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Writer's pictureVasudev Bendre

ACUTE RENAL FAILURE [ARF] :


It majorly occurs when there is a Reversible decrease in glomerular filtration rate which affects its waste filtration rate from blood.

Where it demonstrates clinically as a sudden and prolonged rise in serum urea and blood urea, as well as a disturbance in sodium and water homeostasis.

When our kidneys fail to filter the waste, the amount of water which accumulates might be fatal which indirectly imbalances the blood-chemical level.

Both kidneys must be affected if a patient undergoes acute renal failure (ARF).


Symptoms:

Symptoms sometimes depend on the severity, cause and rate of progression of infection.

  • Water retention is a major and obvious sign of ARF.

  • Body joints, face and hands become swollen.

  • Urine output decreases less than 470ml.

  • Urine color might change to very dark urine.

  • Nausea

  • Fatigue

  • Breathing difficulty

  • Itchiness

Causes:

Reduced Blood Flow:

It is caused by following conditions;

  • Low blood pressure

  • Heart failure

  • Overuse of pain relievers known as "NSAIDs," that are used to reduce swelling or relieve the pain caused by headaches, colds, flu, and other illnesses.

  • Severe allergic reactions.

  • Burns

  • Cardiac problems, heart problems, and other conditions that affect heart function.

  • Major surgery

Damage to the kidneys:

  • Thrombosis in and around the kidneys' arteries and veins

  • Vasculitis is an unique condition that causes inflammatory response and tissue damage in your blood vessels, causing them to stiffen, weaken, and narrow.

  • Conditions that cause swelling or damage to the renal tubules, small blood vessels, or filtering units (such as "tubular necrosis," "glomerulonephritis," "vasculitis," or "thrombotic microangiopathy").

  • Scleroderma is a group of diseases affecting the connective tissue that claims to support your vital organs.

  • Certain drugs can be allergic to kidneys.

Blockage of the urinary tract:

It is caused due to following conditions;[1]

  • 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

Diagnosis:

ARF can be diagnosed by following procedures ;

  • Imaging tests: Ultrasound and Computerized Tomography tests can be done to analyze your kidneys.

  • Urine sample level measurements: Total amount of urine output within 24hrs can help your physician diagnose the cause of kidney failure.

  • Urine tests: Urine should be analyzed in order to reveal abnormalities which can determine the cause of ARF.

  • Kidney Biopsy: A small sample from kidney is removed for lab testing (if recommended by your physician)

Stages of ARF:

Pre-renal: In this stage, the renal perfusion decreases ( it is necessary to maintain renal perfusion) which leads to a decrease in glomerular filtration rate. (Filtration rate reduced).

  • Causes: Hypotension, Excessive sweating, Diuretics, Heart failure.

Intrarenal:

Direct damage to kidneys cause a sudden kidney failure.

  • Causes: Renal hypo-perfusion- the condition occurs when there is a sudden reduction in the blood flow to the kidney. it is a prolonged disease

Post-renal failure:

It is a situation where an obstruction in the urinary tract below the kidneys causes the waste to build up in the kidneys

  • Causes: Stone diseases, Tumor, Fibrosis, Ligation during pelvic surgery.

Complications:

  • Death,

  • Sepsis,

  • Infection,

  • Seizures,

  • Paralysis,

  • Peripheral edema,

  • CHF,

  • Arrhythmias,

  • Uremic pericarditis,

  • Bleeding,

  • Hypotension,

  • Anemia,

  • Hyperkalemia, Uremia. [3]


Treatment:

  • Diet: Till your kidney function heals, your doctor will regulate the number of sodium and potassium you consume. This is due to the fact that both of these drugs are eliminated from your body via your kidneys. Changing your eating habits and diet will not help you recover from acute kidney failure. However, your doctor may advise you to change your eating habits while they treat the underlying conditions. This could include treating a medical condition such as heart failure, discontinuing certain medications, or administering fluids via IV if you're dehydrated. If your doctor has prescribed a low potassium diet, you will need to limit your intake of potassium-rich foods such as bananas, spinach, oranges, potatoes, and tomatoes. On the other hand, low-potassium foods such as apples, strawberries, grapes, and cauliflower can be consumed in greater quantities.

  • Medications to control blood Potassium: If your kidneys are not really filtering potassium from your plasma adequately, your doctor might recommend calcium, glucose, or sodium polystyrene sulfonate to prevent high potassium levels in your blood. A high potassium level in the bloodstream can result in dangerous cardiac problems (arrhythmias) and muscle spasms.

  • Medications to restore blood calcium level: If calcium levels decrease below normal from blood, infusion of calcium is recommended.

  • Dialysis:

  • If toxicants accumulate in your blood, you may require interim hemodialysis, also known as dialysis, to help remove contaminants and excess fluids from your body while your kidney function heals. Dialysis may also aid in the removal of residual potassium from your body.

  • During dialysis, a machine removes waste from your body by pumping blood through an artificial kidney (dialyzer). After that, the blood is returned to your body.

Precautions:

  • Maintain your blood sugar.

  • Maintain your blood pressure.

  • Maintain a healthy weight.

  • Lower your salt intake.

  • Lower alcohol intake as it may affect the kidney majorly.

  • Smoking is injurious to kidney functioning.

  • Stress less.

  • Avoid foods with high cholesterol, high fats & lipids to keep your heart healthy which indirectly reduce the risk of ARF.


REFERENCE:

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