Restoration Of Renal Blood Flow And Associated Complications
Recovery from AKI is first dependent upon restoration of RBF. Early RBF normalization predicts better prognosis for recovery of renal function. In prerenal failure, restoration of circulating blood volume is usually sufficient. Rapid relief of urinary obstruction in postrenal failure results in a prompt decrease of vasoconstriction. With intrinsic renal failure, removal of tubular toxins and initiation of therapy for glomerular diseases decreases renal afferent vasoconstriction.
Once RBF is restored, the remaining functional nephrons increase their filtration and eventually undergo hypertrophy. GFR recovery depends on the size of this remnant nephron pool. If the number of remaining nephrons is below a critical threshold, continued hyperfiltration results in progressive glomerular sclerosis, eventually leading to increased nephron loss.
A vicious cycle ensues; continued nephron loss causes more hyperfiltration until complete renal failure results. This has been termed the hyperfiltration theory of renal failure and explains the scenario in which progressive renal failure is frequently observed after apparent recovery from AKI.
Who Will Be On My Health Care Team
Youll have a whole team of trained health care providers to help you live well with kidney failure. The following people may be part of your health care team:
Nephrologist. A doctor who specializes in kidney health and oversees your treatment.
Dialysis nurse. A dialysis nurse will monitor your in-center dialysis and will see you monthly if youre doing home or peritoneal dialysis. The nurse will make sure youre taking your medicines correctly and help you find ways to lessen the side effects of dialysis. If you do home hemodialysis or peritoneal dialysis, your dialysis nurse will teach you how to set up your treatment, take care of the equipment, and watch for infections or other problems.
Transplant coordinator. A specially trained nurse who will be your point of contact, arrange your appointments, and teach you what to do before and after the transplant.
Renal dietitian. A renal dietitian is trained to help people with kidney failure. Your dietitian will help you make choices about what to eat and drink to help your treatment work better so youll feel better.
Social worker. Dialysis clinics and transplant centers have a social worker who works with people who have ESRD. Your renal social worker can help you find answers to problems such as
- keeping a job or changing jobs
- getting help paying for treatments
- finding services to help with transportation or chores around the house
- finding counseling services to deal with family problems
What Are The Symptoms Of Glomerular Disease
The signs and symptoms of glomerular disease include
- albuminuria: large amounts of protein in the urine
- hematuria: blood in the urine
- reduced glomerular filtration rate: inefficient filtering of wastes from the blood
- hypoproteinemia: low blood protein
- edema: swelling in parts of the body
One or more of these symptoms can be the first sign of kidney disease. But how would you know, for example, whether you have proteinuria? Before seeing a doctor, you may not. But some of these symptoms have signs, or visible manifestations:
- Proteinuria may cause foamy urine.
- Blood may cause the urine to be pink or cola-colored.
- Edema may be obvious in hands and ankles, especially at the end of the day, or around the eyes when awakening in the morning, for example.
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Identification Of Probable Causes
Probable Causes of Acute Renal Failure Based on the Findings of the History
| History | |
|---|---|
|
Sinus, upper respiratory, or pulmonary symptoms |
Pulmonary-renal syndrome, vasculitis |
|
Intravenous drug abuse; prosthetic valve or valvular disease |
Endocarditis |
|
Colicky abdominal pain radiating from flank to groin |
Urolithiasis |
|
Symptoms of benign prostatic hypertrophy |
Obstruction |
|
Bone pain in older patient |
Multiple myeloma, prostate cancer |
|
Allergic interstitial nephritis, atheroemboli, systemic lupus erythematosus, thrombotic thrombocytopenic purpura, vasculitis |
|
|
Constitutional symptoms |
|
|
Anorexia, fatigue, fever, weight loss |
Malignancy, vasculitis |
|
Diabetes mellitus, multiple sclerosis, stroke |
Neurogenic bladder |
|
Atheroemboli, contrast agent, ischemia, endocarditis |
|
|
Medication history |
|
|
Acyclovir , angiotensin-converting enzyme inhibitors, antibiotics, nonsteroidal anti-inflammatory drugs |
Acute tubular necrosis, allergic interstitial nephritis, decreased renal perfusion |
Adapted from Agrawal M, Swartz R. Acute renal failure . Am Fam Physician 2000;61:2080.
