Renal disease: Treatment, symptoms, advice and help

Acute renal failure is caused by a variety of different disorders and occurs in a wide range of clinical settings.  In clinical practice, acute renal failure due to low blood pressure is one of the most common forms of acute renal failure, it may account for 40 to 80 % of all cases, and if prolonged, can lead to chronic renal failure.

Causes of acute renal failure
The most common cause of acute renal failure in hospital (75 %) is acute tubular necrosis.

The different clinical settings are:

• 30% Low blood pressure (hypotension) - due to whatever reason e.g. haemorrhage, fluid loss etc.
• 19% Nephrotoxins- like specific antibiotics (e.g. aminoglycosides), X-ray dyes, organic solvents, heavy metals, pain killers like Brufen)
• 15% due to severe infection(septicaemia)
• 3% rhabdomyolysis- break down of muscle protein which overloads/blocks the kidney
• 7% Glomerulonephritis
• 9% interstitial nephritis
• 4% vascular disease
• trauma or post-operative
• Dehydration is also a significant risk factor for the development of acute renal failure
• Obstructive renal failure (uropathy)- obstruction is a less common cause of acute renal failure and is encountered in 2 - 10 % of all cases and more common in older men with prostatic disease and patients with pelvic cancer
• Renal artery occlusion/renal artery stenosis may result in acute renal failure

Patients at greatest risk of acute renal failure comprise a high-risk group: postsurgical (aortic aneurysm, bowel resection, cardiac surgery, other), trauma (road traffic accident, burns), and medical (sepsis, poor cardiac output, pancreatitis, other).

The mortality rate, previously up to 90%, has declined with the introduction of haemodialysis to 50 Ð 60% . Although there has been little further improvement in the overall mortality rate in the past 40 years there have been significant improvements that have occurred in survival among patients with specific causative disorders e.g. vasculitis, haemolytic Duraemic syndrome and multiple myeloma.

Causes of death are now attributable to infection, cardiorespiratory disease, the underlying causative disorder and associated complications.

Continuous renal replacement therapy methods have been widely used in the past decade for acute renal failure in critically ill patients who need intensive care; in many of these patients acute renal failure occurs in association with multiple organ system failure. There is no proof that continuous renal replacement therapy techniques improve outcome in terms of patient survival among such patients, and it may be that renal failure as such does not contribute sufficiently to death in multiple organ system failure for there to be a demonstrable difference between patients treated with continuous renal replacement therapy and conventional haemodialysis.

Prognosis for recovery of renal function

Prognosis in terms of recovery of renal function has been less extensively studied than mortality.  Several studies have indicated that recovery of renal function may be affected by both age and the nature of the causative disorder.

In general, the following statements can be made regarding prognosis in acute renal failure:

1. Reversible pre- (e.g. dehydration, haemorrhage, fluid loss) and postrenal forms (e.g. obstructed kidneys) of acute renal failure have a better prognosis than acute damage to the kidney tubes.
2. Patients with few or no added clinical complications have a very favourable survival rate, greater than 90%
3. There is an inverse relationship between the number of systems/organs failing and the likelihood of acute renal failure survival.
4. Selected complications such as respiratory failure, cardiac failure, se