Acute Renal Failure
Explain the pathophysiology of acute renal failure. Include prerenal, intrarenal and postrenal causes.
Kidneys are a vital part of our bodies. Their main function is to remove waste from our body. They also release three important hormones:
• Erythropoietin – Stimulates bone marrow to create more red blood cells.
• Renin – Is responsible for regulating blood pressure.
• Calcitrol – Helps to maintain the calcium in our bones.
During acute renal failure or (ARF) the kidneys suddenly stop working which in turn sets off a chain reaction in our bodies and can lead to death. There are three different types of ARF.
1. Prerenal is the most common form of ARF. It is when there is a sudden drop of blood flow to the kidneys. This occurs most often in an accident when there is injury to the kidneys or a form of severe illness.
2. Intrarenal is caused by inflammation, drugs such as antibiotics and infections, for example, glomerulonephritis, which is caused by the strep bacteria.
3. Postrenal is the least common form of ARF. This occurs when there is a sudden obstruction of urine flow that can result from a kidney stone, enlarged prostate, injury or a bladder tumor.
What diagnostic exams would be used to diagnose acute renal failure?
How do these tests change as renal failure progresses through its three stages? Discuss, compare and contrast the three stages.
To diagnose acute renal failure, you will monitor kidney function using both blood, urine and imaging tests.
• The blood tests that are used are Bun and Creatinine. These two tests monitor the amount of urea and creatinine in the blood. Urea is a byproduct of protein breakdown and creatinine is a byproduct of muscle...
... middle of paper ...
... the patient goes on to have a happy, healthy life
with no renal complications.
References
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"Kidney Diseases." Tests Used to Diagnose Kidney Disease. N.p., n.d. Web. 4 Dec. 2013. .
"Read What Your Physician is Reading on Medscape." eMedicineHealth. N.p., n.d. Web. 4 Dec. 2013. .
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Dharmajan,T.S.,Yoo.012,Renal Insufficiency, Chronic-In Old Age Journal of the American Medical Directors Association
Health Communities,2011, Pre Renal, ARF Overview, Causes-Acute Renal Failure.
There are two types of glomerulonephritis—acute renal failure (ARF) and chronic kidney disease (CKD). The ACF form generally develops suddenly as a result of an infection or illness, such as, group A streptococci bacteria, hepatitis, or in diseases such as lupus or HIV (Mathias, 2013). This type may require dialysis to replace renal function while it lasts, however, kidney function usually returns after the primary illness is treated. Many acute patients will not have any other complications as no permanent damage is done. Whereas CKD is found in a person that has had glomerulonephritis for months to years in some cases and may be asymptomatic until the kidney has become irreversibly damaged. ARF can evolve to become chronic if the glomeruli do not respond to
The kidneys play a major role in the blood composition and volume , the excretion of metabolic wastes in the urine, the control the acid/base balance in the body and the hormone production for maintaining hemostasis. The damages to the GBM in the glomeruli alter filtration process that allows the protein and red blood cells to leak into the urine. Loss of protein like albumin in the urine results in a decrease of their level into the blood stream. Consequently, this patient’s blood reveals a decreased albumin (Alb) value of 2.9 g/dL, decreased serum total protein value of 5 .0 g/dL and in the urine presents of the protein and the RBCs. Impaired filtering capacity result in inability of kidneys to excrete excretory products like electrolytes and metabolic waste products that will then accumulate in the blood. Furthermore, inability of distal convoluted tubules to excrete sufficient quantities of potassium, sodium, magnesium (Mg), chloride (Cl), urea, creatinine (Cr), alkaline phosphatase (Alk Phos), and phosphate (PO4) results in their elevation in the blood. His laboratory values reveal an increased of sodium value of 149 meq/L, an increase of potassium value of 5.4meq/L, increased chloride value of 116 meq/L, increased blood urea nitrogen (BUN) serum of 143 mg/dL, and increased creatinine serum of 7.14 mg/dL. The other abnormal blood tests associated with a loss of kidneys’ filtration property identify in this patient are related to an increase of alkaline phosphatase value of 178 IU/L, increased magnesium value of 3.8mgdL, and increased phosphate (PO4) value of 5.9 mg/dL .
1 in 3 Americans Adults are currently at risk for developing kidney disease. What is acute renal failure, when your kidneys functions all of a sudden stop working and your kidneys are the body’s filter which remove waste products and help balance water, salts and minerals especially electrolytes in your blood when your kidneys stop working you end up building all the products in your body that need to be filtered and eliminated. The pathophysiology of Acute Renal Failure are due to three main causes Pre-renal, Intra-renal, and Post renal. Pre-renal is a sudden drop in blood pressure or interruption of blood flow to the kidneys from illness or sever injury. Intra-renal is direct damage to the kidneys by inflammation of drugs, infection, toxins or reduced blood supply. Post-renal is a sudden obstruction of urine flow because of enlarged prostate bladder tumor, kidney stones, or injury.