Probable Causes of Acute Renal Failure Based on the Findings of the History
Adapted from Agrawal M, Swartz R. Acute renal failure . Am Fam Physician 2000;61:2080.
Probable Causes of Acute Renal Failure Based on the Physical Findings
Adapted from Agrawal M, Swartz R. Acute renal failure . Am Fam Physician 2000;61:2081.
Probable Causes of Acute Renal Failure Based on the Physical Findings
Laboratory Values in Acute Renal Failure
FENa, percent*
How Is Kidney Failure Diagnosed
After the patients initial evaluation by the doctor of its signs and symptoms, it will suggest that the patient has Kidney Failure, these are some of the tests that the doctor will ask for.
- Urine output measurements in 24 hours to determine the cause of kidney failure.
- Urine tests: Analyzing a sample of the urine may reveal abnormalities that suggest kidney failure.
- Blood tests: A sample of blood may reveal a sudden increase in urea and creatinine. These two are the most common substances used to measure kidney functionality.
- Imaging tests: The doctor may ask for imaging studies like ultrasound or computerized tomography to see the kidneys.
- Kidney biopsy: Removing a sample of kidney tissue for testing may reveal a lot from the disease and what causes it. The doctor inserts a needle through the skin and into the kidney to remove the sample.
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Questions For Your Doctor About Test Results
When your test results are ready, you can learn more about their significance by discussing them with your doctor. Some questions that you can ask include:
- Were there any abnormal findings on my renal panel test? If so, what were they?
- For any abnormal findings, can you explain what might be the cause?
- Are there any follow-up tests that are warranted based on my renal panel test?
- Should I take this test again? If so, when?
Acute Kidney Injury: A Guide To Diagnosis And Management
MAHBOOB RAHMAN, MD, MS, Case Western Reserve University School of Medicine, Cleveland, Ohio
FARIHA SHAD, MD, Kaiser Permanente, Cleveland, Ohio
MICHAEL C. SMITH, MD, Case Western Reserve University School of Medicine, Cleveland, Ohio
Am Fam Physician.;2012;Oct;1;86:631-639.
The incidence of acute kidney injury has increased in recent years, both in the community and in hospital settings.1,2 The estimated incidence of acute kidney injury is two to three cases per 1,000 persons.3 Seven percent of hospitalized patients and about two-thirds of patients in intensive care units develop acute kidney injury,2 often as part of the multiple organ dysfunction syndrome.4
SORT: KEY RECOMMENDATIONS FOR PRACTICE
The diagnosis of acute kidney injury is based on serum creatinine levels, urine output, and the need for renal replacement therapy.
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to .
SORT: KEY RECOMMENDATIONS FOR PRACTICE
The diagnosis of acute kidney injury is based on serum creatinine levels, urine output, and the need for renal replacement therapy.
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Normal And Critical Findings
The normal GFR for an adult male is 90 to 120 ml per minute. A GFR of less than 15 ml per minute is considered to be end-stage renal failure requiring renal replacement therapy, e.g., dialysis. The presence of a normal GFR does not exclude the presence of renal disease, which may be evidenced by the presence of albuminuria/proteinuria or imaging.
Reference intervals for serum creatinine and urea are dependent on age and gender.
The presence of electrolytes in urine depends on the hydration status, duration of the collection of urine apart from pathological factors, and reference intervals are often wide and dependant on the clinical context.
What Causes Kidney Failure
The most common causes of kidney failure are diabetes and high blood pressure. Sometimes, though, kidney failure happens quickly due to an unforeseen cause.
When the kidneys lose function suddenly , its called acute kidney failure . This type of kidney failure is often temporary. Common causes of acute kidney failure can include:
- Autoimmune kidney diseases
- A urinary tract obstruction
- Uncontrolled systemic disease like heart or liver disease
Kidney failure usually doesnt happen overnight. Chronic kidney disease refers to a group of health conditions that affect how well your kidneys function over time. If left untreated, chronic kidney disease can lead to kidney failure.
