n CME : Your SA Journal of CPD - Acute renal failure in patients with chronic kidney disease : main article




  • Chronic kidney disease (CKD) patients are at a high risk for acute renal failure.
  • Glomerular filtration rate must be estimated in all patients with hypertension, diabetes and other CKD risk factors for diagnosis and staging of CKD.
  • Always look for reversible causes in patients presenting with renal failure.
  • Correction of hypovolaemia and hypotension restores baseline renal function in prerenal causes.
  • Immediate relief of obstruction is critical to prevent further kidney damage in postrenal acute-on-chronic.
  • Avoid NSAIDs, nephrotoxic antimicrobials and radiocontrast agents in CKD patients.
  • ACE-Is and ARBs must be stopped if serum creatinine increases more than 15% from baseline value within a week of starting treatment.
  • Optimal BP control may result in renal recovery in accelerated phase hypertension.
  • Urgent referral for renal biopsy is mandatory where recurrence of active lupus nephritis or rapidly progressive glomerulonephritis are suspected.
  • Preserving renal function and delaying onset of chronic dialysis is the ultimate goal in the care of CKD patients.


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