0 Acute Renal Failure

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Acute renal failure ( better termed as Acute kidney injury )

Markers :

1. NGAL ( Neutrophil gelatinase associated lipocalin )
2. IL-18
3. KIM-1 ( Kidney injury molecule - 1 )

Can be :

• Pre-Renal
• Renal
• Post-Renal

	Pre-Renal (can have hyaline cast)	Renal (granular cast)
Urine Na	<20 meq/l (or < 10 mmol/l)	>40 meq/l (or > 20 mmol/l)
Urine Osmol.	>500	<300
Blood urea / creatinine	>20:1	< 20 : 1
Fractional excretion of Na %	<1	>1

MC cause of ARF in 

• Newborn : Birth Asphyxia

• Children ( 1 - 3yr ) : 1. HUS ; 2. ATN

MC Complications ( and their management ) :

1. Fluid overload ( so restric fluids to 400ml/m2 - dextrose)
2. Hyperkalemia ( so - Nebulize beta 2 agonist , IV -Na Bicarb , IV Insulin with dextrose , Resins , Haemodylasis , Ca Gluconate for cardiac stabilization )
3. Hyponatremia -dilutional ( manage same as 1 )
4. Dilutional anaemia ( so transfuse RBC )
5. Increase phosphate , decrease calcium ( so Restrict phosphate, use phosphate binders )
6. Metabolic acidosis ( so use Na Bicarb )

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