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SPIDER WEB ACUTE RENAL FAILURE (ARF/AKI)

ARF-
PenurunanPerfusi

Factor Resiko Jurnal: Factor Resiko Text book:

 Neonatus dengan  Hemolytic Uremic


Asphyxia syndrome
Kriteria for ARF
 LBW (< 1500 gr)  Acute Glomerulonephritis
 Low Apgar Score  Sepsis
 Patent Ductus Arteriosus  Poisoning
 Adm Antibiotic &Non  Neprotoxic Medication
steroidal anti inflamasi  Hipovolemia
kpd ibu  Obst. Uropathy
 Complication of Cardiac
surgery

Nephrotoxic drug, indude the following:

• Antimicrobials: Aminoglycosides, cephalosporins, tetracycline,

sulfonamides

• Radiographic contrast media with iodine (typically used for CT scan

• Heavy metals: lead, barium, iron, chromium

• Nonsteroidalanti inflammatory drugs (NSAID.): indomethacin,

aspirin, ibuprofen
Pre Renal Renal Post Renal

Hipoperfusi Ginjal Vasoconstriction intra Tubular Injury


renal w/Sloughing of cells

Hipovolemi / decreased
blood pressure
Decrease Intra renal Cast Formation
Blood flow

Possible Glomerulus
Injury
Obstruction

Decrease Permeability
Increase Intraluminal
Pressure

Proximal Tubular Decrease GFR


Reabsorbtion Increase

Clinical Manifestation: Diagnostic Test:

Dark urine output /Hematuria,Headache,Edema,Fatigue,Crackles, Urinalisis, Urine Culture, CBC, serum Chemistry tests (BUN,
gallop heart rhythm,HT, Lethargy, Nausea, Vomiting, Oliguria serum Creatinin, sodium,potassium and calcium level.
Nursing Diagnosis

NsDx : Excess fluid volume related to decreased Glomerular filtration Additional tests:
rate and sodium retention
Toxicology screen, serum complement
Goal : Achieving fluid and electrolyte balance level, antinuclear antibodies, Blood & stool
culture, radiograph
Ns Intervension : Monitor urinary output and urine specific gravity,
measure and record intake and output, Monitor serum and urine New biomarkers in aucte kidney injury:

electrolyte concentrations, Monitor for signs and symptoms of  NGAL (Neutrophil gelatinase)/plasma
hypovolemia or hypervolemia because regulating capacity of kidneys  Cystatin C / Plasma
is inadequate.  NGAL / Urine
 IL 18 ( interleukin-18) /Urine
 KIM-1 ( Kidney injury Molecule-1)/
Ns Dx : Imbalanced nutrition less than body requirements related to urine
anorexia, nausea and vomiting

Goal: Maintaining adequate nutrition

Ns Intervension: Be aware that food and fluids containing large


amounts of sodium, potassium, and phosphorus may need to be
restricted

Ns Dx : Risk for infection related to alterations in the immune system

Goal : no signs of infection appear

Ns Intervension : Remove bladder catheter as soon as possible,


Monitor for all signs of infection. Be aware that renal failure patients
do not always demonstrate fever