Acute Kidney Failure

Acute kidney failure is a condition in which there is a sudden stopping of the kidney function is present which results in an accumulation of nitrogenous waste products as the kidney’s main function is to eliminate the waste products of the body. When the waste products accumulate in the body it leads to disturbance in the endocrine and metabolic functions.

It usually occurs in older age group people. It occurs rapidly in a very less duration. Acute kidney failure is caused when there is a sudden decrease in the blood flow to the kidney, direct damage to the kidney by infections, toxins, or drugs, or whenever there is an obstruction to the flow of urine by kidney or ureteral stones or prostate adenoma.

Acute kidney failure when occurs it requires immediate treatment. Fluid loss should be replaced. Electrolyte imbalance should be treated. Nutrition also plays important role in treating the condition. If treated on time the condition can be reversed.

Acute Kidney Failure Causes

The problems which affect the blood supply to the kidney before reaching the kidneys include the following −

• Dehydration − occurs in patients having vomiting, loose stools, blood loss

• Disturbance in the blood flow to the kidney − Severe injury, following measure surgeries, burns, infections

• Any block or narrowing of the vessels supplying the kidneys

• Heart failure which in turn causes a low blood supply to the kidneys

• Liver failure causes hormonal changes affecting the blood supply and pressure to the kidneys

Post-renal causes include −

• Glomerulonephritis

• Kidney stones

• Tumors of the kidney

• Pyelonephritis

• Cancer of the urinary tract

• Use of some of the medicines

• Ureteral stones or tumors

• Bladder infection, cancer, or stone

• Prostate adenoma

Causes of the kidney itself that affect the filtration of the blood and the production of the urine −

• Glomerulonephritis

• Use of medicines such as antibiotics, pain killers especially NSAIDs

• Immune disorders such as leukemia, lymphoma, or sarcoidosis

• Infections

• Poisons, chemotherapeutic agents, toxins

• Polycystic kidney disease

Acute Kidney Failure Symptoms

The patients with acute kidney failure mainly present with the following symptoms −

• The color of the urine is dark, the urine appears foamy or bubble kind and getting up at night to urinate

• Decrease the amount of urine output, to less than 30ml an hour urine output despite replacement.

• Abnormally high levels of nitrogen-containing compounds such as urea, creatinine, various body waste compounds, and other nitrogen-rich compounds in the blood.

• Skin and mucous membranes are dry because of dehydration

• Hypertension and Rapid heart rate

• Edema or Fluid retention, which causes swelling in legs, ankles, or feet

• Metabolic acidosis

• Gastrointestinal System − Loss of appetite, nausea, vomiting, loose stools or constipation, pain in the abdomen, and may have the dirty smell of urine

• Fluid and electrolyte imbalance

• Increased susceptibility to secondary infection

• Patient looks pale because of anemia

• Electrolyte levels in the blood may be abnormally high or low because of improper filtering

Acute Kidney Failure Risk Factors

Some of the risk factors which increase the risk of acute kidney failure include −

• Advanced age or elder age group people are at more risk

• Liver disease

• Kidney diseases

• Heart failure

• High blood pressure

• Diabetes

• Blockages in the blood vessels in the arms or legs

• Abuse of the medicines

Acute Kidney Failure Diagnosis

The diagnosis of acute kidney failure is done based on various investigations which include −

• Serum electrolytes show the decreased amount of sodium in the urine and high potassium level

• Blood tests show increased blood urea nitrogen, low blood pH

• Urine studies show protein in the urine, blood in the urine, and decreased specific gravity.

• The amount of urine excreted in one day can help to determine the cause of kidney failure.

• Urinalysis − can show abnormalities that suggest kidney failure.

• Imaging tests − such as ultrasonography, plain films of the abdomen, KUB radiography, renal scan, pyelography, and computerized tomography.

• Kidney Biopsy − To look for tumor cells.

Acute Kidney Failure Treatment

Once the cause is found, the aim of treatment is to treat the cause of kidney failure, restore kidney function and prevent fluid and waste from building up in the body while the kidneys heal.

Treatment for acute kidney failure involves −

Pharmacological therapy −

• Drugs to reduce the blood pressure

• Low dose dopamine to dilate the arteries of the kidney

• Diuretic therapy

• Calcium or glucose/insulin is given to avoid an increase in the blood potassium levels

• Intravenous sodium bicarbonate to correct acidosis

• Antibiotics to treat infections

Fluid and electrolyte replacement − Intravenous fluids depending on the patient’s fluid and electrolyte status.

Nutritional therapy − A high-calorie diet low in protein, sodium, and potassium (banana and coffee avoided).

Dialysis − The last measure to be considered. In this, the blood is filtered for toxic products in a machine and the pure blood is returned to the body.

Acute Kidney Failure Prevention

Preventing the risk factors and causes of acute kidney failure can help in reducing its occurrence. Some of the preventive measures include −

• A healthy balanced diet

• Lifestyle modifications which include regular exercise, a balanced diet

• Avoiding the misuse of drugs

• Under control of chronic disorders such as diabetes, hypertension

Conclusion

Acute kidney failure is a condition in which the kidney does not function adequately because of various causes. The cause can be a pre-renal decrease in the blood supply to the kidney or damage to the kidney itself or post-renal obstruction of the urine flow, resulting in the accumulation of blood products. It mainly affects elder patients and also patients having chronic disorders such as hypertension, diabetes, liver disease, etc.

The diagnosis of kidney failure is done by urine analysis, imaging tests, serum electrolyte levels, and a biopsy to find the cause. Once the cause is found the required treatment should be done. The treatment includes fluid replacement, pharmacological therapy, high calorie diet with low protein, restriction of foods containing high potassium. If treated on time the condition can be reversed.