1. Approach to Acute renal failure Dr. Mohammed Al-Ghonaim MBBS,FRCP(C)

5. Median hospital length of stay (LOS) stratified by single acute organ system dysfunction (AOSD), including acute renal failure (ARF).

6. Etiology of ARF

7. Etiology of ARF

8. Hilton, R. BMJ 2006;333:786-790 Causes of acute renal failure

11. Post-renal AKI

20. Renal failure Differentiation between acute and chronic renal failure Acute Chronic History Short (days-week) Long (month-years) Haemoglobin concentration Normal Low Renal size Normal Reduced Renal osteodystrophy Absent Present Peripheral neuropathy Absent Present Serum Creatinine concentration Acute reversible increase Chronic irreversible

23. Acute Renal failure Differentiation between Pre-renal, renal and post-renal causes Causes of acute renal failure Prerenal Renal postrenal Hypovolaemia Decreased active blood volume Decreased cardiac output Renovascular obstruction Acute tubular necrosis Interstinal nephritis Glomerular disease (acute glomerulonephritis) Small vessel diease Intrarenal vasoconstriction (in sepsis) Tubular obstruction Bilateral ureteric obstruction Unilateral ureteric obstruction Bladder outflow obstruction

31. Acute Renal failure Changes during acute renal failure Hyperkalaemia (  ECG abnormalities) decreased bicarbonate elevated urea elevated creatinine elevated uric acid Hypocalcaemia Hyperphoshataemia Causes of acute renal failure In many chases kidney can recover from acute renal failure The function has to be temporarily replaced by dialysis disturbed fluid or electrolyte homeostasis must be balanced primary causes like necrosis, intoxication or obstruction must be treated

36. Hilton, R. BMJ 2006;333:786-790 Differential diagnosis of acute renal failure

38. Diagnosis and Treatment

41. Hilton, R. BMJ 2006;333:786-790 Differential diagnosis of acute renal failure