Acute tubular necrosis
    c. Glomerular injury
    d. Pre renal failure

    2. What additional finding will be present in laboratory test?


    a. Neutrophilia
    b. Neutropenia
    c. Eosinophilia
    d. Lymphocytosis

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