Acute Renal Failure (ARF), also known as Acute Kidney Injury (AKI), is a sudden and rapid decline in kidney function. The kidneys are unable to filter waste, maintain fluid balance, or regulate electrolytes properly. AKI develops over hours or days and requires immediate management to prevent permanent kidney damage. Early identification and correction of the underlying cause are crucial for recovery.
Causes of Acute Renal Failure
AKI is classified into three major categories:
1. Pre-Renal Causes (Reduced blood flow to kidneys)
- Dehydration
- Severe blood loss
- Heart failure
- Shock
- Severe burns
2. Intrinsic (Intra-Renal) Causes
- Acute tubular necrosis (ATN)
- Glomerulonephritis
- Nephrotoxic drugs (NSAIDs, aminoglycosides, contrast agents)
- Infections
3. Post-Renal Causes (Obstruction)
- Kidney stones
- Enlarged prostate
- Tumors causing blockage
Symptoms of Acute Renal Failure
- Decreased urine output (oliguria)
- Swelling in legs, ankles, or face
- Nausea and vomiting
- Fatigue and weakness
- Shortness of breath
- Confusion
Diagnosis
- Blood tests: elevated creatinine and BUN
- Electrolyte tests: high potassium, sodium imbalance
- Urine analysis: helps identify cause
- Imaging: ultrasound to detect obstruction
- Kidney biopsy: for suspected intrinsic disease
Management and Treatment
1. Treat the Underlying Cause
- Rehydration for dehydration
- Stop nephrotoxic drugs
- Treat infections appropriately
- Relieve urinary obstruction (catheterization)
2. Supportive Treatment
- Fluid management (balance intake and output)
- Correct electrolyte imbalance
- Monitor blood pressure
- Manage acid–base disturbance
3. Medications
- Diuretics (furosemide) in some cases to promote urine output
- Insulin + glucose for high potassium levels
- Sodium polystyrene sulfonate to reduce potassium
4. Dialysis (When Required)
Dialysis is needed if:
- Potassium remains dangerously high
- Severe acidosis
- Fluid overload unresponsive to treatment
- Signs of uremia (confusion, seizures)
Complications
- Fluid overload
- Life-threatening hyperkalemia
- Metabolic acidosis
- Permanent kidney damage
- Cardiac arrhythmias
- Death (if untreated)
Prevention
- Adequate hydration during illness
- Avoid unnecessary NSAIDs and nephrotoxic drugs
- Monitor kidney function during high-risk medications
- Control diabetes and blood pressure
- Treat urinary obstructions early
Patient Counseling
- Stay hydrated, especially during vomiting, diarrhea, or heat exposure
- Avoid overuse of painkillers like ibuprofen
- Follow fluid intake guidance given by the doctor
- Report reduced urine output immediately
- Attend follow-up appointments to monitor kidney recovery
Detailed Notes:
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