Acute Renal Failure
Problem: A man arrives at a clinic with complaints of asthenia, malaise, headache, weight gain, and a decrease in urination. A tentative diagnosis of acute renal failure is made.
The generic term for an abrupt and sustained decrease in renal function is called acute renal failure. This is the retention of urea, creatinine, and waste products. Prerenal, intrarenal and postrenal are sub classification for acute renal failure.
Prerenal is the most common form of kidney failure. Blood flow to the kidney that is reduce/interrupted may cause damage to the tissues and recue the ability of the kidney to function. This includes burns, loss of blood volume, heart failure, shock, long-term vomiting/diarrhea/bleeding, injury to the kidney, and certain types of surgery. Prerenal failure if identified early and treated correctly may be reversible.
Intrarenal failure is the actual damage to the nephrons and renal parenchyma . This can be categorized as acute tubular necrosis and is a common type of acute renal failure in critically ill patients. This is a reversible type of renal failure but may take weeks or months before adequate renal function return.
The condition that causes obstruction to urine flow is postrenal failure. Any conditions as in tumors, benign prostatic hypertrophy, kidney stones and bladder neck obstruction may cause this type of acute kidney failure. Untreated the result is actual nephron damage and intrarenal failure.
A patient with kidney disease will have laboratory tests done but first a full and complete history will be taken. Physically the patient’s body will show swelling caused by fluid retention and murmur in the heart, crackles in the lungs or any abnormal sounds in the heart or lungs can be found. These tests include BUN (normal range 6-20 mg/dl), creatinine clearance (compares the levels of creatinine in urine and blood), serum creatinine, serum potassium and urinalysis. The preferred test for diagnosing a blockage in the urinary tract would be an ultrasound. X-ray or MRI can also tell if there is a blockage, and the blood test will help reveal the underlying cause of kidney failure.
Insufficient filtering of the blood by the kidney causing high levels of compounds containing nitrogen and other waste products is called azotemia. This waste product is normally excreted in the urine and can lead to uremia. In Uremia the waste products now show in the blood. With oliguria the body gets reed of an abnormally small amount of urine.
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 .
This can be investigated by a range of procedures. These include a CT scan of the kidneys and bladder in conjunction with an abdominal X-ray. Results obtained from the diagnosis and tests enable judgments’ relating to the stage to which the problem has developed and will inform decisions on the appropriate treatment
The editorial explains that diabetes mellitus is the leading cause of irreversible renal failure, known more commonly as End Stage Renal Disease (ESRD). Diabetes mellitus can cause nerve, vascular and other problems that can result in limb amputation and blindness. There are two types of diabetes: long-duration, non-insulin dependent (type 2) and insulin-dependent (type 1). Type 1 seems to attract the most attention from Physicians and the media. Many of those that suffer from type 1 are children and young adults.
To have a better understanding of your patients particular case with acute kidney failure you would want to gather a patient history to see if they have used any nephrotoxic medications or have had systemic illnesses in the past that may have been related to poor perfusion in their body. The laboratory tests you would want to pay attention to would be a complete blood count, urinalysis, ultrasound, glomerular filtration rate and a measurement of serum creatinine and potassium level (Rahman, Shad, Smith 2012).
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...
When caring for a patient with AKI the main goal is to prevent any complications and manage the complications the patient is experiencing while trying to reverse the cause. Being that urine output is the best sign that the kidneys are being perfused the bedside nurse must be strictly monitoring this patient’s fluid intake and urine output. Diuretic therapy is also started in low doses to help the kidneys along. AKI patient’s electrolyte levels...
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.
According to the Mayo Clinic, Kidney Failure occurs when the kidneys are suddenly unable to filter waste products from the blood. This occurring, results in the body beginning to accumulate high levels of dangerous waste, which eventually leads to a chemical imbalance in the blood. Symptoms of the kidney’s inability to
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.
This mainly happens patients who are already hospitalized. Acute glomerulonephritis is where the blood vessels in kidney becomes inflamed and unable to filter blood properly. Postrenal would include a urinary tract obstruction. Kidney stones or renal malignancy. Next we would need to perform a bladder scan to make sure its not just renal retention, monitor for 50-100mls for neurogenic bladder. To be sure it is an acute renal failure diagnoses test will be performed. A serum creatinine level you compare the patient creatinine level with previous levels to determine the duration and how long the kidneys have been failing, its usually a rise in creatinine has occurred in the first 48 hours. A complete blood count will show if there is acute hemolytic anemia with the peripheral smear showing schistocytes in the setting of acute kidney injury should raise the possibility of hemolytic uremic
blocked has now shut down. This kidney, if left untreated for just a few days,
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.
Nephrotic syndrome is usually diagnosed with dipstick urine test or a 24-hour urine collection. If your test shows that you have nephrotic syndrome, additional tests may be needed to determine its cause. These may include blood, urine, imaging, or kidney biopsy tests.