ACUTE RENAL FAILURE

Acute renal failure Is a sudden decline in renal function, usually marked by increased concentrations of blood urea nitrogen (BUN; azotemia) and creatinine; oliguria (less than 500 ml of urine in 24 hours); hyperkalemia; and sodium retention.

Acute renal failure are classified into following:

Prerenal failure results from conditions that interrupt the renal blood supply; thereby reducing renal perfusion (hypovolemia, shock, hemorrhage, burns impaired cardiac output, diuretic therapy). Postrenal failure results from obstruction of urine flow. Intrarenal failure results from injury to the kidneys themselves (ischemia, toxins, immunologic processes, systemic and vascular disorders).

 The disease progresses through three clinically distinct phase which is oliguric-anuric, diuretic, and recovery, distinguished primarily by changes in urine volume and BUN and creatinine levels. Complication of ARF include dysrhythmias, increased susceptibility to infection, electrolyte abnormalities, GI bleeding due to stress ulcers, and multiple organ failure. Untreated ARF can also progress to chronic renal failure, end-stage renal disease, and death from uremia or related causes.

Assessment:
Oliguric-anuric phase: urine volume less than 400 ml per 24 hours; increased in serum creatinine, urea, uric acid, organic acids, potassium, and magnesium; lasts 3 to 5 days in infants and children, 10 to 14 days in adolescents and adults. Diuretic phase: begins when urine output exceeds 500 ml per 24 hours, end when BUN and creatinine levels stop rising; length is availabe.

 Recovery phase: asymptomatic; last several months to 1 year; some scar tissue may remain. In prerenal disease: decreased tissue turgor, dryness of mucous membranes, weight loss, flat neck veins, hypotension, tachycardia

 In postrenal disease: difficulty in voiding, changes in urine flow. In Intrarenal disease: presentation varies; usually have edema, may have fever, skin rash. Nausea, vomiting, diarrhea, and lethargy may also occur.

Diagnostic Evaluation: Urinalysis shows proteinuria, hematuria, casts. Urine chemistry distinguishes various forms of ARF(prerenal, postrenal, intrarenal). Serum creatinine and BUN levels are elevated; arterial blood gas (ABG) levels, serum electrolytes may be abnormal. Renal untrasonography estimates renal size and rules out treatable obstructive uropathy.

Clinical feature
Since ARF involves the acute retention of nitrogenous waste products, salt, water, potassium and acid, the physical signs and symptoms encountered include:

nausea and vomiting peripheral oedema breathlessness pulmonary oedema itching pleural effusion weakness pericarditis depression of consciousness oliguria convulsion

CASE STUDY

Patient X Sex :Male Hometown : Baggao Cagayan Status : Married Birthday : March 06, 1974 He is suffering from ARF (Acute Renal Failure). He was 65 years old when admitted in the hospital.

History of present illness

5 days of fever, chills, headache, muscle pain, joint pain, epigastric pain and difficulty in urination.

Clinical Impression

UTI APP Pro leptopirosis

Chief complaint

Gastric pain Difficulty in urination Fever Headache Weakness Joint pain Calf pain

DRUGS

Fortifer
Ferrous + folate(Fortifer FA) Classification: Vitamins &Minerals Indication: Prevention &treatment of Fe-deficiency anemia& folate deficiency Side effect: GI irritation Nursing precaution: Should be taken on an empty stomach (Best taken between meals. May betaken w/ meals to reduce GI discomfort.).

AMLODIPINE Classifications: cardiovascular agent; calcium channel blocker; antihypertensive agent. Side effects of amlodipine: dizziness, swelling, edema, heart palpitations, nausea, flushing (redness of the skin, especially the face, abdominal pain (stomach pain and drowsiness.

Doxycycline

Doxycycline is a tetracycline antibiotic. It fights bacteria in the body. Doxycycline is used to treat many different bacterial infections, such as urinary tract infections, acne, gonorrhea, and chlamydia, periodontitis (gum disease), and others.

SIDE EFFECTS OF DOXYCYCLINE

severe headache, dizziness, blurred vision; fever, chills, body aches, flu symptoms, swollen glands, rash or itching, joint pain, or general ill feeling; urinating less than usual or not at all; diarrhea that is watery or bloody pale or yellowed skin, dark colored urine, fever, confusion or weakness;

 severe pain in your upper stomach spreading to your back, nausea and vomiting, fast heart rate; loss of appetite, jaundice (yellowing of the skin or eyes); or severe skin reaction -- fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling. mild nausea, mild diarrhea; upset stomach; mild skin rash or itching; or vaginal itching or discharge.

