Acute Kidney Failure
Overview
Acute kidney failure (AKF), also known as acute renal failure (ARF), causes kidney damage or kidney failure in a short period of time. It can also damage other organs, such as the heart, lungs, and brain.
About 1% of patients who visit emergency departments have AKF (an increasing percentage). Between 1% and 7% of inpatients will present with AKF, and this percentage reaches up to 25% in patients admitted to intensive care units. Between 30% and 60% of patients who will develop AKF will require dialysis to treat it. In terms of prognosis of AKF: (i) 60% will make a full recovery and their renal function will return to normal (ii) 30% will develop chronic kidney disease and (iii) 10% will need to remain on a dialysis program for lifelong treatment.
Diagnosis
Most cases of AKF are caused by reduced blood flow to the kidneys, usually in someone who is already affected by another condition. This reduced blood flow can be caused by:
- Low blood volume due to blood loss, excessive vomiting, diarrhea, severe dehydration, burns and more
- The heart pumping less blood than normal because of heart failure, liver failure or sepsis
- Problems with blood vessels – such as inflammation and blockage in the blood vessels within the kidneys (a rare condition called vasculitis)
- Certain drugs that can affect the blood supply to the kidneys (e.g., antihypertensive drugs that cause hypotension) – other drugs can cause unusual reactions in the kidneys
AKF can also be caused by diseases of the kidney, such as glomerulonephritis. Additionally, it can be caused by a reaction to certain medications, infections or the intravenous contrast used in CT scans and coronary angiography.
Furthermore, AKF can be caused by an obstruction that affects the drainage of the kidneys, such as:
- An enlarged prostate
- A tumor in the pelvic region, such as in the ovaries or bladder
- Kidney stones
Symptoms may vary depending on the cause and severity of AKF. Some people may be asymptomatic. However, when symptoms of AKF are present, these may include:
- Decreased urine volume
- Swelling around the eyes
- Swelling above the ankles and feet
- Nausea
- Difficulty breathing
- Fatigue
- Malaise
- Drowsiness
- Confusion
- Pain or pressure in the chest
- Seizures
- Dehydration
- Diarrhea
Even if AKF does not progress to complete renal failure, it should be taken seriously. It affects the whole body, changes the way certain medications are absorbed and act on the body, and can make some existing conditions more serious. AKF differs from chronic kidney disease (CKD) because in CKD the kidneys gradually lose function over a long period of time.
A doctor may suspect a diagnosis of AKF if the patient belongs to a ‘risk group’ and suddenly becomes ill or develops symptoms of kidney failure.
AKF is usually diagnosed with a blood test that measures your creatinine levels. If blood creatinine levels are high, it means that the kidneys are not functioning as they normally should. At this stage a urine sample may also be required, which can be tested for proteins, blood cells, sugar, and waste products, which may give clues to the underlying cause. Furthermore, your medical team may recommend an ultrasound of the kidneys to look for any possible obstructions, such as a swollen prostate or bladder tumor.
In all cases, the underlying causes, any other symptoms such as signs of sepsis or signs of heart failure, any other medical condition and any medication taken recently should be investigated.
Treatment
The treatment of AKF depends on what caused it and how severe it is. You may need:
- Increased fluid intake in the case of dehydration
- Antibiotics in the case of infection
- Stopping certain medications (at least until the problem is resolved)
- A catheter to drain the bladder if there is an obstruction
- In severe cases, dialysis may be needed.
To prevent AFK, people who are considered high risk should undergo regular blood tests, particularly if they become unwell or start new medication. It is also important to monitor urine levels. Any warning signs of AKF, such as vomiting or low urine volume, require immediate investigation and treatment. People who are dehydrated or at risk of dehydration may need to receive fluids intravenously. Any medication that appears to aggravate the problem or directly damage the kidneys should be stopped, at least temporarily.
The most serious complications of acute kidney failure are:
- High levels of potassium in the blood – in severe cases, this can lead to muscle weakness, paralysis, and heart rhythm problems
- Fluid in the lungs (pulmonary oedema)
- Acidic blood (metabolic acidosis) – which can cause nausea, vomiting, drowsiness, and shortness of breath.
Why GMI
The medical and nursing staff of the Department of Nephrology are highly specialized and trained for the early recognition, diagnosis, and treatment of acute kidney failure.
The GMI is equipped with everything that you may need during your diagnosis and treatment. Additionally, the GMI team will never offer a simple “one size fits all” approach to any patient. We believe each patient’s case is as individual as they are and strive to find the best solution for each of our patients, taking their specific case and diagnosis, their lifestyle, and choices into account.
We believe each of our patients is more than their diagnosis. That’s why our dedicated paramedics team supports patients with AKF by offering more than just expert medical care. We offer psychological help, integrative medical services (including yoga classes, and acupuncture) and have a GMI Patient Advocacy Program.
Adhering to our passion for innovation, and desire to progress the medical field, the GMI both initiates and participates in several clinical trials in which the most modern and advanced treatment concepts are tested. At the GMI patients have the opportunity to participate in these clinical trials.
