Acute kidney failure

Kidney failure is a worldwide health crisis. About 10% of the world’s population is affected by kidney failure. The number of cases are increasing disproportionately in developing countries such as China and India. But, prompt diagnosis and treatment of acute kidney failure can cut death rates.

Acute kidney failure occurs when your kidneys abruptly lose its function of filtering waste products from the blood. Due to this, waste products accumulate in the blood leading to loss of homeostasis. This condition has an acute onset that develops rapidly within few days. It is most common in hospitalized people who are critically ill.

Signs and symptoms

The signs and symptoms of kidney failure depend on the various disturbances occurring in the kidney function due to the disease.

  • Due to the failure of reabsorption and secretion processes in the nephron, there will be decreased urine output. Fluid retention also occurs leading to generalized swelling.
  • Accumulation of waste products in the bloodstream causes fatigue, drowsiness, headache, confusion, nausea, and vomiting.
  • Increased potassium levels lead to irregular heartbeat and muscle weakness.
  • Fluid imbalances cause high or low blood pressure.

Self-management

Follow your doctor’s recommendations and adhere to the treatment plan. Consult your dietitian to have a special diet plan that supports your kidneys and limits its function.

  • Consume foods low in potassium – such as apples, cabbage, green beans, and strawberries.
  • Avoid potassium-rich foods such as bananas, potatoes, oranges, and tomatoes.
  • Reduce sodium intake - avoid salty snacks, canned foods, and processed foods.

Risk factors

Individuals with hospitalization and advancing age are more prone to acute kidney failure. The risk increases if you have peripheral vascular disease, diabetes, heart diseases, kidney diseases, or liver diseases.

Complications

Pulmonary edema, hyperkalemia, metabolic acidosis, and heart damage are the life-threatening complications that require immediate interventions.

Prognosis

In some cases, acute kidney failure leads to permanent damage of kidneys causing chronic kidney failure or end-stage renal disease. In such conditions, your doctor may recommend permanent dialysis or kidney transplantation.

The chances of occurring premature death also increase. The risk increases if there are any kidney problems before the development of acute kidney failure.

Therefore, these people should regularly be monitored for the development of chronic kidney disease.

Prevention

The percentage of morbidity and mortality is high in acute kidney failure. So, there is a need to identify people who are at risk and implement preventive strategies.

  • Maintaining healthy lifestyle – Performing regular physical activity, limiting alcohol intake, and refraining from smoke can keep you away from illnesses.
  • Be attentive while taking over-the-counter (OTC) medications, especially NSAIDs as they can be nephrotoxic.
  • Undergo urine test and blood test at least once in 6 months to monitor kidney disease.
  • Consult a doctor immediately if you find any changes in your urine output.

The diagnosis helps to know the underlying cause of the condition and provide appropriate treatment. Tests and procedures your doctor may recommend for diagnosis include:

Urine output measurements -to measure creatinine clearance.
Urinalysis - to determine osmolality and presence of renal tubular casts, eosinophils, red blood cells, and proteins.
Blood tests  – to determine blood levels of blood urea nitrogen (BUN), serum creatinine, and serum electrolytes (sodium, potassium, calcium, and chloride).
Imaging tests  – such as ultrasound, abdominal X-ray, computed tomography (CT) scan, and magnetic resonance imaging (MRI) scan to examine urinary tract for the blockage

In some cases, you doctor may recommend for renal biopsy to rule out the intrinsic cause of acute kidney failure.

Acute kidney failure occurs due to the following reasons:

Decreased blood flow (prerenal) - This is due to conditions such as low blood volume, low blood pressure, heart failure, liver failure, burns, dehydration, surgeries and use of medications such as naproxen and aspirin.
Direct damage to the kidneys (intrinsic)  - This is due to conditions such as glomerulonephritis, acute interstitial nephritis, acute tubular necrosis, blood clots in the arteries and veins associated with kidney, and inflammation of the blood vessels (vasculitis).
Blockage of the urinary tract (postrenal) - This is due to the conditions such as cancers of prostate, bladder, or cervix, enlarged prostate, kidney stones, and damage to nerves that control the bladder.

The goal of the therapy is to restore kidney function and prevent complications. A kidney specialist, called nephrologist, provides you the treatment. The treatment requires a hospital stay, but most of the people with kidney failure are already hospitalized. The length of the hospital stay depends on the underlying cause and the recovery.

Treatment is given to encounter the illness or injury that is damaging the kidneys. Treatment options depend on the cause of the kidney failure.

Supportive management
  • Saline – to treat volume depletion
  • Antibiotics – to treat kidney infections
  • Diuretics – such as furosemide given intravenously to maintain the fluid balance
  • Calcium, glucose, or sodium polystyrene – to prevent accumulation of potassium in the body
  • Sodium bicarbonate – to treat hyperkalemia, metabolic acidosis, and pulmonary edema
  • Dialysis – to remove toxins from the blood