Renal Failure: Acute

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Chapter 64 Renal Failure

Acute

PATHOPHYSIOLOGY

Acute renal failure (ARF) is the abrupt reduction or cessation of renal function secondary to a sudden loss of functioning nephrons. The rapid loss of renal function leads to a reduction in the glomerular filtration rate (GFR). This causes a build-up of urea and creatinine, fluid-electrolyte imbalances, and other related problems. ARF occurs from a variety of causes (see Box 64-1). These causes are grouped into three categories: prerenal (hypoperfusion), intrarenal (intrinsic renal), and postrenal(obstructive). Acute prerenal failure results from decreased blood flow to the kidneys. Subsequent renal hypoxia causes cellular edema and injury and cell death. Acute intrarenal failure results from injury to the kidney tissue. Acute postrenal failure results from urinary outflow obstruction. ARF occurs suddenly and entails multiple problems and potentially threatening complications. Children with ARF and their families need ongoing support and education. ARF outcomes range from complete recovery to the development of chronic renal failure.

Box 64-1 Causes of Acute Renal Failure

LABORATORY AND DIAGNOSTIC TESTS

Refer to Appendix D for normal values and/or ranges of laboratory and diagnostic tests.

1. Blood tests: chemistry panel provides information related to levels of blood urea nitrogen (BUN), creatinine, serum electrolytes (potassium, sodium, calcium, magnesium, and phosphorus), glucose, and protein (albumen, total protein), as well as acid-base status (bicarbonate). Complete blood count (CBC) provides data related to the hematocrit, hemoglobin, and platelets. Serum blood gas results (arterial, capillary, or venous) provide data related to blood pH and acid-base status. Common alterations of these laboratory results in patients with ARF are listed as follows:

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