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...insights from a Nurses Journey

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Copyright 10/24/09 Donna D. Kincheloe, RN, BSN


Renal Failure, Renal Failure                        When acute there are 3 main causes.

Prerenal failure, Prerenal failure                 Impaired perfusion is the major problem here.

Volume depletion, diuretics, dehydration, GI losses, hemorrhage,

MI, Heart Failure, abnormal rhythms, anaphylaxis, or shock

What do you do with pre-renal?                Identify and treat the cause.

Replace volume, replace the blood, and review the patient’s drugs.

Maintain the pump, the proper rate, and treat the shock before it’s late

Check BUN, GFR, creatinine, I & O and osmolality.  

This is reversible!

Intrarenal, Intrarenal                               The kidney structures are involved

Ischemia, Ischemia                                  to glomeruli and tubes

Injuries cause sludgy sediments and pigmentation.

Intrarenal,  Crush injuries,  intrarenal, trauma and  burns

Myoglobin is released.

NSAIDs and gent, IV contrast, any Nephrotoxic drugs

Infections too can harm the tubes

Hemoglobinuria caused by blood reactions or hemolytic anemia

Acute Tubular Necrosis will occur

Preserve all kidney structures; please          Be sure the toxins leave

In post renal, in post renal            There is an interrupted flow

Perfusion’s fine                           Structures align

Urine production is OK        a BPH, stones, tumors, strictures

Prevent urine from flowing

Identify  (identify )  and treat the cause (and treat the cause)for all Acute Renal Failure