Acute renal failure (ARF)
ARF is defined as an abrupt or rapid decline in the ability of the kidneys to remove waste and concentrate urine without losing electrolytes of the body.
This condition is usually marked with rapid reduction in urine output, rise in serum creatinine concentration and rise in blood urea nitrogen [BUN] concentration.
Risk Factors
High Blood Pressure
Diabetes
Over-use of Pain killers ( paracetamol, diclophenac)
Family History of Kidney Disease
Birth Defects of Kidney
Classification
ARF may be classified into 3 general categories, as follows:
Prerenal — here there is a decrease in the blood flow to the kidneys as a result of low blood pressure, low blood volume, heart failure and changes to the blood vessels supplying the kidneys like narrowing of the renal artery and blood clot in the renal vessels.
Renal — includes damage to the kidneys itself.
Postrenal — results from obstruction to the passage of urine.
CAUSES
Decreased blood flow due to very low blood pressure, inadequate cardiac output which can result from: Blood loss or volume loss from gastrointestinal tract, renal tract, skin (e.g. burns), hemorrhages, internal or external
- Burns
- Dehydration
- Injury
- Septic shock
- Serious illness
- Surgery
- Disorders that cause clotting within the kidney’s blood vessels:
- Idiopathic thrombocytopenic thrombotic purpura (ITTP)
- Hemolytic-uremic syndrome
- Transfusion reaction
- Malignant hypertension
- Scleroderma
- Infections that directly injure the kidney
- Acute pyelonephritis
- Septicemia
- Obstruction of flow of urine
- Renal calculi
- Stricture
- Tumors
- Prostate enlargement
Symptoms:
- Oliguria (Decrease in amount of urine)
- Haematuria (blood in urine)
- Anuria (Urination stops completely)
- Swelling of the body
- Decreased appetite
- Metallic taste in the mouth
- Breath odor
- Fatigue
- Nausea or vomiting
- Diarrhoea
- Weakness
- High blood pressure
- Shortness of breath
- Myoclonic jerks (seizures)
- Persistent hiccups
- Prolonged bleeding
- Bruising easily
- Bloody stools
- Nosebleeds
- Changes in mental status
- Confusion
- Slow, sluggish movements
- Seizures & Coma can occur in very severe cases of Acute kidney injury
Diagnosis –
ARF is diagnosed on the basis of clinical history: Decreased urine production and characteristic laboratory findings, such as elevated blood urea nitrogen and creatinine.
Investigations
The results of laboratory tests may change suddenly (within a few days to 2 weeks). Such tests may include:
BUN
Creatinine clearance
Serum Creatinine
Serum Urea
Serum potassium
Urine Analysis
A kidney or abdominal ultrasound may be done for diagnosing kidney failure, but abdominal x-ray, abdominal CT scan, or abdominal MRI can tell if there is a blockage in the urinary tract. Blood tests may help reveal the underlying cause of kidney failure.
Treatment
Once the cause is found, the goal of treatment is to restore kidney function so that the excess water and waste in the body can be excreted and therefore prevent fluid and waste products from building up in the body while the kidneys heal.
As the kidneys cannot remove excess water, salt or potassium the patient needs to consume these in limited quantities. Potassium rich foods include apricots, bananas, soya flour, raisins, figs, and salt substitutes along with foods rich in Phosphorous e.g. (milk, cheese, nuts, and cola drinks) need to be avoided.
Diet may need to be high in carbohydrates and low in protein, salt, and potassium.
Complications
Chronic (long-term) kidney failure
Heart Failure
Damage to the heart or nervous system
End-stage kidney disease
Role of Homoeopathy in Acute Renal Failure
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