Acute renal failure happens when the kidneys suddenly lose their ability to remove toxins from the urine. Typically the cause for a sudden kidney failure are acute tubular necrosis (ATN) and autoimmune kidney diseases. Other causes leading to kidney damage are acute pyelonephritis and septicemia. The symptoms indicating acute renal failure are changes in urination, lowered sensation in extremities and metallic taste in the mouth. Typical symptoms include nausea, blood in stools, swelling of feet and ankles, swelling of ankle or leg, fluid retention and fatigue. A person might also notice high blood pressure, nausea and reduced appetite. Change in mental alertness might be noticed.
A nephrologist will need to examine the patient and suggest further course of action. BUN test and blood tests for creatinine and potassium are done. Kidney ultrasound or MRI might be done to look for any stones, tumors or blockage. A person suffering acute kidney failure is hospitalized and the amount of liquid ingested in monitored. The diet has to be tailored to reduce proteins and salt. Diuretics might be prescribed for reducing fluid retention. In some cases, dialysis is done; especially when the potassium levels are abnormally high. The balance of body electrolytes is maintained.
Acute kidney failure is more common with older adults and those suffering kidney or liver disease, heart failure or diabetes. An abdominal surgery might also make you more susceptible to kidney failure. Severe dehydration, blood pressure medications and overuse of NSAIDs are other possible causes for renal failure. This condition can be life threatening if not treated in time. It can lead to chronic kidney failure or damage to the nervous system and the heart. The patient can develop very high blood pressure or loss of blood in the intestines leading to last-stage kidney disease. Treatment for kidney disease include antibiotics and iodine-based medications.
Uremia is regarded as the end stage of Kidney Failure. Uremia is also called the 'second cancer'. Uremia is related to the second point filtering blood. The kidney is impaired and does not filter the waste products that result from the body's metabolism. When this function fails, the waste products and blood urea nitrogen accumulate in the bloodstream. This build-up is Azotaemia. Mild levels of azotaemia may not show symptoms. But continued kidney failure to filter the waste result in symptoms and this condition is called uremia.
Uremic patients show varied signs and symptoms collectively called as uremic syndrome.
Gastrointestinal tract: Loss of appetite, discomfort in the abdomen, nausea, vomiting, diarrhea, severe dehydration, oral ulcer, Glossitis (inflammation of the tongue) and urine taste in breath.
Nerves related: Headache, dizziness, lethargy, drowsiness, weakness, fatigue. In advanced stage symptoms such as irritability, muscle trembling, seizures and convulsions may be experienced.
Cardiovascular system: Hypertension and arrhythmia and in the advanced stage heart failure can happen.
Blood forming or hematopoietic system: Serious anemia and in the advanced stage bleeding can happen.
Respiratory system: Shortness of breath, difficulty breathing, chronic cough, respiratory disorders such as pleural effusion (fluid accumulation in the lungs), pneumonia, uremic bronchitis, pleurisy.
To decide on the course of treatment the cause of Uremia is of great significance. As Uremia can be life-threatening, quick and proper treatment may reverse the illness condition. The chief cause is of course, kidney failure or damage to kidneys.
Diseases that affect kidney function:
- Bright disease - Glomerulonephritis
- Chronic hypertension
- Diabetes mellitus
- Kidney diseases (Kidney failure, Kidney anomalies)
- Bladder cancer
- Urinary stones that block flow of urine
- Enlarged prostate glands (in males)
- Injury to kidney
- Renal artery occlusion or embolism
- Cardio vascular problems (excessive bleeding, congestive heart failure)
- Gastro-metabolic disorder (diarrhea, vomiting, severe dehydration)
How is Uremia diagnosed?
Most renal disease including Uremia do not cause symptoms in the early stages. Uremia is likely to be noticed incidentally from blood or urine tests done for other health issues. Urinalysis is done to detect protein and blood in urine. Blood clotting test, kidney biopsy and stool culture to ascertain presence of a certain type of E.coli bacteria or other bacteria.
- A normal hemoglobin level is below 80g/L. In persons with symptoms of Uremia, the level may decline to 40-60g/L. Also, the platelets or leukocyte levels may be high.
- In persons with symptoms of Uremia, BUN increases from its normal value of less than 20 mg/dL to approximately 80-100.
- A 24-hour urine sample for creatinine clearance is taken. If the test result shows below the normal of less than 1.0 mg/dL to approximately 10, there is a high possibility of renal failure.
- Estimated Glomerular Filtration Rate or eGFR is a measure that filtering and waste removal function of the kidneys. eGFR falls to less than 10-15 ml/1.73 m2.
- Calcium, phosphate, parathyroid hormone, albumin, potassium and Bicarbone- abnormalities prevalent in these are also observed as part of blood tests.
How is Uremia treated?
If the diagnosis is confirmed, the patient would be hospitalized for observation and treatment. The cause determines the treatment.
- Patients with diarrhea require intravenous fluids or re hydration and rebalancing of electrolytes like sodium and potassium which is lost with diarrhea. This is the immediate supportive care.
- Severely anemic patients are given blood transfusion when the hemoglobin falls below 6 or 7 gdL.
- Plasma exchange or plasmapherisis is usually for adults patients who are likely to have an abnormal chemical in the plasma stimulating abnormal clot formation. To rectify and balance, the plasma is removed and replaced with donor plasma.
- is done to filter the waste out of the blood while the kidneys recover.
- Kidney transplant is another choice.
- Eculizumab (Soliris) is an intravenous infusion approved by the FDA for the treatment of pediatric and adult patients with atypical hemolytic uremic syndrome (aHUS). Atypical Hemolytic-uremic syndrome is a syndrome characterized by three major problem areas, progressive renal failure, problems associated with red blood cell and platelet counts and problems that occur in the vascular system.
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