The biggest causes of kidney failure from chronic kidney disease are:
- Diabetes: Unmanaged diabetes can lead to uncontrolled blood sugar levels. Consistently high blood sugar can damage the bodys organs, including the kidneys.
- High blood pressure: High blood pressure means blood travels through your bodys blood vessels with increased force. Over time, untreated high blood pressure levels can damage the kidneys tissue.
Other causes of chronic kidney disease include:
- Polycystic kidney disease, a hereditary condition where cysts grow inside your kidneys.
- Glomerular diseases, such as glomerulonephritis, which affect how well the kidneys can filter waste.
- Lupus and other autoimmune diseases that can affect multiple body systems.
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What Are The Symptoms Of Kidney Failure
Symptoms of kidney failure may begin so slowly that you dont notice them right away.
Healthy kidneys prevent the buildup of wastes and extra fluid in your body and balance the salts and minerals in your bloodsuch as calcium, phosphorus, sodium, and potassium. Your kidneys also make hormones that help control blood pressure, make red blood cells, and keep your bones strong.
Kidney failure means your kidneys no longer work well enough to do these jobs and, as a result, other health problems develop. As your kidney function goes down, you may
- have swelling, usually in your legs, feet, or ankles
- get headaches
- feel itchy
- feel tired during the day and have sleep problems at night
- feel sick to your stomach, lose your sense of taste, not feel hungry, or lose weight
- make little or no urine
- have muscle cramps, weakness, or numbness
- have pain, stiffness, or fluid in your joints
- feel confused, have trouble focusing, or have memory problems
Following your treatment plan can help you avoid or address most of these symptoms. Your treatment plan may include regular dialysis treatments or a kidney transplant, a special eating plan, physical activity, and medicines.
Can Kidney Failure Be Prevented
While kidney failure from chronic kidney disease cant be reversed, you can do many things to help preserve the kidney function you have today. Healthy habits and routines may slow down how quickly kidneys lose their functional abilities.
If you have chronic kidney disease or kidney failure, youll want to:
- Monitor your kidney function, with your doctors help.
- Keep your blood sugar levels under control, if you have diabetes.
- Keep your blood pressure levels in a normal range.
- Avoid smoking.
- Make healthy diet choices, such as limiting foods high in protein and sodium.
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When To Call Your Doctor
Seek medical care if you experience the following symptoms:
- Increased water retention with swelling of the legs, face, or hands
- Sudden shortness of breath
- Sudden fatigue or marked changes in energy levels
- Easy bruising
- Persistent or recurrent dizziness and lightheadedness
While these symptoms can be caused by any number of medical conditions, none should be considered “normal.” It is important to have them checked out.
On the other hand, you should seek immediate emergency care if you experience any of the following:
- Changes in the level of consciousness, including extreme sleepiness, difficulty waking up, or fainting
- Chest pain
- Severe bleeding of any sort
What Causes Acute Kidney Injury
Acute kidney injury can have many different causes. ;AKI can be caused by the following:
Some diseases and conditions can slow blood flow to your kidneys and cause AKI.
These diseases and conditions include:
- Low blood pressure or shock
- Blood or fluid loss
- Heart attack, heart failure, and other conditions leading to decreased heart function
- Organ failure
- Overuse of pain medicines called NSAIDs, which are used to reduce swelling or relieve pain from headaches, colds, flu, and other ailments.; Examples include ibuprofen, ketoprofen, and naproxen.;
- Severe allergic reactions
Direct Damage to the Kidneys
Some disease and conditions can damage your kidneys and lead to AKI. Some examples include:
- A type of severe, life-threatening infection called sepsis
- A type of cancer called multiple myeloma
- A rare condition that causes inflammation and scarring to your blood vessels, making them stiff, weak, and narrow
- An allergic reaction to certain types of drugs
- A group of diseases that affect the connective tissue that supports your internal organs
- Conditions that cause inflammation or damage to the kidney tubules, to the small blood vessels in the kidneys, or to the filtering units in the kidneys .
