Acute Renal Failure or Acute Kidney Injury

Acute Renal Failure also known by the name of Acute Kidney Injury signifies the fact the kidneys of an individual have all of a sudden ceased to work. The function of the kidneys is to remove waste products from the body and facilitate balance of water, salt, and electrolytes in the blood. When the kidneys cease to work there is constant buildup of waste products and other fluids and electrolytes in the body, which may potentially have pretty serious consequences. In this article, we will study about various causes of Acute Renal Failure, the various symptoms and treatments rendered for it.

Acute Renal Failure or Acute Kidney Injury

How Is Acute Renal Failure or Acute Kidney Injury Defined?

  • Acute Renal Failure or Acute Kidney Injury results in sudden failure of kidney function.
  • The kidney tissue injury is often caused by low blood flow, tissue trauma or side effects of chemicals.
  • Harmful effects of kidney renal tubule may be secondary to obstruction of urinary flow or chronic infection with severe renal cell inflammation.
  • Acute Renal Failure is diagnosed based on the findings of the diagnostic tests conducted like increased BUN and creatinine or when the kidneys are not able to produce appropriate amounts of urine.

Causes of Acute Renal Failure or Acute Kidney Injury

Causes of Acute Renal Failure or Acute Kidney Injury are as follows-

  • Decrease kidney blood flow
    • Hypotension
    • Congestive heart failure
    • Renal artery stenosis
    • Renal vein thrombosis
  • Anemia-
    • Acute blood loss
    • Low hemoglobin
  • Kidney trauma or injury
    • Injury results in decreased blood flow to surrounding kidney tissue
  • Kidney inflammatory diseases-
    • Glomerulonephritis
    • Interstitial nephritis
  • Urinary Flow Obstruction
    • Stone- Kidney and ureteral stone
    • Malignancy- Kidney and Ureteral cancer.
  • Decreased Blood Volume
    • Dehydration
  • Surgery
    • Surgical complication in obese patient often follows with acute renal failure.1
  • Toxicity-
    • Damage to the kidneys as a result of medications or other infections. Literature suggests Vancomycin intravenous treatment has caused acute renal failure in several patients.2
    • Inhalation or ingestion of Insecticides causes severe kidney injury

What Are Some Of The Medications, Which Can Cause Acute Renal Failure or Acute Kidney Injury?

Side Effects of Medications Causes Acute Renal Failure or Acute Kidney Injury-

  • Antibiotics: Antibiotics like cephalosporins, amphotericin B, bacitracin, vancomycin etc. can cause Acute Renal Failure
  • Antihypertensive Medications: Blood pressure medications like lisinopril, ramipril, or valsartan can also cause Acute Renal Failure
  • Cancer Medications: Medications used for cancer treatments like cisplatin or methotrexate etc. can also cause Acute Renal Failure.
  • Contrast Dyes: Apart from the above mentioned medications, contrast media generally used for radiological studies can also cause Acute Renal Failure.
  • Recreational Drugs: Heroin and methamphetamine have a tendency to cause Acute Renal Failure
  • HIV Medications: Medications used for treating HIV like indinavir and ritonavir also tends to cause Acute Renal Failure
  • NSAIDs: Medications like ibuprofen, naproxen etc. also have a potential to cause Acute Renal Failure.

Symptoms of Acute Renal Failure or Acute Kidney Injury

Non-Specific Symptoms of Acute Renal Failure or Acute Kidney Injury

  • Loss of appetite
  • Nausea
  • Headache
  • Vomiting
  • Feeling of confusion and anxiety
  • Drowsiness

Specific Symptoms of Acute Renal Failure or Acute Kidney Injury

  • Urine Output- Absent or very little.
  • Irregular Heart Beats- Caused by increased potassium
  • Hypertension- Caused by retention of fluid and sodium as well as increased level of angiotensin in the blood.
  • Flank Pain- Pain is paravertebral between levels 12th thoracic vertebra to 5th lumbar vertebra.
  • Retention of Water- Causes edema of feet, pulmonary edema and cardiac tamponed

Diagnosis of Acute Renal Failure or Acute Kidney Injury

  • Hospital Admission- Acute Renal Failure is generally diagnosed following routine investigation during hospital admission.
  • Routine Annual Examination- Disease is diagnosed in asymptomatic patient when routine blood and urine examination suggest abnormal results.
  • Urine Examination-
    • Hematuria
    • Proteinuria- Increased excretion of albumen and globulin in urine.
  • Blood Examination-
    • Anemia- Low hemoglobin
    • Abnormal Electrolytes
    • Increased BUN and Creatinine
  • Ultrasound-
    • Kidney is small in later stage.
  • MRI
    • Check size of the kidney. Kidney may be smaller in size.

Treatment for Acute Renal Failure or Acute Kidney Injury

Conservative Treatment for Acute Renal Failure or Acute Kidney Injury

Diet Control-

Electrolytes, Salt and Water- Diet containing electrolyte, salt and water control depending on symptoms and metabolism of water and electrolytes.

  • Restrict water intake according to need
  • Restrict salt and potassium.

Specific Treatment for Acute Renal Failure

  • Pain- NSAIDs or Opioids.
  • Discontinue antibiotics and chemotherapy, which may be causing kidney toxic effects.
  • Treat blood pressure
  • Dialysis in End Stage Renal Disease.3
  • Treat Infection

Complications Of Acute Renal Failure or Acute Kidney Injury

  • Anemia
  • Hypertension
  • Renal Failure
  • Hyperkalemia causing cardiac arrhythmia
  • Fluid retention causing edema, pulmonary edema and cardiac tapenade

In majority of the cases of Acute Renal Failure, the nephrologist is able to correct the problem with treatment, which may take some days to weeks. These individuals with temporary Acute Renal Failure lead normal lives without any issues with treatment.

How Is Acute Renal Failure Different From Chronic Kidney Disease?

It is very important to know the difference between Acute Renal Failure and Chronic Kidney Disease. In Acute Renal Failure, the kidney ceases to function abruptly. In order to treat Renal Failure, it is important to find out whether it has developed suddenly (acute in origin) or as a result of some prolonged illness (chronic in origin).

The major difference between Acute Renal Failure and Chronic Kidney Disease is:

In Acute Renal Failure

  • Symptoms are observed within short time
  • Severe symptoms and complications causes need for hospitalization
  • Symptoms follow history of serious bodily insults like dehydration, severe hypotension, and severe blood loss or kidney trauma.
  • Symptoms follow shortly after antibiotic treatment, chemotherapy or radiological dye study.

In Chronic Kidney Disease

  • History of prolonged kidney disease.
  • Serious symptoms of renal failure are observed in patients with history of prolonged illnesses.
  • End Stage Renal Disease is observed following prolonged out patient treatment.
  • History suggests chronic illness preceding kidney failure. Chronic disease precedes hypertension and diabetes.

References

1. Obesity and perioperative acute kidney injury: A focused review.

Suneja M1, Kumar AB2.

J Crit Care. 2014 Mar 5. pii: S0883-9441(14)00077-X.

2. Risk factors for acute kidney injury in adult patients receiving vancomycin.

Cappelletty D1, Jablonski A, Jung R.

Clin Drug Investig. 2014 Mar;34(3):189-93.

3. The renal recovery of critically ill patients with acute renal failure requiring dialysis.

Alsultan MA.

Saudi J Kidney Dis Transpl. 2013 Nov;24(6):1175-9.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: May 7, 2014

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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