Pathophysiology There are three different stages of acute renal failure; prerenal, intrarenal, and post renal. Prerenal failure is a result from an illness or injury that causes obstruction of blood flow to the kidneys, called hypoperfusion. Hypotension, hypervolemia and inadequate cardiac output are all examples that could cause prerenal failure. According to Lippincott Williams and Wilkins (2009), “prerenal azotemia, excess nitrogenous waste products in the blood, account for 40% to 80% of all cases of acute renal failure” (p. 307). Intrarenal is when there is direct damage to the kidney tissue by either inflammations, drugs, infections or a reduction in the blood supply to the kidney. Post renal is when there is an obstruction of the urine flow. Causes of obstruction could be enlarged prostate gland, kidney stones, bladder tumor or injury. There are four phases of acute renal failure; onset, oliguria, diuresis and recovery. The onset phase can last hours or up to days. The BUN and creatinine levels may start to increas...
Nephrology consult called with M169 for Acute Kidney injury on Chronic Renal Failure. M169 consult impression Acute Kidney injury superimposed on Chronic Kidney Disease most likely 2nd to ATN caused by Hypoxia and Hypotension, severe metabolic acidosis 2nd to acute kidney injury.
AKI is usually found when a patient’s serum creatinine is abnormally elevated or they have a sudden reduction in urine output. Due to these clinical manifestations a patient can develop azotemia, meaning that a large amount of waste products build up in the blood. AKI has a high mortality rate of 60-70%, especially if not noted quickly. AKI is sometimes reversible depending on the co-existing morbidities of the patient and how well the patient’s body reacts to treatments.
There are several diagnostic test or evaluations done to prognosis acute renal failure. These are:
The renal disease are common nowadays .The acute renal failure is a medical term means that the kidneys stopped from working and not able to clear toxins from body ,not able to maintained a stable electrolyte balance inside the body and not able to secret the extra fluid as urine outside the body. The renal replacement therapy (RRT) or dialysis has been discovered on 1913 by Able, Rowntree and Turner in London, UK.
Renal failure is a broad health problem that is prevalent in today’s general population. There are five different types of kidney failure categorize the diagnosis of renal failure. Having a definition of Kidney Failure helps form an understanding of medical treatment issues surrounding this diagnosis and the impact had on not only the individuals but on support systems as well.
Kidney damage can occur from hypertension which causes blood vessels in the kidneys to shrink and harden; infections travelling though the bloodstream; long-term and uncontrolled diabetes, and genetically inherited kidney problems. (Edith Cowan University, 2001-2004)
Healthy kidneys clean the blood by filtering out extra water and wastes. They also make hormones that keep your bones strong and blood healthy. When both of your kidneys fail, your body holds fluid. Your blood pressure rises. Harmful wastes build up in your body. Your body doesn't make enough red blood cells. When this happens, you need treatment to replace the work of your failed kidneys.
If the patient has a urinary catheter, and most ICU patients do, he or she may not have any reportable symptoms. Therefore, good assessment of urinary elimination, done in relation to a patient’s signs, symptoms, urine amount, intake and output, and lab values, is important. The lab values are discussed in Chapter 5. Acute and chronic renal failure can cause numerous systemic symptoms and altered homeostasis ( Collins, 2011). See Table 3-10 for abnormal urinary elimination.
A Urine test analyzes a sample of the patient’s urine may reveal abnormalities that point to chronic kidney failure and help identify the cause of chronic kidney disease. One the abnormalities are the presence of albumin in the urine. Albumin is a protein found in the blood. A healthy kidney does not let albumin pass into the urine. A damaged kidney lets some albumin pass into the urine, the fewer albumins in your urine, the better. Albumin can be detected by a dipstick test. The dipstick test involves using chemically treated paper to detect albumin in the urine sample. If the presence of albumin is found then the treating paper will change color. I perform the dip test and the treated paper changed
Renal ultrasonography is done for evaluating renal disease and blockage of the urinary system. Aortorenal angiography also helps in the diagnosis of many renal vascular diseases. Renal biopsy is useful for identification of intra renal causes of AKI.
As mentioned above; Hypoalbuminaemia is a predominantly events that occur due to losses of protein urinary. In response to this, hepatic albumin synthesis increased but they are still insufficient to prevent the fall in the serum albumin concentration. Proteinuria, Nephrotic range proteinuria is almost invariably due to glomerular disease.