Aspilet EC
Aspilets/Aspilets-EC helps to relieve pain and inflammation. It also helps to bring down a fever. Aspilets/Aspilets-EC is also a blood-thinning medicine. It prevents special cells in the blood -the platelets -- from sticking to each other. This reduces the risk of harmful blood clots forming. Blood clots that form in a blood vessel inside the heart or brain can cause a heart attack or a stroke.

Aspilets/Aspilets-EC may be used on its own or together with other medicines to prevent heart attacks and strokes in people who are at risk. Aspilets/Aspilets-EC is also used together with other medicines to prevent blood clots in people who have had stents inserted into their heart arteries. It can also be used to prevent harmful blood clots in people who have an artificial heart valve. Aspilets/Aspilets-EC can also be used for other medical conditions, as decided by your doctor.

Side effect
Stomach discomfort, nausea and indigestion are common side effects of Aspilets/Aspilets-EC. Take Aspilets/Aspilets-EC with or immediately after food to minimise these side effects. Let your doctor know if these side effects bother you or if they do not go away. Aspilets/Aspilets-EC may cause dizziness. If you feel dizzy, do not drive or take part in any activity in which you need to be alert. Let your doctor know if the dizziness persists.

 Less commonly, Aspilets/Aspilets-EC may cause some side effects which can be serious. Alert your doctor quickly if you experience any of these: - swelling of face, eyes or lips - rashes - breathlessness - ringing in the ears - unusual bleeding, especially excessive bleeding or bleeding that takes a long time to stop - unusual bruises, especially if the bruises appear by themselves or if they cover a large area - black, sticky stools

Vidastat
Indications:For the management of primary hypercholesterolemia, heterozygous familial hypercholesterolemia, homozygous familial hypercholesterolemia or combined (mixed) hyperlipidemia in patients who have not responded adequately to diet and other appropriate measures; prevention of coronary events, need for revascularisation procedures and to slow progression of coronary heart disease.

 Contraindication:Acute liver disease or unexplained persistent elevations of serum transaminases. Porphyria. Pregnancy and lactation. Precaution:Liver enzymes should be monitored at the start and during simvastatin therapy. Use simvastatin with caution in patients who consume alcohol and/or have a history of liver disease.

 Side Effect:Increase creatinine clearance conc of at least 3 times the upper limit of normal, rhabdomyolysis with acute renal failure secondary to myoglobinuria on rare occasions, Other side effects: >1% - pain, asthenia, diarrhea, nausea/vomiting, and headache; constipation; dyspepsia; and flatulence.

Xatral Xatral tablets contain the active ingredient alfuzosin, which is a type of medicine called an alpha-blocker. It works by blocking alpha receptors that are found in the muscle in the prostate gland. (NB. Alfuzosin is also available without a brand name, ie as the generic medicine.)

 The prostate gland, which is found only in men, lies at the top of the tube connecting the bladder to the outside (urethra). The prostate gland often enlarges with advancing age (benign prostatic hyperplasia), pressing on the urethra and obstructing the flow of urine from the bladder. This can cause various urinary symptoms, such as difficulty passing urine.

 Alfuzosin blocks alpha receptors in the muscle of the prostate gland, which causes the muscle in the prostate to relax. This allows urine to flow freely past the prostate and relieves the urinary symptoms.

Side effect
Dizziness. Feeling faint. Headache. Spinning sensation (vertigo). A drop in blood pressure that occurs when going from lying down to sitting or standing, which results in dizziness and lightheadedness (postural hypotension). Nausea. Abdominal pain. Diarrhoea. Dry mouth. Weakness or loss of strength (asthenia). General feeling of being unwell (malaise).

Hytaz Indications:In the treatment of edema associated with heart failure and with renal and hepatic disorders; also used in hypertension. Contraindication:Anuria, renal impairment and sulfonamide allergy. Precaution:Renal and hepatic disease. Gout or hyperuricemia. History of pancreatitis.

