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Acute renal failure (ARF) can be divided into three main types: perennial, renal, and postrenal.
Based upon the cause, acute renal failure or ARF (also called acute kidney injury) can be divided into three main types: prerenal, renal, and postrenal.
- Prerenal causes of ARF: Prerenal ARF occurs when the blood supply to the kidneys is compromised or reduced. It is the most common type of ARF occurring in almost 60 to 70 percent of all ARF cases.
- It may occur due to several reasons such as:
- Excessive bleeding or hemorrhage
- Reduced blood pressure
- Severe diarrhea
- Heart diseases including heart failure or heart attack
- Infections
- Severe burns
- Liver failure
- Use of nonsteroidal anti-inflammatory drugs such as aspirin, ibuprofen, and naproxen
- Severe dehydration
- Anaphylaxis (severe allergic reaction)
- It may occur due to several reasons such as:
- Renal (intrinsic) causes of ARF: This includes conditions that cause direct injury or damage to the kidneys.
- Intrinsic causes of ARF include:
- Clots in the blood vessels (arteries and veins) in or around the kidneys
- Glomerulonephritis (a condition causing the inflammation of the structural units of the kidney, called the glomeruli, which impairs the kidney's ability to filter urine)
- Lupus (a type of autoimmune disorder that causes the immune system to attack the body’s tissues)
- Infections including COVID-19
- Drug abuse
- Alcohol
- Heavy metal poisoning
- Medications that are toxic to the kidneys (such as certain antibiotics, chemotherapy drugs, and dyes used for imaging tests, including computed tomography scan and magnetic resonance imaging)
- Blood disorders such as hemolytic uremic syndrome and thrombotic thrombocytopenic purpura
- Rhabdomyolysis (a condition in which there is excessive muscle breakdown that precipitates in the kidney filtration apparatus)
- Blood vessel disorders
- Intrinsic causes of ARF include:
- Postrenal causes of ARF: These include conditions that cause blockage or obstruction to urine flow. Postrenal causes account for just 5 to 10 percent of all ARF cases.
- Postrenal causes of ARF include:
- Certain cancers such as cancer of the urinary bladder, colon, or cervix
- Blood clots in the urinary tract
- Kidney stones
- Prostate diseases such as benign prostatic hyperplasia and prostate cancer
- Damage to the nerves controlling urine flow and bladder function
- Postrenal causes of ARF include:
What is acute renal failure?
Acute renal failure (ARF), also called acute kidney injury (AKI) or acute kidney failure, is a condition in which there is a sudden loss of kidney function over a short period such as a few hours or a few days.
- ARF is a serious medical condition but is often reversible with appropriate and timely treatment.
- This is particularly seen in people with previously healthy kidneys who received treatment in the early stages.
In some cases, however, ARF can progress to cause further kidney damage leading to chronic kidney disease or chronic renal failure.
ARF can happen to anyone although it is more common in hospitalized people especially those requiring intensive care.
Some conditions may increase your risk of getting ARF, such as:
- Older age (65 years and above)
- High blood pressure
- Pre-existing kidney diseases
- Chronic conditions such as diabetes, heart diseases, and liver diseases
- Polycystic kidney disease
What are the symptoms of acute renal failure?
The symptoms of acute renal failure (ARF) may vary depending upon the cause. Some people may not have any symptoms initially and may be diagnosed based upon blood tests done for some other reason.
The symptoms of ARF may include:
- Decreased urine frequency or not passing any urine
- Swelling particularly on the feet or legs
- Weakness or fatigue
- Blood in urine
- Dark brown urine
- Nausea and vomiting
- Reduced appetite
- Pain in the abdomen or back
- Muscle cramps
- Chest discomfort or pain
- Breathing difficulty
- Confusion
- Seizures
- Unconsciousness or coma
How is acute renal failure diagnosed?
The diagnosis of acute renal failure (ARF) will be done by your doctor based upon:
- Medical history: Your doctor will take a detailed history concerning
- any illnesses you have (such as previous kidney diseases, diabetes, or high blood pressure)
- any medications you are on
- drug abuse including alcohol abuse
- heavy metal exposure
- investigations in the past using dyes such as contrast-enhanced computed tomography (CT) or magnetic resonance imaging scan
- any allergies
- other relevant information
- Physical examination: Your doctor will perform a detailed examination including examining the
- Abdomen: To look for any palpable lump or mass, prominent veins, distension, etc.
- Feet: To look for swelling, prominent blood vessels, etc.
- Eyes: To examine any blood clots, inflammation, jaundice, etc.
- Chest: To examine the presence of any abnormal heart sounds or murmurs and respiratory sounds
- Ears: To look for any ulcers (may occur in conditions such as Wegener granulomatosis) or hearing loss (may occur in certain drug toxicities or hereditary conditions)
- Skin: To look for any rashes, paleness, yellowing, etc.
- Blood tests: These include
- Kidney function test to estimate blood levels of urea, creatinine, blood urea nitrogen, and serum proteins
- Complete blood count
- Peripheral smear
- Serologic tests
- Complement testing
- Other diagnostic tests: These include
- Urine tests to look for any blood cells, proteins, or other findings in the urine
- Imaging studies such as ultrasound, CT scan, and X-ray
- Biopsy (a small piece of tissue is collected from the kidney and examined under the microscope)
- Other investigations such as electrocardiogram, bladder pressure assessment, and angiography
Based upon the investigations, ARF may be divided into different stages to ascertain its severity and plan proper treatment.
How is acute renal failure treated?
The treatment of acute renal failure (ARF) mainly depends on the severity of the disease and its cause. For example, if any medications are responsible for ARF, your doctor will stop those medications and prescribe a relevant replacement.
If kidney stones or blood clots caused the disease, your doctor will give medications or perform surgery to remove them. If an infection is present, your doctor will prescribe appropriate antibiotics for its treatment.
The treatment generally includes:
- Medications
- Fluid and electrolyte replacement
- Renal replacement therapy or dialysis (hemodialysis or peritoneal dialysis) to remove toxins and waste products from your body and give your kidneys time to heal
