Acute Renal Failure

Presentation

Acute renal diseases are of 3 types. They are:

-       Pre-renal ARF

-       Intrinsic renal ARF

-       Post-renal ARF

Symptoms of ARF:

• Fluid retention, causing swelling legs, ankles or feet
• Confusion
• Reduced alertness
• Nausea
• Dry mouth
• Fatigue
• Pale skin color
• Disturbances in blood flow in the body
• Decreased urine output
• Drowsiness
• Shortness of breath
• Confusion
• Seizures or coma in severe cases
• Chest pain or pressure

(Mayoclinic. 2012) & (Davita)

Causes

Figure 1 : Causes of acute renal failure

Source - acner.org

Acute kidney failure can occur:

-       Due to impaired blood flow to your kidneys

-       Damage to the kidneys

-       Urine blockage in the kidneys

Pre-renal ARF 

Impaired blood flow to the kidneys

Diseases and conditions that may slow the blood flow to the kidneys include:

-       Blood or fluid loss

-       Blood pressure medications

-       Heart attack

-       Heart disease

-       Infection

-       Liver failure

-       Use of aspirin, ibuprofen, naproxen, or related drugs

-       Severe allergic reaction (anaphylaxis)

-       Severe burns

-       Severe dehydration

Intrinsic ARF 

Damage to the kidneys

Diseases and conditions that may damage the kidneys include:

-       Formation of thrombus in the veins and arteries in and around the kidneys

-       Cholesterol deposits in the vessels of kidneys

-       Glomerulonephritis

-       Hemolytic uremic syndrome - a condition of premature destruction of red blood cells

-       Infection

-       Lupus

-       Medications used to treat osteoporosis and high blood calcium levels (Chemotherapy         drugs, antibiotics, dyes used during imaging tests and Zoledronic acid).

-       Multiple myeloma

-       Scleroderma

-       Thrombotic thrombocytopenic purpura (TTP)

-       Toxins, such as alcohol, heavy metals and cocaine

-       Vasculitis

Post-renal ARF

Urine blockage in the kidneys

Urine blockage can occur when the ureters become blocked. Diseases and conditions of urinary obstructions include:

-       Bladder cancer

-       Blood clots in the urinary tract

-       Cervical cancer

-       Colon cancer

-       Enlarged prostate

-       Kidney stones

-       Nerve damage involving the nerves that control the bladder

-       Prostate cancer

(Mayoclinic. 2012)

Investigations

• Urine output measurements
• Imaging test such as ultrasound and computerized tomography (CT)
• Removing a sample of kidney tissue for testing
• BUN
• Creatinine clearance
• Serum creatinine
• Serum potassium
• Urinalysis

(Mayo Clinic. 2012) & (Silberberg C. 2014)

Stepwise Management

• Treatment should be focused on the underlying cause of the kidney failure.
• The illness or injury that originally damaged the kidneys should be identified because the treatment options will depend on the cause of the kidney failure.
• Treatment of the complications until the kidneys recover.
• Fluid balance in blood

             - If the acute kidney failure is caused by a lack of fluids in the blood, intravenous                fluids should be administered.

  - If it is caused by excess fluid, leading to edema in the arms and legs administer diuretics to expel extra fluids.

• Medications to control blood potassium.

If the kidneys aren't properly filtering potassium from the blood, administer calcium, glucose or sodium polystyrene sulfonate to prevent hyperkalemia. Hyperkalemia can also cause arrhythmias and muscle weakness.

•        Medications to restore blood calcium levels.

If the patient is having hypocalcaemia administer a calcium infusion.

•        Dialysis

If toxins or excess potassium build up in the blood they are removed using dialysis.

(Mayoclinic. 2012)

Figure 2 : Dialysis
Source - www.nocturnaldialysis.org

REFERENCES

Mayoclinic. 2012. Mayo Clinic.  [ONLINE] Available at: http://www.mayoclinic.org/diseases-conditions/kidney-failure/basics/definition/con-20024029  [Accessed 27^th April 15].

Silberberg C. 2014. Medline Plus. [ONLINE] Available at: http://www.nlm.nih.gov/medlineplus/ency/article/000501.htm [Accessed 27^th April 15].

Davita. (nd.) Davita. [online] Available at: http://www.davita.in/acute_kidney_injury.php [Accessed 27^th April 15].