All the reasons due to which the disease may appear can be divided into three groups: renal; prerenal; postrenal. Each group of reasons has its own distinctive features. Diagnostic methods, treatment and clinic of acute renal failure is determined only by a specialist.
Renal causes
The causes of renal renal failure include the following:
- various injuries: burns, injuries, severe skin damage;
- various diseases, due to which the body's supply of salt and water is reduced, for example, diarrhea and vomiting;
- serious infections, such as pneumonia.
Prerenal causes
Prerenal causes of renal failure may include the following:
- severe or severe form of glomerulonephritis, it also has its own varieties;
- anaphylactoid purpura;
- localized intravascular coagulation;
- the presence of thrombosis in the renal vein;
- the presence of necrosis on the adrenal medulla;
- hemolytic uremic syndrome;
- severe tubular necrosis;
- interaction with salts of heavy metals, chemistry or drugs;
- developmental abnormalities;
- cystosis
Postrenal causes
Postrenal form of renal failure may occur in the following cases:
- serious abnormalities in the urine (stones, tumors, blood in the urine);
- spinal cord diseases;
- pregnancy.
The basis of the disease are a variety of disorders, which are characterized by the presence of disorders in the renal blood flow, a decrease in glomerular separation passing through the walls of the channels susceptible to diseases, squeezing of these channels by edema, possible humoral effects, due to which biological substances become active, due to which damage can occur and violations. Spasms and arterial thrombosis may occur. Formed during this change most strongly affect the tubular apparatus.
Key factors
There are many reasons that can lead to kidney failure, and one of the most common is traumatic shock, which can occur due to tissue damage that occurs when lowering the amount of circulating blood. Traumatic shock, in turn, can provoke extensive burns, abortions, as well as incompatible blood transfusions, large blood loss, severe toxicosis in the early stages of pregnancy, as well as depleting uncontrollable vomiting.
Another reason for the appearance of acute renal failure is the effect on the body of neurotropic poisons, the source of which may be mercury, snakebite, mushrooms or arsenic. Acute renal failure can result in severe intoxication in case of an overdose of drugs, alcohol, some medications, such as antibiotics.
Infections, such as dysentery or cholera, as well as leptospirosis or hemorrhagic fever, can become another common cause of this condition. Uncontrolled intake of medical diuretics, as well as dehydration, decreased vascular tone can cause acute renal failure.
Symptoms
In the early stages, the disease is difficult to detect. In this case, differential diagnosis of acute renal failure will come to the rescue. Criteria (leading and additional) are determined by the attending doctor. With the further development of this disease, a significant decrease in the volume of urine excreted can be observed, in rare cases, urination stops completely. This stage of acute renal failure is considered the most dangerous, and it can last about three weeks.
At this time, other signs of the disease appear, such as lowering blood pressure, severe swelling on the hands and face, there is general anxiety or lethargy. In addition, the patient may experience nausea with vomiting, shortness of breath, due to the appearance of swelling in the lung tissue. All of the above symptoms can be accompanied by the appearance of severe chest pain, disturbance of the heart rhythm, the appearance of pain in the lumbar region.
At the same time, severe intoxication begins in the body, which leads to the development of an ulcer, both in the intestine and in the stomach. With the further development of acute renal failure, an increase in the liver is observed, shortness of breath is growing, edema appears on the legs. The patient may complain of a complete loss of appetite, severe weakness, growing pain in the lumbar region, and also drowsiness. In especially severe cases, drowsiness can also turn into a uremic coma.
In addition, the patient’s stomach is gradually growing due to constant flatulence, the skin turns pale and dry, a specific halitosis appears. After about three weeks, the last stage of acute renal failure occurs, in which the volume of urine released increases gradually, and this leads to the appearance of a condition such as polyuria. In this condition, the amount of urine released can reach two liters per day, and this leads to severe dehydration of the body. At this stage, the patient also has general weakness, periodically pain in the heart, intense thirst, and skin becomes very dry due to dehydration.
Diagnostics
The main factor is considered to be an increase in potassium and nitrogen compounds in the blood amid a significant decrease in the number of urine given by the body and the state of anuria. The volume of daily urine and the concentration functioning of the kidneys are assessed using a Zimnitsky test. The monitoring of such characteristics of blood biochemistry as urea, creatinine and electrolytes plays an essential role. These characteristics make it possible to assess the severity of acute renal failure and the result after the necessary therapeutic actions.
The main problem in the diagnosis of acute renal failure is the establishment of its form. For this purpose, an ultrasound of the kidneys and bladder is done, which makes it possible to identify or exclude obstruction of the urinary tract. In some cases, bilateral catheterization of the pelvis is performed. If at the same time two catheters easily passed into the pelvis, but urine excretion is not traced, it is possible to completely eliminate the postrenal form of acute renal failure.
At a later stage, acute renal failure is diagnosed by the criteria of the tests, which are determined by a specialist after a comprehensive examination.
If necessary, assess renal blood flow perform ultrasound of the vessels of the kidneys. Suspicion of tubular necrosis, acute glomerulonephritis, or systemic disease is considered an indication for a kidney biopsy.
After laboratory diagnosis of acute renal failure, emergency treatment is the first thing to do so that the patient’s condition does not worsen.
Treatment
Therapy of acute renal failure is carried out depending on the cause, form and stage of the disease. As the pathology progresses, both the prerenal and postrenal forms are necessarily transformed into the renal. In the treatment of acute renal failure, early diagnosis, finding the cause and timely initiation of therapy are very important. After receiving answers according to the criteria for the diagnosis of acute renal failure, proceed to treatment.
