ACUTE RENAL FAILURE (ARF):
Sudden cessation of kidney function. It could happen in one day or
over a period of up to 4 weeks. Due to rapid onset of the disease most of the
patients will become extremely ill if not diagnosed early. The symptoms of acute
renal failure are for the most part same as that of acute nephritis. In majority of the instances this condition is
reversible, but it does depend on several factors including age, cause of such ARF and other coexisting
illnesses (comorbid conditions). Recovery to normal or adequate kidney function, if
it happens, will take a few days to several months. In many such patients
dialysis becomes a life support device until their kidneys recover adequately, since the
kidneys are responsible to maintain the internal
chemical environment of the body. Such well and accurately maintained chemical
environment is vital for the other organs (Brain, Lungs, Heart, Stomach, Intestines, Blood
etc) to function. Understandably, if ARF is not recognized and treated then all
other organ systems will fail. Therefore occurrence of ARF in a patient who has already
been hospitalized for another ailment is an ominous development, since it increases
the chances of death by several folds. For the most part the treatment of ARF depends on its severity and
the cause of ARF.
CAUSES OF ACUTE RENAL FAILURE:
A. Reduction in Blood flow to the kidneys under
various circumstances like:
1. Shock (Due to blood loss, burns, infection, heart attack etc.)
2. Dehydration
3. Unjustified, unsupervised excessive use of diuritics ("water
pills")
4. Failing heart unable to pump enough blood to the kidneys
(Congestive Heart Failure)
5. Obstruction to the blood vessel, preventing adequate blood flow to
the kidneys
(such an obstruction could be due to clots, cholesterol, scar formation in the
blood vessel, macerated tissue products from one's own body tissues
esp, muscles due to injury)
6. Injury to the blood vessels to both the kidneys
1. Shock (Due to blood loss, burns, infection, heart attack etc.)
2. Dehydration
3. Unjustified, unsupervised excessive use of diuritics ("water
pills")
4. Failing heart unable to pump enough blood to the kidneys
(Congestive Heart Failure)
5. Obstruction to the blood vessel, preventing adequate blood flow to
the kidneys
(such an obstruction could be due to clots, cholesterol, scar formation in the
blood vessel, macerated tissue products from one's own body tissues
esp, muscles due to injury)
6. Injury to the blood vessels to both the kidneys
B. Primary injury to the kidneys by:
1. Medications (Antibiotics, Arthritis Medications, Pain Medications, Medications
used in treating cancers, certain older agents used when delivering general-
anesthesia)
2. Dye (contrast) given intravenously during CT scans, Xray of
blood vessels
(angiograms) and kidneys (IVP)
3. Industrial solvents and other chemicals (especially when consumed)
4. Infections (Sepsis, Pneumonia, Strep sore-throat etc)
5. Occasionally secondary to pregnancy
6. Extremely high blood pressure (Malignant Hypertension)
7. Inflammation of Blood Vessels (Vasculitis)
8. Preexisting chronic nephritis and
chronic renal failure compounded by A, B and C.
9. Acute Nephritis
9. Acute Nephritis
C. Obstruction down stream to the flow of urine from the kidneys:
1. Obstruction to the tubes
(ureters) draining the urine
from the kidneys to the bladder
2. Obstruction to the urinary flow out of the bladder
(Urethral, Prostate)
(Such obstructions usually develop over a period of time and therefore cause chronic
rather than acute renal failure. At the time of initial presentation, however,
it may be difficult to distinguish such chronic renal failure from acute renal failure)
SYMPTOMS OF ACUTE RENAL FAILURE
(ARF):
One or more of the following:
1. Sudden decrease or loss of urine volume
2. Dark colored urine 3. Blood in the urine
4. Loin Pain
5. Difficulty in breathing
6. Swelling of legs, hands and face
7. Lack of appetite, nausea and vomiting
8. Lethargy leading to Coma
9. Tremulousness leading to seizure
10. Other symptoms depending on the cause
of ARF / and its severity
TREATMENT OF ACUTE RENAL FAILURE:
For the most part depends on the condition that caused
the Acute Renal Failure.
But in general might involve:
1. Removing / treating the cause
2.
Cardiovascular Support as needed
3. Controlling the high blood pressure
4. Restricting fluid consumption as long as measured urine volume is low
5. Dietary restrictions of water, protein, potassium and Phosphorus
consumption
6. Adjusting the doses of all medications to account for loss of their
elimination of those
medications from the body by the diseased kidneys, so as not to let those
medications accumulate to dangerously high levels
7. Avoiding other medications and agents that are potentially toxic to
kidneys
8. Controlling anemia with medications and blood transfusions
9. Preventing infections and treating them promptly if they do occur
10. Preventing internal bleeding (stomach and intestine) and treating if it
occurs
11. As long as kidneys are not functioning to meet the needs of the body,
supplementing
kidney function with Artificial Kidney Treatment (Dialysis)
12. Other measures as needed
