If the kidney is not functioning properly, then there will be retention of nitrogenous wastes like urea and creatinine in the blood. The two main diagnostic criteria for acute kidney failure is within 48 hrs, there will be a reduction in the urine output (less than 0.5ml/kg/hr for >6hrs) and the serum creatinine will be increased from the normal reference range. The serum creatinine level is analysed by blood report.
The causes of acute kidney failure are classified into...
Pre-renal failure:
Hypovolemia (dehydration, blood loss), Nephrotic syndrome, Congestive heart failure,.
Intrinsic renal failure(problem within kidney)
Acute tubular necrosis, alcohol intake, intravascular hemolysis, hemolytic uremic syndrome, glomerulonephritis, bilateral renal vessel occlusion,...
Post-renal failure:
Urethral stricture, B/L pelvic ureteric junction obstruction, obstruction in the ureter (stenosis, stone and ureterocele)...
Investigation:
- complete blood count
- Abdominal ultrasonography (seeing any structural abnormality)
- Chest X-ray for cardiomegaly due to congestive heart failure
Peripheral blood smear if the Hemolytic uremic syndrome is suspected.
Doppler ultrasonography for detecting any arterial or venous thrombosis.
For specific diagnosis, If possible - Renal Biopsy.
Management:
#In hypovolemia and dehydration, the perfusion is decreased and cause decreased urine output.
The treatment is IV infusion of normal saline or Ringer lactate is needed.
#In patients with oedema and hypertension associated with heart failure, the medicines are diuretics, angiotensin converting enzyme inhibitors are recommended.
In complicated acute kidney failure, the patient should be admitted to the intensive care unit and the recommendation like dialysis with intensive drug therapy is likely to be done under the supervision of the physician.
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