Chronic Renal Failure
Acute renal failure is a sudden loss of the kidneys' ability to excrete wastes, concentrate urine, and conserve electrolytes .
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The kidneys filter wastes and excrete fluid when the pressure of blood in the bloodstream forces blood through the internal structures of the kidney.Decreased blood flow is one cause of damage to the kidney. It may occur when there is extremely low blood pressure from trauma, complicated surgery, septic shock, hemorrhage, burns and associated dehydration, or other severe or complicated illness.Acute tubular necrosis (ATN) is another cause of acute renal failure. ATN may be caused by ischemia (decreased oxygenationof the tissues) from obstruction or stricture of the renal artery (see acute arterial occlusion of the kidney, renal artery stenosis) . Itmay also occur following toxic injury to the kidney after exposure to metals, solvents, radiographic contrast, certain antibioticsand other medications, and other substances that are toxic to the kidney.Myoglobinuria (myoglobin in the urine) may cause acute renal failure. This condition may be caused by rhabdomyolysis,alcohol abuse (see alcoholism) , a crush injury, necrosis (tissue death) of muscles from any cause, seizures, and other causes.Acute renal failure may follow direct injury to the kidney. It may also follow infections such as acute pyelonephritis orsepticemia. It may be a consequence of urinary tract obstruction such as a narrowing of the urinary tract (stricture), tumor,kidney stones, nephrocalcinosis, or enlarged prostate with subsequent acute bilateral obstructive uropathy . Severe acutenephritic syndrome can cause acute renal failure.Other causes include disorders of the blood, such as idiopathic thrombocytopenic purpura (ITP) , transfusion reaction, or otherhemolytic disorders. Causes also include malignant hypertension and disorders associated with childbirth such as postpartumrenal failure and bleeding associated with placenta abruptio or placenta previa. Autoimmune disorders such as scleroderma maycause acute renal failure.Hemolytic uremic syndrome is one of the most frequent causes of acute renal failure in young children and appears to beincreasing in prevalence. It is associated with the rapid onset of renal failure and other systemic manifestation. A toxinsecreting bacterium, Eschereshia coli, found in contaminated undercooked meats, has been implicated as the cause of hemolyticuremic syndrome.Acute renal failure affects approximately 3 out of 10,000 people admitted to the hospital. The urine produced usually decreasesin volume, and there may be no urine produced. This causes fluids and waste products to accumulate in the body. Lab tests how an accumulation of nitrogen wastes such as creatinine and urea in the body (azotemia) . These waste products act aspoisons when they accumulate in the body, damaging tissues and the functioning of many different organs. If the wastes are notremoved from the body, death eventually results.
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- Decreased urine output (There may be none.)
- Decreased urine volume (oliguria)-
- No urine output (anuria)- urination, excessive at night (can occur in some types of renal failure)-
- Ankle, feet, and leg swelling-
- Generalized swelling, fluid retention-
- Decrease in sensation, especially the hands or feet-
- Changes in mental status or mood
Treatment of causative disorders may help to prevent acute renal failure. Many cases may not be preventable.
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