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Sunday, August 6, 2017

Acute Kidney Failure / Injury


ACUTE KIDNEY FAILURE / INJURY

About Kidney

Your blood flows through your kidneys, which are the key organs in the complex system that removes excess fluid and waste material from the blood. Blood that flows into your kidneys is diffused through filtering structures called nephrons. Each nephron contains a tuft of capillary blood vessels (glomerulus) and tiny tubules that lead to larger collecting tubes. The glomeruli filter fluid from your blood, extracting both waste products and substances your body needs — such as sodium, phosphorus and potassium. The substances your body needs are reabsorbed into your bloodstream. Waste products are excreted in the urine.

Definition

  Acute kidney failure occurs when your kidneys suddenly become unable to filter waste products from your blood. When your kidneys lose their filtering ability, dangerous levels of wastes may accumulate and your blood's chemical makeup may get out of balance.
  Acute kidney failure — also called acute renal failure or acute kidney injury — develops rapidly over a few hours or a few days. Acute kidney failure is most common in people who are already hospitalized, particularly in critically ill people who need intensive care.
  Acute kidney failure can be fatal and requires intensive treatment. However, acute kidney failure may be reversible. If you're otherwise in good health, you may recover normal kidney function.

Symptoms

  Decreased urine output, although occasionally urine output remains normal
  Fluid retention, causing swelling in your legs, ankles or feet
  Drowsiness
  Shortness of breath
  Fatigue
  Confusion
  Nausea
  Seizures or coma in severe cases
  Chest pain or pressure
  Sometimes acute kidney failure causes no signs or symptoms and is detected through lab tests done for another reason.

Causes

  Acute kidney failure can occur when:
  You have a condition that slows blood flow to your kidneys
  You experience direct damage to your kidneys
  Your kidneys' urine drainage tubes (ureters) become blocked and wastes can't leave your body through your urine
  Impaired blood flow to the kidneys
  Diseases and conditions that may slow blood flow to the kidneys and lead to kidney failure include:
  Blood or fluid loss
  Blood pressure medications
  Heart attack
  Heart disease
  Infection
  Liver failure
  Use of aspirin, ibuprofen (Advil, Motrin IB, others), naproxen (Aleve, others), or related drugs
  Severe allergic reaction (anaphylaxis)
  Severe burns
  Severe dehydration

Damage to the kidneys
These diseases, conditions and agents may damage the kidneys and lead to acute kidney failure:

  Blood clots in the veins and arteries in and around the kidneys
  Cholesterol deposits that block blood flow in the kidneys
  Glomerulonephritis inflammation of the tiny filters in the kidneys (glomeruli)
  Hemolytic uremic syndrome, a condition that results from premature destruction of red blood cells
  Infection
  Lupus, an immune system disorder causing glomerulonephritis
  Medications, such as certain chemotherapy drugs, antibiotics, dyes used during imaging tests and zoledronic acid (Reclast, Zometa), used to treat osteoporosis and high blood calcium levels (hypercalcemia)
  Multiple myeloma, a cancer of the plasma cells
  Scleroderma, a group of rare diseases affecting the skin and connective tissues
  Thrombotic thrombocytopenic purpura (TTP), a rare blood disorder
  Toxins, such as alcohol, heavy metals and cocaine 
  Vasculitis, an inflammation of blood vessels
  Urine blockage in the kidneys
  Diseases and conditions that block the passage of urine out of the body (urinary obstructions) and can lead to acute kidney failure include:
  Bladder cancer
  Blood clots in the urinary tract
  Cervical cancer
  Colon cancer
  Enlarged prostate
  Kidney stones
  Nerve damage involving the nerves that control the bladder
  Prostate cancer



Risk Factors

  Acute kidney failure almost always occurs in connection with another medical condition or event. Conditions that can increase your risk of acute kidney failure include:
  Being hospitalized, especially for a serious condition that requires intensive care
  Advanced age
  Blockages in the blood vessels in your arms or legs (peripheral artery disease)
  Diabetes
  High blood pressure
  Heart failure
  Kidney diseases
  Liver diseases

Complication

  Potential complications of acute kidney failure include:
  Fluid buildup. Acute kidney failure may lead to a buildup of fluid in your chest, which can cause shortness of breath.
  Chest pain. If the lining that covers your heart becomes inflamed, you may experience chest pain.
  Muscle weakness. When your body's fluids and electrolytes — your body's blood chemistry — are out of balance, muscle weakness can result. Elevated levels of potassium in your blood are particularly dangerous.
  Permanent kidney damage. Occasionally, acute kidney failure causes permanent loss of kidney function, or end-stage renal disease. People with end-stage renal disease require either permanent dialysis — a mechanical filtration process used to remove toxins and wastes from your body — or a kidney transplant to survive.
  Death. Acute kidney failure can lead to loss of kidney function and, ultimately, death. The risk of death is highest in people who had kidney problems before acute kidney failure.

