Acute and Chronic Renal Failure

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1. Acute renal failure (ARF)

A. Characterized by a sudden decrease in renal function that results in retention of nitrogenous waste products.

B. Etiology can be divided into prerenal (acute decrease in renal perfusion), renal (intrinsic renal disease, renal ischemia, or nephrotoxins), and postrenal (urinary tract obstruction or disruption).

C. Clinical features include hypervolemia, hypovolemia, potassium retention, impaired excretion of drugs and toxins, potential progression to CRF.

2. Chronic renal failure (CRF)

A. Characterized by a permanent decrease in GFR with a rise in serum creatinine and azotemia.

B. Most common causes include hypertensive nephrosclerosis, diabetic nephropathy, chronic glomerulonephritis, and polycystic renal disease.

C. Clinical features include hypervolemia, hypertension, accelerated atherosclerosis, uremic pericarditis/effusions, hyperkalemia, hypermagnesemia, hyponatremia, hypocalcemia, hyperphosphatemia, metabolic acidosis, chronic anemia, platelet dysfunction, delayed gastric emptying, increased susceptibility to infection, CNS changes, glucose intolerance, altered pharmacodynamics.

3. Dialysis is indicated in ARF and CRF for hyperkalemia, volume overload, uremic complications (encephalopathy, pericarditis, tamponade), acidosis, severe azotemia.

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