ARF therapy includes the following:
- cure of the cause - the main pathology that triggered the onset of acute renal failure;
- normalization of water-electrolyte and acid-base balance;
- providing adequate nutrition;
- therapy of concomitant pathologies;
- temporary replacement of the kidneys.
Depending on the cause of the arrester, you may need:
- antibacterial drugs in the presence of infection;
- compensation for a lack of fluid (with a decrease in the volume of blood circulation);
- diuretics and fluid restriction to reduce edema and stimulate urination;
- cardiac remedies for heart failure;
- antihypertensive drugs to lower blood pressure;
- surgery to restore kidney function or remove obstructions in the urine;
- stimulants of blood supply and blood flow in the kidneys;
- gastric lavage, antidotes and other measures for poisoning.
Do I need hospitalization?
If there is a suspicion of acute renal failure and a confirmed diagnosis of patients, they are urgently hospitalized in a multidisciplinary hospital with a hemodialysis unit. When moving the patient, provide him with a state of rest, warmth and keep his body in a horizontal position. It is wiser to go by ambulance, then qualified doctors will be able to take all the necessary measures in a timely manner.
Indications for hospitalization:
- Acute renal failure with a sharp deterioration in kidney function, requiring intensive treatment.
- The need for hemodialysis.
- With uncontrolled increase in pressure, multiple organ failure, hospitalization in the intensive care unit is required.
After discharge, a patient with acute renal failure is prescribed long-term (at least 3 months) outpatient monitoring and treatment by a nephrologist at the place of residence.
Non-drug treatment of acute renal failure
Treatment of prerenal and renal acute renal failure differs in the volume of infusion. With a lack of blood circulation, an urgent restoration of the volume of fluid in the vascular system is required. Whereas in case of renal acute renal failure, intensive infusion, on the contrary, is prohibited, since pulmonary and brain edema may begin. For proper infusion therapy, it is necessary to determine the degree of fluid retention in the patient, daily diuresis and blood pressure.
The prerenal form of acute renal failure requires an urgent restoration of the volume of circulating blood and normalizing blood pressure. In acute renal failure caused by poisoning with drugs and other substances, early detoxification (plasmapheresis, hemosorption, hemodiafiltration or hemodialysis) is necessary, and the antidote is administered as early as possible.
The postrenal form involves the speedy drainage of the urinary tract to restore normal outflow of urine through them. Bladder catheterization, surgery of the urinary tract, epicystostomy may be required. It is necessary to control the balance of fluid in the body. In the case of parenchymal acute renal failure, it is necessary to limit the intake of fluids, potassium, sodium and phosphates.
Drug treatment of acute renal failure
If the patient does not need to eat on his own, the need for nutrients is filled with droppers. In this case, you need to control the amount of incoming nutrients and fluids. As medicines stimulating the excretory function of the kidneys, loop diuretics, for example, Furosemide up to 200-300 mg / day in several doses, are prescribed. Anabolic steroids are prescribed to compensate for the splitting process in the body.
With hyperkalemia, glucose (5% solution) is injected intravenously with insulin and calcium gluconate solution. If hyperkalemia cannot be corrected, emergency hemodialysis is indicated. Preparations for stimulating blood flow and energy metabolism in the kidneys:
- Dopamine
- "No-shpa" or "Papaverine";
- "Eufillin";
- glucose (20% solution) with insulin.
What is hemodialysis for?
At different stages of the clinic of acute renal failure, a hemodialysis method can be prescribed - this is the processing of blood in a mass transfer apparatus - dialyzer (hemofilter). Other varieties of the procedure:
- plasmapheresis;
- hemosorption;
- peritoneal dialysis.
These procedures are used to restore the activity of the kidneys. Water-electrolyte and acid-base balance of the body is regulated by the introduction of solutions of salts of potassium, sodium, calcium and others. Indications for emergency hemodialysis or other varieties of this procedure are a threat of cardiac arrest, pulmonary edema, or brain. In chronic and acute PN, the approach to the procedure is different. The doctor calculates the duration of blood dialysis, dialysis load, the amount of filtration and the qualitative composition of the dialysate individually before starting treatment. At the same time, it is ensured that the concentration of urea in the blood does not rise above 30 mmol / L. A positive prognosis is given when the creatinine content in the blood decreases earlier than the concentration of urea in it.
With the timely and correctly started therapy of acute renal failure, we can talk about a favorable prognosis. The most difficult treatment is a combination of acute renal failure with urosepsis. Two types of intoxication - uremic and purulent - simultaneously significantly complicate the treatment process and worsen the prognosis for recovery.
Prevention
Timely preventive measures will help to avoid the appearance of acute renal failure, and the very first and most important step is the maximum elimination of various factors that can lead to this condition. In addition, preventive measures taken on time will help maintain normal kidney function and avoid serious consequences.
So, in order to prevent, it is necessary to undergo a regular annual examination, in which the physician can prescribe an x-ray. Those who have previously been diagnosed with chronic kidney disease, it is recommended to gradually reduce the dose of medicines previously prescribed by doctors. Naturally, you should not reduce the dosage of drugs yourself without first consulting a doctor and diagnosis.
The treatment of existing chronic diseases such as urolithiasis or pyelonephritis will also help prevent acute kidney failure.
Forecast
Doctors note that the kidneys are a unique internal organ, they are able to recover, which means that the right, and most importantly, timely measures to prevent acute renal failure will help the patient recover completely.