Presented by/
Lareen Abo-Seif

Definition of ARF.

Etiology of ARF.

Pathophysiology of ARF.

Clinical manifestations of ARF.

Diagnostic evaluation of ARF.

Therapeutic management of a child suffering
from ARF.

Nursing care of a child suffering from ARF.
Is the failure of kidneys to function,
when kidneys are suddenly unable to
regulate the volume and composition
of urine appropriately.
 Pre-renal
 Blood
loss: hemorrhage.
 Plasma
 Fluid
cause:
loss: burns.
loss & dehydration: diarrhea,
vomiting or DKA.
 Septicemia.
 Renal
cause:
 Glomerulonephritis.
 Ischemia
to the kidneys.
 Leukemic
infiltration of the kidneys.
Post-renal
 Anatomic
cause:
or functional obstruction of
kidneys: stone or atresia.
 Pre-renal
failure lead to decreased
perfusion to kidneys leading to
ischemia and cellular swelling and
injury and eventually cell death.
 Renal
failure lead to actual ischemic
damage to kidneys.
 Post-renal
failure is due to the
obstruction
of
urine
outflow,
leading
increased
pressure
inside
to
the
kidneys
and
decreasing the renal function.
thus

Specific: Oliguria • Anuria uncommon (except
in obstructive disorders)

Nonspecific:
•
Nausea
•
Vomiting
•
Drowsiness • Edema • Hypertension

Manifestations
of
underlying
pathologic condition.
disorder
or

Azotemia
is
the
accumulation
of
nitrogenous waste within the blood.

Uremia is a more advanced condition
in which retention of nitrogenous
products produces toxic symptoms.
Azotemia is not life threatening, uremia
is
a
serious
condition
that
involves other body systems.
often

BUN.

serum creatinine.
 sodium,
potassium, and calcium.
The main objectives:
(1) treatment of the underlying cause.
(2) management of the complications.
(3) provision of supportive therapy
within the constraints imposed by the
renal failure.

The
avoidance
substances
substances
as
of
is
crucial,
include
ibuprofen,
nephro-toxic
NSAIDs
many
these
such
antibiotics
as gentamicin.

Treatment of poor perfusion resulting
from dehydration consists of volume
restoration.

Foley catheter is inserted to rule out
urine retention or to aid in collecting
urine for analysis or to monitor results
of diuretic administration.

Hyperkalemia.

Hypertension.

Anemia.

Seizures.

Cardiac failure.

Pulmonary edema.
Assessment:
 Meticulous
assessment of fluid
intake and output
 Assessment of signs of fluid
imbalance and vital signs.
 Observe signs of complications.
 Observe for marked Weight loss,
inadequate growth.

Altered Nutrition: Less Than Body
Requirements related to restricted diet

Risk for Injury related to accumulated
electrolytes and waste products

Limiting
fluid
intake
is
crucial.
Rationing the intake of small amounts
of fluid in large containers give the
impression of larger volumes.

When nourishment is provided by the
IV
route,
careful
monitoring
essential to prevent fluid overload.
is

nursing measures such as maintaining
an optimal thermal environment and
reducing restlessness and anxiety are
used to decrease the catabolism.

Fluid
and
acidosis,
nitrogenous
electrolyte
and
imbalances,
accumulation
waste
products
produce coma, seizures.
of
can
 Recreational
activities are most
encouraged than physical activity.
 Non-pharmacological
measures
to relive pain is encouraged due
to many painful diagnostic and
therapeutic modalities.
Dialysis is the process of separating
colloids and crystalline substances in
solution by the difference in their rate of
diffusion
through
a
semipermeable
membrane.
Methods
of
dialysis
are:
peritoneal
dialysis, hemodialysis and hemofiltration.
Requires the creation of a vascular
access and the use of special dialysis
equipment as the hemodialyzer.
 Vascular access may be one of three
types: fistulas, grafts, or external
vascular access devices.
 An arteriovenous fistula is an access
in which a vein and artery are
connected surgically.


The preferred site is the radial artery and a
forearm vein that produces dilation and
thickening of the superficial vessels of the
forearm to provide easy access for repeated
venipuncture.

Hemodialysis is the best for children who live
close to a dialysis center.

The procedure is usually performed three
times per week for 4 to 6 hours, depending
on the child’s size.

Hemodialysis achieves rapid correction of
fluid and electrolyte abnormalities but can
cause problems in association with this
rapid change, such as muscle cramping and
hypotension.

Disadvantages
include
school
absence
during dialysis and strict fluid and dietary
restrictions between dialysis sessions and
Boredom for the child and family.

Growth
rate
and
skeletal
maturation
improve, but recovery of normal growth is
infrequent.

In
many
although
completion.
cases,
sexual
delayed,
development,
progresses
to