DefinitionAcute kidney failure is the rapid loss your kidneys' ability to remove waste and help balance fluids and electrolytes in your body. In this case, rapid means less than 2 days.
Alternative NamesKidney failure; Renal failure; Renal failure - acute; ARF; Kidney injury - acute
Causes, incidence, and risk factorsThere are many possible causes of kidney damage. They include:Acute tubular necrosis (ATN)Autoimmune kidney diseaseBlood clot from cholesterol (cholesterol emboli)Decreased blood flow due to very low blood pressure, which can result from:
BurnsDehydrationHemorrhageInjurySeptic shockSerious illnessSurgeryDisorders that cause clotting within the kidney's blood vessels
Infections that directly injure the kidney, such as:
Acute pyelonephritisSepticemiaPregnancy complications, including:
Placenta abruptioPlacenta previaUrinary tract blockage
SymptomsBloody stoolsBreath odor and metallic taste in mouth
Bruising easilyChanges in mental status or moodDecreased appetiteDecreased sensation, especially in the hands or feetFatigueFlank pain (between the ribs and hips)Hand tremorHigh blood pressureMetallic taste in mouthNausea or vomiting, may last for daysNosebleedsPersistent hiccupsProlonged bleedingSeizuresShortness of breathSlow, sluggish movementsSwelling due to the body keeping in fluidSwelling, usually in the ankles, feet, and legsUrination changes:
Little or no urineExcessive urination at nightUrination stops completely
Signs and testsThe doctor or nurse will examine you. Many patients with kidney disease have body swelling caused by fluid retention. The doctor may hear a heart murmur, crackles in the lungs, or other abnormal sounds when listening to the heart and lungs with a stethoscope.The results of laboratory tests may change suddenly (within a few days to 2 weeks). Such tests may include:BUNCreatinine clearanceSerum creatinineSerum potassiumUrinalysisA kidney or abdominal ultrasound is the preferred test for diagnosing a blockage in the urinary tract. X-ray, CT scan, or MRI of the abdomen can also tell if there is a blockage.Blood tests may help reveal the underlying cause of kidney failure. Arterial blood gas and blood chemistries may show metabolic acidosis.
TreatmentOnce the cause is found, the goal of treatment is to help your kidneys work again and prevent fluid and waste from building up in the body while they heal. Usually, you have to stay overnight in the hospital for treatment.The amount of liquid you eat (such as soup) or drink will be limited to the amount of urine you can produce. You will be told what you may and may not eat to reduce the buildup of toxins that the kidneys would normally remove. Your diet may need to be high in carbohydrates and low in protein, salt, and potassium.You may need antibiotics to treat or prevent infection. Diuretics ("water pills") may be used to help remove fluid from your body.Medicines will be given through a vein to help control your blood potassium level.Dialysis may be needed for some patients, and can make you feel better. It can save your life if your potassium levels are dangerously high. Dialysis will also be used if: Your mental status changes, if you stop urinatingYou develop pericarditisYou retain too much fluidYou cannot eliminate nitrogen waste products from your bodyDialysis will most often be short term. Rarely, the kidney damage is so great that dialysis may be permanently needed.
Support GroupsThe stress of having an illness can often be helped by joining a support group where members share common experiences and problems.See: Kidney disease - support group
Calling your health care providerCall your health care provider if your urine output slows or stops or you have other symptoms of acute kidney failure.
PreventionTreating disorders such as high blood pressure can help prevent acute kidney failure.
ReferencesMolitoris BA. Acute kidney injury. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 122.Sharfuddin AA, Weisbord SD, Palevsky PM, Molitoris BA. Acute kidney injury. In: Taal MW, Chertow GM, et al, eds. Brenner & Rector's The Kidney. 9th ed. Philadelphia, PA: SaundersElsevier; 2011:chap 30.