Acute renal failure (patient information)

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Editors-in-Chief: C. Michael Gibson, M.S., M.D. Associate Editor-In-Chief: Ujjwal Rastogi, MBBS [mailto:urastogi@perfuse.org]

Overview
Acute (sudden) kidney failure is the sudden loss of the ability of the kidneys to remove waste and concentrate urine without losing electrolytes.

What are the symptoms of Acute renal failure?

 * Bloody stools
 * Breath odor
 * Bruising easily
 * Changes in mental status or mood
 * Decreased appetite
 * Decreased sensation, especially in the hands or feet
 * Fatigue
 * Flank pain (between the ribs and hips)
 * Hand tremor
 * High blood pressure
 * Metallic taste in mouth
 * Nausea or vomiting, may last for days
 * Nosebleeds
 * Persistent hiccups
 * Prolonged bleeding
 * Seizures
 * Slow, sluggish movements
 * Swelling - generalized (fluid retention)
 * Swelling of the ankle, foot, and leg
 * Urination changes:
 * Decrease in amount of urine
 * Excessive urination at night
 * Urination stops completely

What causes Acute renal failure?
There are many possible causes of kidney damage. They include: Decreased blood flow due to very low blood pressure, which can result from: Disorders that cause clotting within the kidney's blood vessels: Infections that directly injure the kidney, such as: Pregnancy complications, including:
 * Acute tubular necrosis
 * Autoimmune kidney disease
 * Acute nephritic syndrome
 * Interstitial nephritis
 * Burns
 * Dehydration
 * Hemorrhage
 * Injury
 * Septic shock
 * Serious illness
 * Surgery
 * Hemolytic-uremic syndrome
 * Idiopathic thrombocytopenic thrombotic purpura(ITTP)
 * Malignant hypertension
 * Transfusion reaction
 * Scleroderma
 * Acute pyelonephritis
 * Septicemia
 * Placenta abruptio
 * Placenta previa
 * Urinary tract obstruction

Who is at highest risk?
Factors that may increase your risk of Kidney failure include:
 * Diabetes
 * High blood pressure.
 * Heart disease
 * Smoking
 * Obesity
 * High cholesterol
 * African-American, American Indian or Asian-American race
 * A family history of kidney disease
 * Age 65 or older

When to seek urgent medical care?
Call your health care provider if your urine output slows or stops or you have other symptoms of acute kidney failure.

Diagnosis
Many patients have generalized swelling caused by fluid retention. The doctor may hear a heart murmur, crackles in the lungs, or signs of inflammation of the lining of the heart when listening to the heart and lungs with a stethoscope.

The results of laboratory tests may change suddenly (within a few days to 2 weeks). Such tests may include:


 * BUN
 * Creatinine clearance
 * Serum creatinine
 * Serum potassium
 * Urinalysis
 * A kidney or abdominal ultrasound is the preferred test for diagnosing kidney failure, but abdominal x-ray, abdominal CT scan, or abdominal MRI can tell if there is a blockage in the urinary tract.

Blood tests may help reveal the underlying cause of kidney failure. Arterial blood gas and blood chemistries may show metabolic acidosis.

Treatment options
Once the cause is found, the goal of treatment is to restore kidney function and prevent fluid and waste from building up in the body while the kidneys heal. Usually, you have to stay overnight in the hospital for treatment.

The amount of liquid you eat (such as soup) or drink will be limited to the amount of urine you can produce. You will be told what you may and may not eat to reduce the buildup of toxins normally handled by the kidneys. Your diet may need to be high in carbohydrates and low in protein, salt, and potassium.

You may need antibiotics to treat or prevent infection. Diuretics ("water pills") may be used to help the kidneys lose fluid.

Calcium or glucose/insulin will be given through a vein to help avoid dangerous increases in blood potassium levels.

Dialysis may be needed, and can make you feel better. It is not always necessary, but it can save your life if your potassium levels are dangerously high. Dialysis will also be used if your mental status changes, you stop urinating, develop pericarditis, retain too much fluid, or cannot eliminate nitrogen waste products from your body.

Support Groups The stress of having an illness can often be helped by joining a support group where members share common experiences and problems.

Where to find medical care for Acute renal failure?
Directions to Hospitals Treating Acute renal failure

What to expect (Outlook/Prognosis)?
Acute kidney failure is potentially life-threatening and may require intensive treatment. However, the kidneys usually start working again within several weeks to months after the underlying cause has been treated.

In some cases, chronic renal failure or end-stage renal disease may develop. Death is most common when kidney failure is caused by surgery, trauma, or severe infection in someone with heart disease, lung disease, or recent stroke. Old age, infection, loss of blood from the intestinal tract, and progression of kidney failure also increase the risk of death.

Possible complications

 * Chronic (long-term) kidney failure
 * Damage to the heart or nervous system
 * End-stage kidney disease
 * High blood pressure
 * Loss of blood in the intestines

Prevention
Treating disorders such as high blood pressure can help prevent acute kidney failure.