1. Acute Renal Failure Acute Renal Failure Dr. Rawi Ramadan Dept. of Nephrology Rambam Medical Center

2. Definition A Clinical syndrome characterized by: Rapid decline (hours- weeks) in GFR Perturbation of ECF volume Perturbation of electrolytes + a-b Accumulation of nitrogenous waste products from protein catabolism, such as BUN + Creatinine

3. ARF - 5% of hospital admissions - up to 30% of ICU admissions ARF- is usually asymptomatic. ARF is associated with high morbidity + mortality. ARF- can be prevented in many settings.

6. Causes of ARF Prerenal Renal Post renal

19. Heme Pigment Nephropathy 10-15% of hospitalized patients with ARF Rhabdomyolysis - symptomatic - asymptomatic CPK > 10000. Correspond purely with severity of ARF Treatment - I.V. saline - NaHCO 3

20. Radiocontrast Nephropathy 20-50% is patients with cr. > 2 5 - respectively Diabetics, CHF, Vol. Depletion, M.M, NSAID, ACE-I. Begins 24-48h, peak 4-5 days, resolve 7-10 day

21. NSAID Cox-2, Cox-1 Impaired renal autoregulation Atx1, AIN, papillary necrosis Reversible 2-7 days after stop NSAID

22. Aminoglycosides Nonoliguric ARF Following 5-10 days of treat Hypokalemia hypomagnesemia