what is renal failure aka acute kidney injury
Previously referred to as acute renal failure, acute kidney injury (AKI) is a sudden decline in renal function resulting in a decreased ability of the kidneys to regulate fluid, electrolyte and acid-base balance. Acute kidney injury can be categorised based on prerenal causes, intrarenal (intrinsic) causes or postrenal causes.
Acute kidney injury is associated with a reduction of GFR by 25% or more, oliguria (in most cases) and retention of metabolic wastes, particularly azotemia (high levels of urea in the blood); these changes typically occur within a few hours to days of the initial insult.
what are the effects of renal failure (acute kidney injury)
- decreased GFR (glomerular filtration rate which checks how well the kidneys work)
- blood urea nitrogen (BUN) elevation
- elevated serum creatinine
- oliguria
Intrarenal (intrinsic) causes are due to abnormalities or complications within the kidney(s) itself, such as:
- acute tubular necrosis
- interstitial nephritis
- glomerulonephritis
- vascular diseases affecting renal vasculature
- tumours, cancer
- polycystic kidney disease
Prerenal causes are the most common and relate to impairments in renal blood flow , such as:
- hypovolemia (low extracellular fluid in the body)
- hemorrhage
- hypotension
- severe burns
- cardiac dysfunction (e.g MI)
- septic shock
- renal artery stenosis or clamping
Postrenal causes relate to complications within the renal tract that affect kidney function, such as:
- urinary tract obstructions
- ureteral destruction
- neurogenic bladder (bladder dysfunction due to neurological disorders/ lesions)
what are signs and symptoms of acute kidney injury/ renal failure
- fluid retention and oedema
- metabolic acidosis
- anuria (urine output of less than 100mL a day
- nausea or vomiting
- anorexia
- various neurological manifestations such as irritability, drowsiness or confusion
what is the management of acute kidney disease/ renal failure
- maintenance of adequate fluid, electrolyte and acid-base balances
- adequate nutrient intake
- prevention/ management of infection
Renal replacement therapy (dialysis) may be required if adequate fluid, electrolyte and acid-base balance is not maintained. Consideration must also be given to any medications/drug therapy used by patients who develop AKI due to alterations in renal clearance occurring with the condition.
what is chronic kidney disease
Chronic kidney disease is a complex condition whereby there is progressive and irreversible destruction of nephrons. There is a progressive reduction in GFR and subsequent reductions in nephron function and other kidney functions. CKD progresses through stages, related to the progressive decline in GFR.
what are the causes of chronic kidney disease
- diabetes mellitus
- hypertension
- glomerulonephritis
- polycystic kidney disease
what are signs and symptoms of chronic kidney disease
- uremia (buildup of toxins in the blood)
- fatigue
- anorexia
- nausea/ vomiting
- weight loss
- hypertension
- pruritis (itching sensation in the skin which may be widespread or localised)
- neurological, musculoskeletal and cardiovascular changes
what is the management of chronic kidney disease
- dietary control with adequate calorie intake and;
- protein restriction
- vit D supplement
- fluid evaluation
- sodium, potassium and phosphate restriction
- erythropoietin supplementation
- ACE inhibitors or receptor blockers
- hyperglycaemic control and insulin (for patients with diabetes)
When end-stage renal disease occurs, dialysis or renal transplant will be necessary for survival.
what do the kidneys do
- regulate whats in the blood
- remove waste
- steady electrolytes
- regulate water - make hormones
what causes chronic kidney disease
- hypertension
- diabetes
- systemic diseases like lupus and rheumatoid arthritis
- infections such as HIV
- medications such as NSAIDS
- toxins like tobacco
what are the complications of chronic kidney disease
- electrolyte abnormalities
- toxin buildup
- hypertension
- weak bones
what is dialysis
Dialysis is a treatment for people whose kidneys are failing. When you have kidney failure, your kidneys don’t filter blood the way they should. As a result, wastes and toxins build up in your bloodstream. Dialysis does the work of your kidneys, removing waste products and excess fluid from the blood
when should you start dialysis
- when glomerular filtration rate is below 12
- when you start to get symptoms such as severe fatigue, nausea, decreased appetite, SOB
what are the options when you have deteriorating kidneys
- conservative care which is preserving kidney function for as long as possible through diet or medication but knowing this will not stop the decline in kidney function and will lead to death. Often in people with other chronic diseases
- get a donated kidney from a deceased or living person. You will live longer than with dialysis
- dialysis
what are the two types of dialysis
- hemodialysis
- your blood is passed through an artificial kidney called a dialyser. usually done for 4 hours, 3 times a week. Need to make dietary changes - peritoneal
- when the blood is cleaned through a lining in the inside of the abdomen called the peritoneum. a tube goes in near your belly button and a dialysate solution is poured through, the solution slowly diffuses the waste product. takes 20-30 minutes 4 times a day or at night time for 7 hours which does it by itself
