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Risk factors
Acute kidney failure almost always occurs in connection with another medical condition
or event. Conditions that can increase your risk of acute kidney failure include:
Being hospitalized, especially for a serious condition that requires intensive care
Advanced age
Blockages in the blood vessels in your arms or legs (peripheral artery disease)
Diabetes
High blood pressure
Heart failure
Kidney diseases
Liver diseases
Certain cancers and their treatments
As for Patient Rio’s case, he is 90 years old which means he is in the advanced age.
He was also diagnosed with Acute Renal Failure secondary to Hypertension, which
means that the cause of his ARF was due to high blood pressure. Over time, uncontrolled
high blood pressure can cause arteries around the kidneys to narrow, weaken or harden.
These damaged arteries are not able to deliver enough blood to the kidney tissue.
Symptoms
Signs and symptoms of acute kidney failure may include:
Decreased urine output, although occasionally urine output remains normal
Fluid retention, causing swelling in your legs, ankles or feet
Shortness of breath
Fatigue
Confusion
Nausea
Weakness
Irregular heartbeat
Chest pain or pressure
Seizures or coma in severe cases
As for Patient Rio’s case, he manifested fluid retention as evidence by pitting edema
on both upper and lower extremities, weakness, and tachycardia. Although he had a
normal urine output.
Complications
Potential complications of acute kidney failure include:
Fluid buildup. Acute kidney failure may lead to a buildup of fluid in your lungs,
which can cause shortness of breath.
Chest pain. If the lining that covers your heart (pericardium) becomes inflamed,
you may experience chest pain.
Muscle weakness. When your body's fluids and electrolytes — your body's blood
chemistry — are out of balance, muscle weakness can result.
Permanent kidney damage. Occasionally, acute kidney failure causes permanent
loss of kidney function, or end-stage renal disease. People with end-stage renal
disease require either permanent dialysis — a mechanical filtration process used
to remove toxins and wastes from the body — or a kidney transplant to survive.
Death. Acute kidney failure can lead to loss of kidney function and, ultimately,
death.
ARF staging
Guidelines for staging ARF
* Stage 1: SCr 1.5-1.9 times baseline or greater than/equal to 0.3 mg/dL increase with
urine output of less than 0.5 mL/kg/h for 6-12 hours.
* Stage 2: SCr 2.0-2.9 times baseline and urine output of less than 0.5 mL/kg/h for
greater than/equal to 12 hours.
* Stage 3: SCr 3.0 times baseline or increase in SCr to greater than/equal to 4.0 mg/dL;
or initiation of RRT; or in patients <18 years, decrease in estimated glomerular filtration
rate (eGFR) to <35 mL/min per 1.73 m2 and urine output less than 0.3 mL/kg/h for 24
hours or more; or anuria for 12 hours or more.
Phases of ARF
Phase Characteristic features Duration
Symptoms of the underlying illness causing AKI may be Hours to
Kidney injury
present. days
Oliguric or Progressive deterioration of kidney function Generally < 2
anuric phase Reduced urine production (oliguria) weeks
Increased retention of urea and creatinine
Complications: fluid retention (pulmonary edema),
hyperkalemia, metabolic acidosis, uremia, lethargy,
asterixis
Polyuric Glomerular filtration returns to normal, thus increasing ∼ 3 weeks
phase urine production (polyuria), while tubular reabsorption
remains disturbed.
Complications: loss of electrolytes and water
(dehydration, hyponatremia, and hypokalemia)
Recovery Kidney function and urine production normalize. Up to 2 years
phase
Patients have a higher risk of secondary infection throughout all phases (most common
reason for a fatal outcome).
Diagnosis
Kidney biopsy
If your signs and symptoms suggest that you have
acute kidney failure, your doctor may recommend
certain tests and procedures to verify your diagnosis.
These may include:
Urine tests. Analyzing a sample of your urine (urinalysis) may reveal abnormalities
that suggest kidney failure.
Blood tests. A sample of your blood may reveal rapidly rising levels of urea and
creatinine — two substances used to measure kidney function.
Imaging tests. Imaging tests such as ultrasound and computerized tomography
may be used to help your doctor see your kidneys.
Removing a sample of kidney tissue for testing. In some situations, your doctor
may recommend a kidney biopsy to remove a small sample of kidney tissue for lab
testing. Your doctor inserts a needle through your skin and into your kidney to
remove the sample.
Treatment
Treatment for acute kidney failure typically requires a hospital stay. Most people with
acute kidney failure are already hospitalized. How long you'll stay in the hospital
depends on the reason for your acute kidney failure and how quickly your kidneys
recover.
Treatment for acute kidney failure involves identifying the illness or injury that originally
damaged your kidneys. Your treatment options depend on what's causing your kidney
failure.
Your doctor will also work to prevent complications and allow your kidneys time to heal.
Treatments that help prevent complications include:
Treatments to balance the amount of fluids in your blood. If your acute kidney
failure is caused by a lack of fluids in your blood, your doctor may recommend
intravenous (IV) fluids. In other cases, acute kidney failure may cause you to have
too much fluid, leading to swelling in your arms and legs. In these cases, your
doctor may recommend medications (diuretics) to cause your body to expel extra
fluids.
Medications to restore blood calcium levels. If the levels of calcium in your blood
drop too low, your doctor may recommend an infusion of calcium.
Dialysis to remove toxins from your blood. If toxins build up in your blood, you may
need temporary hemodialysis — often referred to simply as dialysis — to help
remove toxins and excess fluids from your body while your kidneys heal. Dialysis
may also help remove excess potassium from your body. During dialysis, a
machine pumps blood out of your body through an artificial kidney (dialyzer) that
filters out waste. The blood is then returned to your body.
Medications and other products the patient ingests will be reviewed. Any that might
harm the kidneys will be eliminated or the dose reduced.
Fluid restriction: For those types of kidney failure in which excess fluid is not
Increase blood flow to the kidney: Usually related to improving heart function or
properly
Try to limits these drugs, watch labs and antibiotic troughs. Look out for
signs
3. Statins NSAIDS Aspirin Acetaminophen Insulin Some antibiotics Herbal
supplements
o Be mindful of medications that can become toxic when the kidneys aren’t
functioning at their prime.
Try to limits these drugs, watch labs and antibiotic troughs. Look out for
signs and symptoms of overdose.
Here are the most common signs and symptoms of overdose. *note this is
not a comprehensive list*
There are three kinds of diuretics: Loop, Thiazide, and potassium sparing.
Loop: works on the loop of henle and excretes Na+, K+, and Ca-. (Yikes!
Watch your patient’s electrolytes!)
Thiazide: Works on the distal convoluted tubule and blocks the Na+/Cl-
symporter (which reabsorbs...you guessed it Na+ and Cl-). This symporter
is responsible for about 5% of Na+ reabsorption. So monitor your patient’s
sodium and chloride. Oh, and your K+...Why? Because K+, Cl- and Na+
have direct relationships!
Blood Urea Nitrogen (BUN): measures the amount of urea in the blood.
When protein is broken down ammonia is formed. Ammonia is converted
to urea in the liver and is eventually excreted in the kidneys.