ARF (Acute renal failure)

Introduction
Kidney failure occurs when the kidneys partly or completely lose their ability to filter water and waste from the blood.

·         The build up of toxic substances normally removed from the body by the kidneys can cause dangerous health problems.

·         Acute kidney failure (also referred to as renal failure) can happen rapidly.

·         Mild kidney dysfunction is often called renal insufficiency.

Acute kidney failure occurs when kidneys suddenly become unable to filter waste products from the blood. When kidneys lose their filtering ability, dangerous levels of wastes may accumulate and 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.

Acute kidney failure occurs in a few people who are hospitalized for any reason. It is even more common in those receiving intensive care. (Emedicinehealthcom, 2015)

Presentation
Signs and 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 (Mayoclinic 2015).

Causes

·         condition that slows blood flow to your kidneys

·         direct damage to your kidneys

·         ureters become blocked and wastes can't leave the body through 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 (gloe-mer-u-loe-nuh-FRY-tis), 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

·         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

Complications

·         Fluid buildup.  cause shortness of breath & edema

·         Chest pain. 

·         Muscle weakness

·         Permanent kidney damage

·         Death

Investigations

·         Urine output measurements. 

·         Urine tests. 

·         Blood tests. A sample of your blood may reveal rapidly rising levels of urea and creatinine

·         Imaging tests. Imaging tests such as ultrasound and computerized tomography (CT) ·         Removing a sample of kidney tissue for testing. 

Management 

Treating the underlying cause of kidney failure

Treating complications until kidneys recover
The goals of acute kidney failure treatments are to maintain the volume levels and correct electrolyte imbalances. 
Reduce fluid load with use of diuretics such as Frusemide.  
Severe acidosis can be correct with hemodialysis and administering bicarbonate. 
It is needed to correct hyperkalemia in body.  
Hematologic abnormalities can be correct with transfusion and administration ofdesmopressin or estrogens. 
Restriction of salt and fluid admintration can be apply for oliguric renal failure to excrete toxins and fluids

 (Uptodatecom, 2015)