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Acute Kidney Failure – Causes, Symptoms and Treatment

Acute kidney failure is a sudden loss of kidney function that develops within hours or days. Prompt medical treatment is essential to prevent permanent damage.

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Things worth knowing about "Acute Kidney Failure"

Acute kidney failure is a sudden loss of kidney function that develops within hours or days. Prompt medical treatment is essential to prevent permanent damage.

What is Acute Kidney Failure?

Acute kidney failure, also known as acute kidney injury (AKI), is a rapid and sudden decline in kidney function that occurs over hours to days. The kidneys become unable to adequately filter waste products, excess fluids, and electrolytes from the blood, leading to a dangerous buildup of these substances in the body. Acute kidney failure is a medical emergency and is frequently seen in patients who are already hospitalised.

Causes

The causes of acute kidney failure are divided into three main categories:

Prerenal Causes (before the kidney)

These result from reduced blood flow to the kidneys:

Severe drop in blood pressure (e.g., during shock or sepsis)
Significant fluid loss (e.g., from vomiting, diarrhoea, or excessive sweating)
Heart failure with reduced cardiac output

Intrinsic Renal Causes (within the kidney)

Direct damage to kidney tissue:

Acute tubular necrosis (the most common cause, often due to oxygen deprivation or toxic substances)
Kidney inflammation (glomerulonephritis, interstitial nephritis)
Certain medications (e.g., non-steroidal anti-inflammatory drugs, contrast agents, certain antibiotics)

Postrenal Causes (after the kidney)

Obstruction within the urinary tract:

Kidney stones
Enlarged prostate
Tumours in the pelvic region

Symptoms

Symptoms of acute kidney failure can vary depending on severity and may include:

Reduced urine output (oliguria) or no urine production (anuria)
Fluid retention and swelling (oedema), particularly in the legs and ankles
Fatigue, weakness, and confusion
Nausea and vomiting
Shortness of breath due to fluid accumulation in the lungs
Irregular heartbeat caused by elevated potassium levels in the blood
Dark or foamy urine

Diagnosis

The diagnosis of acute kidney failure involves several investigations:

Blood tests: Measurement of creatinine, urea, and electrolytes (especially potassium). A rise in serum creatinine of more than 0.3 mg/dl within 48 hours is a key diagnostic criterion.
Urine tests: Analysis of urine volume, colour, composition, and the presence of protein or blood.
Imaging: Renal ultrasound to assess kidney structure and detect possible obstructions.
Kidney biopsy: Performed in specific cases to examine kidney tissue.

Treatment

Treatment depends on the underlying cause and severity of the kidney failure:

General Measures

Fluid management -- either increasing or restricting fluids depending on the cause
Discontinuation of nephrotoxic medications
Treatment of the underlying condition (e.g., infections, heart failure)
Close monitoring of blood pressure, electrolytes, and fluid balance

Medication

Diuretics to promote urine output
Treatment of elevated potassium levels to protect the heart
Antibiotics if an underlying infection is present

Renal Replacement Therapy (Dialysis)

In severe cases, dialysis may be required to take over the filtering function of the kidneys. There are two main forms:

Haemodialysis: Blood is filtered through a machine outside the body
Peritoneal dialysis: Filtration takes place through the lining of the abdominal cavity

Prognosis and Outlook

With early and appropriate treatment, kidney function can fully recover in many patients. However, in severe or prolonged cases, there is a risk of developing chronic kidney disease. The prognosis depends significantly on the underlying cause, the severity of injury, and the overall health status of the patient.

References

Kidney Disease: Improving Global Outcomes (KDIGO) - Clinical Practice Guideline for Acute Kidney Injury, 2012. Available at: https://kdigo.org/guidelines/acute-kidney-injury/
Kellum JA et al. - Acute kidney injury. Nature Reviews Disease Primers, 2021. Available at: https://www.nature.com/articles/s41572-021-00284-z
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) - Acute Kidney Injury. Available at: https://www.niddk.nih.gov/health-information/kidney-disease/acute-kidney-injury

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