Acute kidney failure (ANV) can be a life-threatening condition. Fatigue, discolored urine and water in the legs – hardly anyone worries about their health with these symptoms.
What is acute renal failure?
Acute renal failure refers to the rapid deterioration of the function of one or both kidneys. Acute renal failure refers to the rapid deterioration of the function of one or both kidneys. This can happen within a few hours to a few days. In acute kidney failure, the kidneys no longer properly filter the person’s blood. Little or no urine is produced and the body is literally poisoned from the inside. If acute kidney failure is not treated, life is in danger. In the beginning, the symptoms of acute kidney failure are unspecific and not recognizable to the layperson: fatigue, small amounts of urine or nausea. Later, acute kidney failure is accompanied by water retention in the legs, shortness of breath and cardiac arrhythmias. In severe cases, pulmonary or cerebral edema may also develop. This can lead to coma.
Causes
Acute renal failure is not a disease in its own right. It is a consequence of serious underlying diseases, such as cardiovascular disease or circulatory disorders of the kidneys. Causes of acute renal failure include a sudden drop in blood pressure. Often, blood flow to the kidneys is also disturbed. X-ray contrast media, antibiotics or ACE inhibitors can be to blame. Acute kidney failure can also occur due to loss of blood and fluids during accidents or surgery. Inflammation and infection with viruses or bacteria can also cause acute kidney failure. Causes can also include kidney stones, enlargement of the prostate, tumors or narrowing of the urethra. In rare cases, acute kidney failure is caused by blood poisoning or heart failure.
Symptoms, complaints, and signs
Acute renal failure progresses in several phases within which different symptoms occur. In the manifest renal failure phase, urine output is reduced, which can lead to muscle weakness, acute acidosis, and cardiac arrhythmias. In addition, hyperhydration may occur, associated with pulmonary or cerebral edema. Typical symptoms in the diuretic or polyuric phase are increased urination and the resulting deficiency symptoms. In chronic renal insufficiency, the above-mentioned symptoms occur permanently and increase in intensity in the long term. In a positive course, these symptoms disappear after some time or at least decrease. A recovery of kidney function can be recognized by a normalization of urinary behavior and a decrease in pain. Acute kidney failure is primarily manifested by hypertension. Hypertension, in turn, can be recognized by the typical visual disturbances and headaches. Furthermore, uremia can lead to fatigue, fever and edema formation. Fluid accumulation occurs primarily around the eyes, but also in the legs and arms, which in turn is associated with functional disorders and restricted mobility. Acute kidney failure may also cause pain and possibly sensory disturbances and itching in the kidney area.
Diagnosis and course
When acute renal failure is suspected, the patient’s urine and blood are examined. Increased creatinine and urea levels confirm the diagnosis. Blood salts are also altered in acute renal failure. The potassium level, for example, is noticeably elevated. In addition to the amount of urine, the physician also examines the salt content and weight of the urine. In acute kidney failure, an enlarged kidney can be seen on ultrasound. Ultrasound can also detect troublesome kidney stones in the urinary tract. If the diagnosis is still uncertain, a tissue sample can be taken. An x-ray may also be helpful. The course of acute kidney failure depends first on the existing underlying disease. If there is damage to the kidneys, the course of acute kidney failure is less positive. Chronic kidney failure often develops as a result. Sometimes acute kidney failure can also lead to multi-organ failure and be fatal. Otherwise, if treated early, healing without a trace is normal.
Complications
Acute renal failure results primarily in disturbances of fluid and electrolyte balance.Because the kidney can no longer function properly, much less water is filtered, which means that it remains in our body. As a result, the volume of blood increases and the heart has to pump harder, leading to increased blood pressure (hypertension). In addition, more fluid is squeezed out of the vessels into the tissue, resulting in edema. In the worst cases, this leads to a stroke or pulmonary edema, which causes severe shortness of breath and overloads the right heart. The increased workload of the heart can lead to permanent heart failure (cardiac insufficiency). This can progress to a heart attack. The altered electrolyte balance leads to hyperkalemia, which promotes cardiac arrhythmias that increase the risk of heart attack and also cardiac death. The acid-base balance is also altered and the blood becomes over-acidified, which also causes hyperkalemia and thus also promotes cardiac arrhythmias. The body is also more susceptible to infections in acute kidney failure. In addition, bleeding in the gastrointestinal tract occurs more frequently, leading to nausea and vomiting. Kidney failure also causes anemia and can lead to vitamin D deficiency. There is also a risk that, in the worst case, dialysis or even organ transplantation may be necessary.
When should you see a doctor?
