Discover the causes, symptoms, and recovery insights of acute kidney failure. Your comprehensive guide on Meri Sehat.

Acute Kidney Failure

A. JABBAR DENTAL CLINIC KARACHI

Sadia Khan

Overview

Acute kidney failure is a sudden episode of kidney damage or failure that occurs within a couple of hours or days. 
&nbsp;

AKF, commonly referred to as acute kidney injury (AKI), usually presents in hospitalized, critically ill, or elderly when their kidneys fail to effectively filter waste products from the blood and maintain fluid and electrolyte balance in the body.<a href="#accordion">[1]</a>

For instance, 27-40% of patients hospitalized for acute decompensated heart failure (ADHF) appear to develop AKF, highlighting the interplay between cardiac and renal conditions.<a href="#accordion">[2]</a>

According to research, around 1% of patients in the US already have AKI when they are being admitted to hospitals. However, the incidence rate increases to 2-5% during hospitalization.<a href="#accordion">[3]</a>

&nbsp;&nbsp;

AKF is classified into:

<ul>
	<li>Acute Prerenal Kidney Failure &ndash; Insufficient blood flow to the kidneys</li>
	<li>Acute Intrinsic Kidney Failure &ndash; Direct damage or injury to the kidneys, like an accident, ischemia, or drug abuse</li>
	<li>Acute Postrenal Kidney Failure &ndash; Stones or another blockage in the urinary tract 
	&nbsp;</li>
</ul>

Approximately 60-70% of all AKF cases in critically ill patients are acute prerenal failure, while postrenal failure accounts for 5-10%.<a href="#accordion">[4]</a> 
&nbsp;

Sign and Symptoms

The signs and symptoms of AKF can vary depending on the underlying cause and the severity of the condition. Many patients are asymptomatic, i.e., they have no symptoms. 
&nbsp;

Others, however, may present:

<ul>
	<li>Decreased urine output or oliguria</li>
	<li>Fluid retention, leading to swelling in the legs, ankles, or around the eyes</li>
	<li><a href="https://merisehat.pk/disease/chronic-fatigue-syndrome">Fatigue</a> and weakness</li>
	<li>Shortness of breath</li>
	<li><a href="https://merisehat.pk/disease/confusion">Confusion </a></li>
	<li>Nausea and vomiting</li>
	<li>Chest pain or pressure</li>
	<li>High blood pressure</li>
	<li>Irregular heartbeat</li>
	<li>Seizure or coma (in severe cases)</li>
</ul>

&nbsp;

Note: These symptoms can be nonspecific and may overlap with other medical conditions. Therefore, a thorough evaluation by a healthcare professional is essential for an accurate diagnosis and appropriate management. 
&nbsp;

Causes

These include:<a href="#accordion">[5]</a> 
&nbsp;

<ul>
	<li>Certain conditions, such as low blood pressure, dehydration, severe burns, or septic shock, which decrease blood flow to the kidneys and cause ischemic injury.</li>
	<li>Certain medications, toxins, and contrast agents used in medical imaging procedures that cause direct damage to the kidney tissue.</li>
	<li>Blockages in the urinary tract, such as kidney stones, tumors, or an enlarged prostate, which obstruct the urine flow.</li>
	<li>Severe infections, particularly sepsis, which trigger an inflammatory response and affect kidney function. 
	&nbsp;</li>
</ul>

Diagnosis

Early detection is crucial because the condition is associated with extremely poor outcomes.<a href="#accordion">[4][6]</a> 
&nbsp;

<ul>
	<li>Medical History And Physical Assessment: A detailed review of the patient&#39;s medical history and a thorough physical assessment, including any recent illnesses, medications, surgeries, or exposures to nephrotoxic agents, can provide valuable insights into the potential causes of AKF.</li>
	<li>Laboratory Tests: Blood and urine tests to measure serum creatinine (sCr), estimated glomerular filtration rate (eGFR), albumin-to-creatinine ratio (ACR), and blood urea nitrogen (BUN) help assess kidney function and identify abnormalities indicative of acute kidney injury.</li>
	<li>Imaging Studies: Imaging techniques such as ultrasound, CT scans, or MRI may be used to visualize the structure of the kidneys and urinary tract and identify any obstructions or abnormalities that could contribute to acute kidney injury.</li>
	<li>Biomarker Assessment: Biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) may be used for early identification of patients at high risk of developing AKF.</li>
	<li>Biopsy: In some cases, a kidney biopsy is needed to obtain a tissue sample for microscopic examination, particularly when the underlying cause of AKF is unclear or when glomerular diseases are suspected. 
	&nbsp;</li>
</ul>

Treatment

The selection of treatment options for AKF depends on the underlying cause, the severity of the kidney injury, and the individual patient&#39;s clinical status. 
&nbsp;

<ul>
	<li>Fluid And Electrolyte Management: AKF often requires careful monitoring and adjustment of fluid intake, diuretic therapy, and electrolyte supplementation.</li>
	<li>Addressing Underlying Causes: Identifying and addressing the underlying causes of acute kidney failure, such as sepsis, is essential for preventing further kidney damage and promoting recovery.</li>
	<li>Renal Replacement Therapy: Therapies like hemodialysis or continuous renal replacement therapy may be necessary to support kidney function and manage fluid and electrolyte imbalances.</li>
	<li>Medication Management: Adjusting medication dosages and avoiding nephrotoxic agents are important considerations to prevent further harm to the kidneys.</li>
	<li>Supportive Care: Patients with acute kidney injury may require supportive measures such as nutritional and respiratory support to address complications and optimize overall health. 
	&nbsp;</li>
</ul>

