Acute Renal Failure

Kidney Function Restoration Program

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Acute renal failure occurs when the kidneys suddenly fail to function. As a chief organ of the excretory system, the kidney is important in the elimination of some soluble waste products from the body, and the regulation of water and electrolyte balance in the body. Renal failure stops these all-important functions, and disrupts the fine balance of the body's systems. Medical treatment can usually reverse this problem. If medication is unsuccessful, the condition may progress to end-stage renal disease, uremic syndrome, and death.

NOTE: Uremic syndrome is a condition that may appear in a patient who is in the late stages of renal failure. The skin also serves as an excretory organ. When the failed kidneys cannot excrete waste products, the skin excretes these products. This skin excretion causes a white film to form on the skin.

a. Etiology of Acute Renal Failure. Three classifications of acute renal failure are prerenal failure, intrinsic (or parenchymal) failure, and postrenal failure.

(1) Prerenal failure. Diminished blood flow to the kidneys causes this type of renal failure. The reason for the decreased blood flow may be any of the following:

(a)

Hypovolemia.

(b)

Shock.

(c)

Abdominal fullness

(d)

Blood loss.

(e)

Sepsis.

(f) Pooling of fluid in ascites or burns.

(g) Cardiovascular disorders such as congestive heart failure and dysrhythmias.

(2) Intrinsic (parenchymal) renal failure. This type of renal failure is caused by damage to the kidneys themselves, the damage usually resulting from acute tubular necrosis. Possible causes of such damage include:

(a) Sickle-cell disease.

(b) Acute post-streptococcal glomerulonephritis.

(c) Acute pyelonephritis.

(d) Ischemia (lack of blood in the kidneys).

(3) Postrenal failure. Obstruction of urinary flow bilaterally causes this type of renal failure. Possible causes of obstruction include:

(a) Kidney stones.

(c) Papillae from papillary necrosis.

(e) Urethral edema from catheterization.

b. Signs and Symptoms of Acute Renal Failure. Early signs of renal failure become more severe if the kidneys do not begin functioning again. The renal failure soon disrupts other body systems. Note the signs and symptoms in the following body systems:

(1) Gastrointestinal system. - Anorexia, nausea, vomiting, diarrhea or constipation, stomatitis, bleeding, hematemesis, dry mucous members, uremic breath.

(2) Central nervous system. - Headache, drowsiness, irritability, confusion, peripheral neuropathy, convulsions, coma.

(3) Integumentary system. The cutaneous skin layer has these characteristics: dryness, pruritus, pallor, purpura, and, rarely, uremic frost.

(4) Cardiovascular system. An early symptom is hypotension. Later, these signs and symptoms occur: hypertension, dysrhythmias, fluid overload, congestive heart failure, systemic edema, and anemia.

(5) Respiratory system.--Deep or rapid respirations caused by metabolic acidosis and, occasionally, pulmonary edema.

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