Renal Failure

renal failure

What is Acute renal failure?

An Acute renal failure – ARF, also known as acute kidney injury, results in decreased kidney function (reduced glomerular filtration rate) over a relatively short period of time. This could occur as an acute-on-chronic phenomenon.

Causes of Renal Failure

In usual scenarios, renal /kidney failure is caused due to certain infections related illness. There would be no symptoms shown by the patients having an intrinsic renal disease or low-grade chronic obstruction. A person suffering from Diabetes mellitus or with high blood pressure are more prone to the renal failure.

Listed below are three main categories associated with the causes of an acute kidney injuries:

  1. Prerenal acute kidney injury
  2. Intrinsic acute renal injury.
  3. Post-renal Intrinsic renal injury.

Prerenal acute kidney injury

A pre-renal failure, which is caused mainly by the reduction in the blood flow to the kidney. It is not due to the direct damage of the nephron itself, owing to the inability to maintain renal blood flow which results from the kidney injury. Other factors resulting in pre-renal failure are:

  • Gastroenteritis, or loss of blood,
  • Vasodilation caused by the drugs reaction,
  • Active hypovolemia sepsis,
  • Decreased cardiac output,
  • Anaphylaxis,
  • Addisonian crisis,
  • Salt wasting syndrome,
  • Protein-losing enteropathy,
  • Altered hemodynamics or dynamics of blood flow caused by dehydration,
  • Deficiency of blood in kidneys by– Intrarenal redistribution, mainly caused by, vasoconstrictors, anesthesia, stress, surgery,

Intrinsic acute renal injury.

The intrinsic renal injury is characterized by direct damage to the nephrons. It is often complex and may be secondary to another illness. Prerenal etiologies noted above could lead to acute tubular necrosis (ATN). Additional causes –

  • Vasculitis (polyarteritis nodosa, Lupus, Wegener’s granulomatosis),
  • Microangiopathic states (hemolytic uremic syndrome, DIC, TTP),
  • Glomerulonephritis (acute post-streptococcal and others).

Post-renal Intrinsic renal injury.

The post-renal injury is caused by a blockage to the flow of urine, resulting in back pressure to the kidney, which causes damage to

  • Nephrons.
  • Posterior urethral valves.
  • Urethral strictures – narrowing of the urethra
  • Bladder obstruction from clots (hemorrhagic cystitis),
  • Formation of ureteral stones.

Symptoms of Renal Failure

As mentioned above, patients having Renal failure or kidney failure symptoms would not show any symptoms in the early stages. The symptoms usually develop slowly or may not appear until both the kidneys are badly damaged by the accumulation of more wastes and extra fluid building up in the body. The common symptoms include:

  • Fever
  • Rashes
  • Diarrhea
  • Insomnia
  • Vomiting
  • Muscle cramps
  • Frequent urine
  • Loss of Appetite
  • Nausea and vomiting
  • Trouble in breathing
  • Abdominal and back pain
  • Swelling of both feet and ankles

Prevention and Treatment of Renal Failure

As per the outcome of established renal /kidney failure, prevention is critical. In certain cases, the risk of developing renal failure could be predicted such as decreased perfusion secondary to abdominal surgery, coronary bypass surgery, acute blood loss in trauma, and uric acid nephropathy, where preventative strategies could prove effective. When patients with risk factors for developing renal failure are scheduled for surgery, the doctor should be aware that the likelihood of the patient developing the renal failure is high and consider preventative measures, including discontinuation of medications that might enhance the likelihood of renal damage (e.g., NSAIDs, angiotensin-converting enzyme inhibitors).

Preventive Dialysis

A novel approach to reduce the incidence of nephrotoxicity associated with radiocontrast dye administration is to provide prophylactically to patients who are at high risk of acute renal failure.

Hemofiltration initiated prior to and continued for 24 hours after dye administration has resulted in a significant reduction in mortality and a reduced need for dialysis.

Dopamine and Diuretics

Given the dismal outcome of established acute renal failure, many drugs have been investigated for its prevention. Almost all of these approaches have been shown to be of little to no value. Low doses of dopamine (≤ 2 mcg/kg/min) increases renal blood flow and might be expected to increase GFR (glomerular filtration rate). Theoretically, this could be considered beneficial, as an enhanced GFR (glomerular filtration rate) might flush nephrotoxins from the tubules, minimizing their toxicity.

For more additional information about renal failure and other kidney related disorders, check for the links given below.

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