Nephro-Uro-Andrology » Renal failure

Acute Renal Failure

Acute renal failure is defined as an abrupt or rapid decline in renal filtration function. This condition is usually marked by a rise in serum creatinine levels or azotemia (a rise in blood urea nitrogen levels). Based on the amount of urine that is excreted over a 24-hour period, patients with ARF are separated into two groups: oliguric: patients who excrete less than 500 ml/ day and nonoliguric: patients who excrete more than 500 ml/ day. ARF may be classified as prerenal, renal (intrinsic) and postrenal. Acute renal failure does not produce a classic set of symptoms. The most common symptom is reduced urine output, which occurs in 70% of patients.

Aggressive treatment should begin at the earliest indication of renal dysfunction. Maintenance of volume homeostasis and correction of biochemical abnormalities remain the primary goals of treatment. Correcting acidosis with bicarbonate administration is important. Hyperkalemia, which can be life-threatening, should be treated by decreasing the intake of potassium, delaying the absorption of potassium, exchanging potassium across the gut lumen using potassium-binding resins, controlling intracellular shifts, and instituting dialysis. Correcting hematologic abnormalities (eg, anemia, platelet dysfunction) warrants appropriate measures. Dietary modulation is an important facet of the treatment of ARF. There are several modalities of renal replacement therapy (RRT) for patients with acute renal failure: intermittent hemodialysis continuous hemodialysis (used in critically ill patients) and peritoneal dialysis (rarely used).

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