 Side Effect:Weakness. Orthostatic hypotension. Pancreatitis, jaundice, diarrhea, vomiting, sialadenitis, cramping, constipation, gastric irritation, nausea, anorexia. Aplastic anemia, agranulocytosis, leukopenia, hemolytic anemia, thrombocytopenia. Anaphylactic reactions, necrotizing angiitis, respiratory distress, including pneumonitis and pulmonary edema, photosensitivity, fever, urticaria, rash, purpura. Electrolyte imbalance, hyperglycemia, glycosuria, hyperuricemia. Muscle spasm. Vertigo, paresthesias, dizziness, headache, restlessness. Renal failure and dysfunction, interstitial nephritis. Erythema multiforme including Stevens-Johnson syndrome, exfoliative dermatitis including toxic epidermal necrolysis, alopecia. Impotence

Pentoprazole

Pantoprazole is in a group of drugs called proton pump inhibitors. It decreases the amount of acid produced in the stomach Side effects: nausea, vomiting; gas, stomach pain; diarrhea; or headache.

Folic acid Folic acid is a type of B vitamin that is normally found in foods such as dried beans, peas, lentils, oranges, whole-wheat products, liver, asparagus, beets, broccoli, brussels sprouts, and spinach. Folic acid helps your body produce and maintain new cells, and also helps prevent changes to DNA that may lead to cancer

 As a medication, folic acid is used to treat folic acid deficiency and certain types of anemia (lack of red blood cells) caused by folic acid deficiency. Folic acid is sometimes used in combination with other medications to treat pernicious anemia. However it will not treat Vitamin B12 deficiency and will not prevent possible damage to the spinal cord. Take all of your medications as directed.

 How should I take folic acid? Take folic acid exactly as prescribed by your doctor. Do not take it in larger amounts or for longer than recommended. Follow the directions on your prescription label. Take folic acid with a full glass of water. Your doctor may occasionally change your dose to make sure you get the best results from this medication. Store folic acid at room temperature away from moisture and heat.

 Folic acid side effects Get emergency medical help if you have any of these signs of an allergic reaction to folic acid: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Less serious side effects are more likely, but may include: nausea, loss of appetite; bloating, gas; bitter or unpleasant taste in your mouth; sleep problems; depression; or feeling excited or irritable. This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

Ceftriaxone

Treating bacterial infections. Ceftriaxone is a cephalosporin antibiotic. It works by interfering with the formation of the bacteria's cell wall so that the wall ruptures, resulting in the death of the bacteria.

Side effect

Mild diarrhea; mild pain, swelling, or redness at the injection site; nausea; vomiting.

hydrocortisone

Enters target cells and binds to cytoplasmic receptors; initiates many complex reactions that are responsible for its anti-inflammatory, immunosuppressive (glucocorticoid), and salt-retaining (mineralocorticoid) actions. Some actions may be undesirable, depending on drug use.

 Drug Interactions: Increased steroid blood levels with hormonal contraceptives, troleandomycin Decreased steroid blood levels with phenytoin, phenobarbital, rifampin, cholestyramine Decreased serum level of salicylates Decreased effectiveness of anticholinesterases (ambenonium, edrophonium, neostigmine, pyridostigmine)

Side effect

Difficulty sleeping; dizziness or lightheadedness; headache; increased appetite; increased sweating; indigestion; nervousness.

Arcoxia
Arcoxia is used for the following: acute and chronic treatment of the signs and symptoms of osteoarthritis and rheumatoid arthritis management of ankylosing spondylitis relief of chronic musculoskeletal pain relief of acute pain to treat acute gouty arthritis

Side effects feeling sick (nausea), vomiting heartburn, indigestion, uncomfortable feeling or pain in the stomach diarrhoea swelling of the legs, ankles or feet high blood pressure dizziness headache

Hytrin

alpha 1-blockers is used to treat high blood pressure. It relaxes blood vessels, allowing blood to flow through them more easily.

Side effects

Dizziness; drowsiness; lightheadedness; nasal congestion; nausea; weakness.

Cephalexine
DRUG CLASS AND MECHANISM: Cephalexin belongs to a class of antibiotics called cephalosporins. They are similar to penicillin in action and side effects. They stop or slow the growth of bacterial cells by preventing bacteria from forming the cell wall that surrounds each cell. The cell wall protects bacteria from the external environment and keeps the contents of the cell together. Without a cell wall, bacteria are not able to survive. Bacteria that are susceptible to cephalexin include Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, E. coli and several others.