Blockage of the urinary tract
In some people, conditions or diseases can block the passage of urine out of the body and can lead to AKI.;
Blockage can be caused by:
- Bladder, prostate, or cervical cancer
- Enlarged prostate
- Blood clots in the urinary tract
The following tests may be done:
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How Can I Live Well With Kidney Failure
Doing well with kidney failure is a challenge. You will feel better if you
- stick to your treatment schedule
- review your medicines with your health care provider at every visit and take your medicines as prescribed
- work with a dietitian to develop an eating plan that includes foods you enjoy eating while also helping your health
- stay activetake a walk or do some other physical activity that you enjoy
- stay in touch with your friends and family
Treatment with dialysis or transplant will help you feel better and live longer. Your health care team will work with you to create a treatment plan to address any health problems you have. Your treatment will include steps you can take to maintain your quality of life and activity level.
Your eating plan plays an important role. When you have kidney failure, what you eat and drink may help you maintain a healthy balance of salts, minerals, and fluids in your body.
Acute Kidney Injury And Extra
Recent evidence in both basic science and clinical research are beginning to change our view for AKI from a single organ failure syndrome, to a syndrome where the kidney plays an active role in the evolution of multi-organ dysfunction. Recent clinical evidence suggests that AKI is not only an indicator for severity of illness, but also leads to earlier onset of multi-organ dysfunction with significant effects on mortality. Animal models of renal injury have been used extensively in order to elucidate the mechanism of remote organ dysfunction after AKI despite their limitations due to interspecies differences. These studies have shown a direct effect of AKI on distant organs. These animal studies include models of ischaemiareperfusion injury and sepsis, mainly lipopolysaccharide endotoxin induced sepsis due to its reproducibility in creating distant organ failure. AKI is not an isolated event and it results in remote organ dysfunction to the lungs, heart, liver, intestines and brain through a pro-inflammatory mechanism that involves neutrophil cell migration, cytokine expression and increased oxidative stress . Three recent excellent reviews explore the mechanisms and the long-term consequences of AKI other organ systems.
Kidney-lung crosstalk in the critically ill patient
Heart-kidney crosstalk: the cardiorenal syndrome
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Can I Take The Test At Home
Very few options exist for a complete renal panel test that can be taken with an at-home test kit. Some at-home kidney tests involve taking a fingerstick blood sample at home and sending it to a lab for analysis, but these tests do not include all of the same measurements that are included in a typical renal panel test.
Etiology In Newborns And Infants
Prerenal AKI
The patient’s age has significant implications for the differential diagnosis of AKI. In newborns and infants, causes of prerenal AKI include the following:
- Perinatal hemorrhage – Twin-twin transfusion, complications of amniocentesis, abruptio placenta, birth trauma
- Neonatal hemorrhage – Severe intraventricular hemorrhage, adrenal hemorrhage
- Perinatal asphyxia and hyaline membrane disease – Both may result in preferential blood shunting away from the kidneys to central circulation
Intrinsic AKI
Causes of intrinsic AKI include the following:
-
ATN – Can occur in the setting of perinatal asphyxia; ATN also has been observed secondary to medications given to the mother perinatally
-
ACE inhibitors – Can traverse the placenta, resulting in a hemodynamically mediated form of AKI
-
Acute glomerulonephritis Rare; most commonly the result of maternal-fetal transfer of antibodies against the neonate’s glomeruli or transfer of chronic infections associated with acute glomerulonephritis
Postrenal AKI
Congenital malformations of the urinary collecting systems should be suspected in cases of postrenal AKI.
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Acute Kidney Injury & Failure Symptoms Causes & Treatments
When your kidneys stop working suddenly, over a very short period of time , it is called acute kidney injury . AKI is sometimes called acute kidney failure or acute renal failure. It is very serious and requires immediate treatment.
Unlike kidney failure that results from kidney damage that gets worse slowly, AKI is often reversible if it is found and treated quickly. If you were healthy before your kidneys suddenly failed and you were treated for AKI right away, your kidneys may work normally or almost normally after your AKI is treated. Some people have lasting kidney damage after AKI. This is called chronic kidney disease, and it could lead to kidney failure if steps are not taken to prevent the kidney damage from getting worse.