Monday, May 14, 2012

Acute Renal Failure

Acute Renal Failure


Acute renal failure is the rapid deterioration of the ability of the kidneys in the blood of toxic materials, which leads to accumulation of metabolic wastes in the blood (eg urea).

Cause
Acute renal failure may be a result of various circumstances that lead to:
- Reduced blood flow to the kidneys
- Blockage of urine flow after leaving the kidney
- Trauma to the kidney.


Major Causes of Acute Renal Failure
Problems that may cause
Decreased blood flow to the kidneys
Shortage of blood due to bleeding, dehydration or physical injury that causes blockage of blood vessels
Pump power decreased heart (heart failure)
A very low blood pressure (shock)
Heart failure (hepatorenalis syndrome)
Blockage of urine flow
An enlarged prostate
Tumor which suppress the urinary tract
Trauma to the kidney
Allergic reaction (eg allergic to a substance which is used radioopak on X-ray examination)
Toxic substances
Circumstances which affect the kidneys' filtering units (nephrons)
Blockage of an artery or vein in the kidney
Crystals, proteins or other substances in the kidneys


Symptoms 
The symptoms found in acute renal failure:
 - Decreased urine production (oliguria = urine
volume decreased or anuria = no urine is formed)
- Nocturia (urination at night)
- Swelling of the leg, foot or ankle
- Swelling of the whole (due to accumulation of fluid)
- Reduced sense, especially in the hands or feet
- Mental or mood changes
- Seizures
- Tremor hand
- Nausea, vomiting

The symptoms depend on the severity of renal failure, progression of the disease and its causes.

Circumstances that lead to kidney damage usually produces serious symptoms are not related to the kidneys.

For example, high fever, shock, heart failure and liver failure, kidney failure can occur before and could be more serious than the symptoms of kidney failure.

Some of the circumstances that led to acute renal failure also affects other parts of the body.
For example, Wegener's granulomatosis, which causes damage to blood vessels in the kidneys, also cause damage to blood vessels in the lungs, so that the patient experienced coughing up blood.

Skin rashes are typical symptoms for a number of causes of acute renal failure, namely polyarteritis, systemic lupus erythematosus and some drugs that are toxic.

Hydronephrosis can cause acute renal failure due to blockage of urine flow.
Reverse flow of urine in the kidneys causes urinary collecting region in the kidney (renal pelvis) stretches, causing cramping pain (may be mild or very severe) on the affected side.
In about 10% of patients, bladder containing blood.

Diagnosis

If urine production is reduced, then the suspect as acute renal failure.
Blood tests indicate the presence of urea and creatinine levels are high, accompanied by metabolic disorders (eg, acidosis, hyperkalemia, hyponatremia).

On physical examination, conducted an assessment of the kidneys; if there is swelling or tenderness.
Narrowing of the main renal artery can cause noise (bruit) that will be heard at the examination with a stethoscope.

If a blockage is suspected, digital rectal examination or a vaginal plug to determine the existence of mass in both places.

Laboratory examination of urine can help determine the cause and severity of renal failure.
If the cause is reduced blood flow to the kidneys or urinary tract obstruction, the urine will appear normal.

If the cause is an abnormality in the kidney, the urine will contain a collection of blood or red blood cells and white blood cells. Urine also contains large amounts of protein or various types of proteins that are normally not found in the urine.

Angiography (X-ray examination of the artery and vein) is performed if the suspected cause is a blockage of blood vessels.

Other tests that could help is a CT scan and MRI.

If the examination can not demonstrate the cause of acute renal failure, then do a biopsy (removal of tissue for microscopic examination).

Treatment

The goal of treatment is to find and treat the cause of acute renal failure. Moreover focused treatment to prevent accumulation of fluid overload and metabolic waste.

Restricted fluid intake, and adjusted to the volume of urine output.
Salt intake and substances that are normally removed by the kidneys, is also limited.
Patients are encouraged to undergo a diet rich in carbohydrates and low in protein, sodium and potassium.
Antibiotics can be given to prevent or treat infection.

To increase the amount of fluid excreted through the kidneys, may be given diuretics such as furosemide

Dopamine is given to improve perfusion and reduce the reabsorption of sodium.
Sodium polystyrene sulfonate is sometimes given to cope with hyperkalemia.
To remove excess fluid and waste products can do dialysis. With a dialysis patient will feel better and easier to control kidney failure.

Dialysis should not be undertaken by each patient, but often can prolong survival, especially if serum potassium levels are very high.

Indications of dialysis is done:
- The state of mental decline
- Pericarditis
- Hyperkalemia
- Anuria
- Excessive fluid
- Creatinine levels> 10 mg / dL and BUN> 120 mg / dL.

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