If acute kidney failure is suspected, a doctor should be consulted immediately. Medical advice is especially needed if the amount of urine excreted continues to decrease over the course of a few days and fluid is simultaneously deposited in the limbs. If accompanying symptoms such as shortness of breath, heart palpitations or sweating occur, a trip to the emergency room is recommended. The emergency physician should be alerted if the symptoms lead to severe physical discomfort or extreme fatigue. A physician must be consulted if there are problems during urination or pain in the area of the kidney. Patients with a previous disease of the kidneys as well as other risk groups (pregnant women, children, elderly, patients with immunodeficiency) should immediately talk to the responsible doctor if renal insufficiency is suspected. Medical advice is also required if there are recurrent temporary problems with urination or mild kidney pain. Then there is possibly damage to the kidney, which can lead to acute kidney failure in the longer term.
Treatment and therapy
Treatment of acute kidney failure depends on the cause. Almost always, acute kidney failure requires a high intake of fluids. Infusions are necessary. Acute renal failure requires discontinuation of harmful medications. Instead, the intake of urine-forming drugs is necessary. These primarily include the active ingredient furosemide. It is important not to drink too much at this stage so that overhydration does not occur. Sufficient fluids should only be supplied when the body is again producing urine on its own. If the acute kidney failure still does not improve after medication, the patient must undergo dialysis. Harmful substances are flushed out of the blood until the kidneys resume their function on their own. The chances of recovery from acute kidney failure are very good if treatment is given in good time. Many patients have normal functioning kidneys again. They are completely free of symptoms after therapy. However, if kidney failure cannot be stopped even in the long term, the last resort in acute kidney failure is transplantation of a new kidney.
Outlook and prognosis
In acute renal failure, the outlook and prognosis depend, among other things, on the timing of treatment and possible previous illnesses. For example, patients who have experienced kidney failure before are much more susceptible to progressive kidney failure. If dialysis treatment has already been performed once in the past, the prospect of a full recovery of kidney function is further worsened. However, the actual prognosis is relatively positive. If urinary output can be maintained, there is a prospect of full recovery. However, acute renal failure may also be associated with various complications that worsen the prognosis. For example, concomitant symptoms such as high blood pressure or edema can lead to permanent health problems that must be treated throughout life.The elevated potassium levels in the blood can also lead to hyperkalemia, which quickly develops into an emergency if left untreated. Depending on the severity of the symptom, hyperacidity of the kidney can lead to severe cardiac arrhythmias and, rarely, to a heart attack. Furthermore, gastric ulcers and bleeding may also occur and require further treatment. Because of the variety of possible complications, a final prognosis can only be made by the treating physician.
Prevention
Acute renal failure can only be prevented by regular check-ups with the physician. For example, he examines the urine for suspicious protein traces and measures the potassium level in the blood. To prevent acute kidney failure from developing during surgery, all bodily functions are monitored intensively. The primary care physician should be consulted before taking any medication. After all, over-the-counter medications, especially pain relievers, can cause acute kidney failure.
Follow-up
Until now, follow-up after acute renal failure occurred only in very rare cases. However, that has since changed. To prevent complications that can lead to death, some physicians recommend seeing a nephrologist. This procedure is particularly useful for patients who have been in the hospital for a long period of time. People leaving a hospital are extensively informed about the further procedure. In a conversation, they receive information about further medication. If the condition is severe, outpatient dialysis is usually necessary. Sufferers are given a schedule of when future blood washes will take place. In addition, they sometimes have to follow a low-protein diet for a while. If further treatments take place, they are regularly arranged by the primary care physician. Acute renal failure must be distinguished from a chronic form of expression. In the case of the sudden form, sufficient treatment leads to the kidney being able to resume its work completely. In contrast, the chronic form usually leads to a gradual loss of organ function. Since treatment after acute kidney failure thus comes to an end, follow-up care leads a shadowy existence. There is no reason to continue treatment in the absence of symptoms.
Here’s what you can do yourself
If acute renal failure is suspected, a physician should always be consulted. In addition, possible triggers should be identified and recorded for the doctor’s visit. Patients who, for example, regularly take medication or have already suffered from dehydration should consider these causes as the reason for the renal insufficiency. The next step is to prevent the possible complications of kidney failure by drinking enough fluids, replenishing the electrolyte balance and taking care of the body. If acute renal failure has already occurred, an emergency physician must be called immediately. Accompanying first aid measures must be applied. In the first stages of the disease, attempts can be made to restore kidney function by hydration. If the affected person already shows strong signs of illness, the respective symptoms must be alleviated. In addition, the circulation must be stabilized as quickly as possible to avoid further complications. If the patient already has kidney disease, appropriate preparations (dopamine, diuretics, ANP) can be administered after consultation with the patient to restore kidney function. Subsequently, the emergency medical services must be informed about the patient’s constitution and his or her condition to enable rapid and targeted treatment.