AKF requires intensive treatment, or it may prove fatal. However, in some cases, where the individual is otherwise healthy, the condition may be reversible. 
&nbsp;

AKF can lead to various complications.<a href="http://Complications Of Acute Kidney Failure (AKF)">[3]</a> 
&nbsp;

<ul>
	<li>Cardiovascular Complications: Conditions like arrhythmias, heart failure, and cardiac arrest have been observed in around 35% of patients with AKF. Although rare, pericarditis may occur and further cause systemic lupus erythematosus and hepatorenal syndrome.</li>
	<li>Gastrointestinal (GI) Complications: One-third of the patients suffer from GI bleeding. 3-8% of these cases cause death. </li>
</ul>

In addition to this, patients with AKI often have anorexia, jaundice, pancreatitis, and hepatitis.

<ul>
	<li>Infectious Complications: Impaired immune function and fluid overload can predispose individuals to infections, which can further exacerbate kidney injury.</li>
	<li>Pulmonary Complications: Nearly 54% of individuals with AKI suffer from acute lung injuries, including sarcoidosis and hypoxia. </li>
	<li>Long-Term Kidney Damage: Severe or recurrent episodes of AKF can increase the risk of end-stage renal disease.</li>
	<li>Other complications include: Fluid buildup and edema, Muscle weakness and Death. </li>
</ul>

&nbsp;

The most common risk factors for developing acute kidney failure include: 
&nbsp;

<ul>
	<li>Advanced age</li>
	<li>Use of certain medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), aminoglycoside antibiotics, and contrast agents used in medical imaging.</li>
	<li>Dehydration, due to inadequate fluid intake, excessive fluid loss, or conditions such as diarrhea and vomiting.</li>
	<li>Underlying medical conditions, such as diabetes, hypertension, heart failure, autoimmune diseases, glomerulonephritis, certain. genetic conditions, chronic kidney disease, and certain cancers. 
	&nbsp;</li>
</ul>

Common preventive measures for reducing the risk of acute kidney failure may include: 
&nbsp;

<ul>
	<li>Maintaining adequate fluid intake and avoiding dehydration, particularly during illness or medical procedures</li>
	<li>Assessing the risks and benefits of medications, particularly nephrotoxic agents, and adjusting dosages or selecting alternative therapies, especially in case of pre-existing kidney disease, high blood pressure, or diabetes</li>
	<li>Monitoring high-risk individuals, especially those with chronic medical conditions, older adults, and those undergoing medical interventions</li>
	<li>Prioritizing healthy lifestyle &ndash; be active, eat a balanced diet, quit smoking, and treat UTIs promptly 
	&nbsp;</li>
</ul>

key points

<ul>
	<li>Acute kidney failure (AKF) is a sudden episode of kidney damage or failure that occurs within a couple of hours or days. </li>
	<li>AKF can be classified into prerenal, intrinsic, and postrenal.</li>
	<li>Common symptoms associated with AKF include decreased urine output, edema, fatigue, and high blood pressure.</li>
	<li>Common causes of AKF include blockages in the urinary tract, certain medications, and severe infections.</li>
	<li>Screening and diagnosis of AKF involve laboratory tests, imaging studies, and biopsy.</li>
	<li>Treatment of AKF may involve fluid and electrolyte management, addressing underlying health concerns, renal replacement therapy, and medication management.</li>
	<li>Complications of AKF can include cardiovascular complications, long-term kidney damage, and death.</li>
	<li>Common risk factors for developing AKF include certain medications, dehydration, and advanced age.</li>
	<li>Preventive measures for reducing the risk of acute kidney failure include adequate fluid intake, monitoring high-risk individuals, and prioritizing healthy lifestyles.</li>
</ul>

[1] Pavlakou, P., Liakopoulos, V., Eleftheriadis, T., Mitsis, M., & Dounousi, E. (2017). Oxidative stress and acute kidney injury in critical illness: pathophysiologic mechanisms—biomarkers—interventions, and future perspectives. Oxidative Medicine and Cellular Longevity, 2017, 1-11.

[2] Ronco, C., McCullough, P. R., Anker, S. D., Anand, I. S., Aspromonte, N., Bagshaw, S. M., … & Ponikowski, P. (2009). Cardio-renal syndromes: report from the consensus conference of the acute dialysis quality initiative. European Heart Journal, 31(6), 703-711.

[3] Biruh T Workeneh M. Acute kidney injury (AKI). Practice Essentials, Background, Pathophysiology. June 28, 2023. Accessed November 14, 2023.

[4] Kidney failure treatment: Acute renal diagnosis, types &amp; treatment. CARE Hospitals. Accessed November 14, 2023.

[5] Acute kidney injury (AKI). National Kidney Foundation. August 11, 2022. Accessed November 14, 2023.

[6] Mohsenin V. Practical approach to detection and management of acute kidney injury in critically ill patient. J Intensive Care. 2017;5:57. Published 2017 Sep 16.