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ACUTE KIDNEY FAILURE - ACUTE RENAL FAILURE

What is an Acute Kidney Failure ?

The two kidneys are situated, one on each side, at the back of the abdomen. They remove waste products and excess water from the blood in the form of urine. The urine then passes down a tube called the ureter on each side, and enter the bladder. Acute renal failure occurs when the kidneys suddenly do not work properly. It also occurs when the ureters or bladder are blocked. The symptoms depend on how much damage is being done to the kidneys, and what the damage consists of. As waste products accumulate in the blood, you may feel tired, sick or lose appetite. With more severe kidney failure, drowsiness occurs, one might pass out, or even have a fit. The body can suffer from fluid overload as the kidneys can no longer get rid of excess water. This causes swelling (oedema) of the legs and difficulty in breathing. This is because the lungs literally get waterlogged. Someimes vomiting occurs, with or without blood.

How does an Acute Kidney Failure occur ?

There are three groups of causes of acute kidney failure: TOO LITTLE BLOOD flows through the kidneys when a patient has lost a lot of fluid. This can happen either through bleeding or with excessive diarrhoea or vomiting. Blood flow through the kidney is also reduced when the heart does not work properly. Severe heart failure and heart attacks may be responsible. DAMAGE TO THE KIDNEYS can occur in a number of different ways. Sometimes, when there is not enough blood flowing through the kidneys, the kidneys themselves become damaged. Even when the blood flow is restored, the kidney function may not improve. This condition is called acute tubular necrosis. Many drugs can also damage the kidneys either directly or by causing an allergic reaction. Glomerulonephritis can sometimes cause acute renal failure. This often occurs as part of some other disease, e.g. systemic lupus erythematosus, infective endocarditis and arteritis. OBSTRUCTION can cause acute kidney failure when either the ureters or outflow from the bladder (urethra) become blocked. This can be caused by a stone, a growth or by enlargement of the prostate gland.

Why does an Acute Kidney Failure occur ?

It is not understood why some people develop acute tubular necrosis and others do not. It is more likely to happen in the elderly and in people already with kidney damage. Patients on certain types of painkillers (such as ibuprofen, indomethacin) are also more likely to get acute kidney failure.

Treatment Involved for an Acute Kidney Failure

You will always need to be in hospital. First, it has to be decided whether you are dry (too little fluid in the body) or overloaded (too much fluid in the body). If dry , then the blood pressure will be low, the pulse rate will be high, and the skin will be loose. If overloaded , then the legs will be swollen. Sometimes, a fine tube called a catheter has to be placed in a vein in the neck to measure pressure in the veins. This will help the doctor to decide how much fluid needs to be given.

If you are dry , extra fluids are sometimes all that is needed for the kidneys to work properly, and this can be given most easily through a drip in the arm. If you have acute tubular necrosis, kidney function will not improve with fluid alone. More information is needed using a kidney ultrasound. This is a type of radar instrument using sound waves. It will tell the doctor about the size of the kidneys and if they are obstructed. If the kidneys are obstructed, then a catheter tube can be passed into the bladder or directly into one of the kidneys. This is known as a nephrostomy tube.

If the kidneys are not blocked and are of normal size, then a renal biopsy may be performed. This involves taking a tiny sample of kidney tissue through a needle in the side of the back. This renal biopsy will usually show what sort of damage there is in the kidney, and how it may be best treated. Glomerulonephritis and damage caused by drugs can be treated by steroids (cortisone-like drugs)in the form of tablets.. The severity of kidney failure also needs to be measured. This is done by blood tests measuring urea and creatinine. These are waste products which are usually got rid of by the kidneys. Potassium can also build up, causing the heart to beat irregularly. If the kidney failure is severe, you will need some type of dialysis. This is essentially just a way of purifying the blood.

During Treatment for an Acute Kidney Failure

As kidney function recovers, more urine is produced. If kidney failure is due to lack of fluids then normal function will return as fluids are given to you. Acute tubular necrosis, in most instances, recovers on its own. Kidney failure resulting from drugs usually recovers fully with steroid treatment. Glomerulonephritis may or may not recover. With obstruction, the degree of recovery of kidney function depends on how long the kidneys have been obstructed. The longer this has been, the more damage there will be to the kidneys.

After Treatment for an Acute Kidney Failure

If kidney function returns to normal, there are no long-term problems. If there is only partial recovery, then you will need regular blood-pressure checks and blood tests at follow-up visits to the specialist. Sometimes kidney function never improves and long-term dialysis will be needed.

If an Acute Kidney Failure is Left Untreated

Obstruction will cause more and more kidney damage if not relieved early. Glomerulonephritis and damage from drugs are less likely to respond to treatment if treatment is delayed. Fluid replacement, if given too late may fail to prevent acute tubular necrosis from developing.

Effects on Family of an Acute Kidney Failure

Patients with acute renal failure are often quite ill. They will need support and reassurance from those close to them.