Test and Diagnosis

  If your signs and symptoms suggest that you have acute kidney failure, your doctor may recommend tests and procedures to verify your diagnosis. These may include:
  Urine output measurements. The amount of urine you excrete in a day may help your doctor determine the cause of your kidney failure.
  Urine tests. Analyzing a sample of your urine, a procedure called urinalysis, may reveal abnormalities that suggest kidney failure.
  Blood tests. A sample of your blood may reveal rapidly rising levels of urea and creatinine — two substances used to measure kidney function.
  Imaging tests. Imaging tests such as ultrasound and computerized tomography (CT) may be used to help your doctor see your kidneys.
  Removing a sample of kidney tissue for testing. In certain situations, your doctor may recommend a kidney biopsy to remove a small sample of kidney tissue for lab testing. To remove a sample of kidney tissue, your doctor may insert a thin needle through your skin and into your kidney.

Treatment and Drugs

  Treatment for acute kidney failure typically requires a hospital stay. Most people with acute kidney failure are already hospitalized. How long you'll stay in the hospital depends on the reason for your acute kidney failure and how quickly your kidneys recover.
  Treating the underlying cause of your kidney failure
  Treatment for acute kidney failure involves identifying the illness or injury that originally damaged your kidneys. Your treatment options will depend on what's causing your kidney failure.
  Treatments to balance the amount of fluids in your blood. If your acute kidney failure is caused by a lack of fluids in your blood, your doctor may recommend intravenous (IV) fluids. In other cases, acute kidney failure may cause you to have too much fluid, leading to swelling in your arms and legs. In these cases, your doctor may recommend medications (diuretics) to cause your body to expel extra fluids.
  Medications to control blood potassium. If your kidneys aren't properly filtering potassium from your blood, your doctor may prescribe calcium, glucose or sodium polystyrene sulfonate (Kayexalate, Kionex) to prevent the accumulation of high levels of potassium in your blood. Too much potassium in the blood can cause dangerous irregular heartbeats (arrhythmias) and muscle weakness.
  Medications to restore blood calcium levels. If the levels of calcium in your blood drop too low, your doctor may recommend an infusion of calcium.
  Dialysis to remove toxins from your blood. If toxins build up in your blood, you may need temporary hemodialysis — often referred to simply as dialysis — to help remove toxins and excess fluids from your body while your kidneys heal. Dialysis may also help remove excess potassium from your body. During dialysis, a machine pumps blood out of your body through an artificial kidney (dialyzer) that filters out waste. The blood is then returned to your body

Life style and Home remedies

  During your recovery from acute kidney failure, your doctor may recommend a special diet to help support your kidneys and limit the work they must do. Your doctor may refer you to a dietitian who can analyze your current diet and suggest ways to make your diet easier on your kidneys.
  Depending on your situation, your dietitian may recommend that you:
  Choose lower potassium foods. Your dietitian may recommend that you choose lower potassium foods. High-potassium foods include bananas, oranges, potatoes, spinach and tomatoes. Examples of low-potassium foods include apples, cabbage, green beans, grapes and strawberries.
  Avoid products with added salt. Lower the amount of sodium you eat each day by avoiding products with added salt, including many convenience foods, such as frozen dinners, canned soups and fast foods. Other foods with added salt include salty snack foods, canned vegetables, and processed meats and cheeses.
  Limit phosphorus. Phosphorus is a mineral found in foods such as milk, cheese, dried beans, nuts and peanut butter. Too much phosphorus in your blood can weaken your bones and cause skin itchiness. Your dietitian can give you specific recommendations on phosphorus intake in your situation.
  As your kidneys recover, you may no longer need to eat a special diet, although healthy eating remains important.

Prevention

  Acute kidney failure is often difficult to predict or prevent. But you may reduce your risk by taking care of your kidneys. Try to:
  Follow instructions on over-the-counter (OTC) medications. Follow the instructions on OTC pain medications such as aspirin, acetaminophen (Tylenol, others) and ibuprofen (Advil, Motrin IB, others). Taking doses that are too high may increase your risk of acute kidney failure. This is especially true if you have pre-existing kidney disease, diabetes or high blood pressure.
  Work with your doctor to manage kidney problems. If you have kidney disease or other diseases or conditions that increase your risk of acute kidney failure, such as diabetes or high blood pressure, follow your doctor's recommendations for managing your condition.
  Make a healthy lifestyle a priority. Be active; eat a sensible, balanced diet; and drink alcohol only in moderation — if at all.

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