 SIDE EFFECTS: The most common side effects of cephalexin are diarrhea,nausea, abdominal pain, vomiting, headaches, dizziness, skin rash, fever,abnormal liver tests and vaginitis. Individuals who are allergic to penicillin may also be allergic to cephalexin.

Metoclopramide

Metoclopramide increases the movements or contractions of the muscles in the stomach and intestines. This decreases the amount of time it takes for the stomach contents to move through the digestive tract. Metoclopramide can be used alone or with other medicine.

 Side Effects Metoclopramide does not cause as many side effects as many other medicines used to prevent nausea and vomiting. Possible side effects include: Sleepiness or confusion. Twitching or muscle spasms. Decreased blood pressure (hypotension). Rapid or uncontrolled movements of lips and tongue.

Pharmacort
Indications: Primary & secondary adrenocortical insufficiency; endocrine, hematologic, rheumatic & collagen disorders; severe shock, bilateral adrenalectomy, acute hypersensitivity reactions, severe lupus erythematosus in relapse; other conditions requiring immediate metabolic & anti-inflammatory actions of hydrocortisone.

Side effects:

tinging, burning, irritation, dryness, or redness at the application site may occur. Acne, unusual hair growth, "hair bumps" (folliculitis), skin thinning/discoloration, or stretch marks may also occur.

Metodopramide IV

its mechanism of action in the treatment of migraine headache.

FOODS TO EAT FOR ACUTE RENAL FAILURE

Acute renal failure occurs when your kidneys suddenly lose the ability to clean waste products and other impurities from your blood. This type of renal failure usually happens over a few hours to a few days; it may be a temporary condition or it could lead to chronic kidney problems. Because your kidneys are unable to perform their normal functions, you will need to adjust your diet to limit the work that your kidneys have to do.

FEWER PROTEIN FOODS

You will need to eat less protein if you have acute renal failure, reports Drugs.com. When the body breaks down protein, the kidneys get rid of the waste products. To protect your kidneys and prevent a buildup of waste products in the blood during acute renal failure, you need to lower your protein intake. High-protein foods include meats, poultry, dairy products and eggs. Your renal dietitian will educate you about the protein in foods and about how much protein you should eat each day. You may be instructed to eat more healthy carbohydrate foods or healthy fats to obtain nutrition and calories, notes the kidney care company DaVita.

LOW-SODIUM FOODS
High levels of sodium can increase fluid retention in your body. Fluid retention can lead to swelling in the body or even high blood pressure, according to DaVita. High blood pressure can further hamper kidney function in acute renal failure, and kidneys in failure may not be able to clear fluids effectively. You should avoid foods like processed meats, salty chips and crackers, canned soup and vegetables, reports the Mayo Clinic. You can also control your salt intake by cooking your own meals and using herbs and spices to season food instead of salt.

LOW-POTASSIUM FOODS
One of the functions of the kidneys is to maintain the proper balance of potassium in the body. Too much potassium in the body can lead to heart problems and death, notes the Kidney Patient Guide. You will need to monitor your intake of high-potassium foods like bananas, oranges, potatoes and tomatoes. Eating apples, grapes, cabbage and strawberries are better choices if you have acute renal failure. If your potassium level becomes too high, you may have to undergo dialysis treatments to clean your blood because high potassium can be life threatening.

LOW-PHOSPHORUS FOODS
The kidneys also clear excess phosphorus from the body. In acute renal failure, phosphorus levels may become too high and cause bone problems, notes Drugs.com. Limiting high-phosphate foods like dairy products, peas and nuts can lower your phosphate levels and protect your bones. Your dietitian can tell you how much phosphorus you can eat each day.

Given below are the nutrients that need to be eaten in limited quantities or preferably avoided as far as possible:Protein: Eggs, dairy products, beans, meat, chicken and turkey Phosphorus: Nuts, nut butters, peas, beans, milk, cheese, yogurt and colas Potassium: Bananas, avocado, pears, raisins, cantaloupe, potatoes, broccoli, spinach and tomatoes Sodium: Table salt, chips, crackers, pretzels, commercial sauces and other salty snacks