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Tuesday, October 7, 2008

How To Win Against Acute Renal Failure (2)

Part 1 Part 2

Risk Factors

Conditions that increase your risk of acute kidney failure include:

  • Advanced age
  • Chronic infection
  • Diabetes
  • High blood pressure
  • Heart failure
  • Various blood disorders
  • Immune disorders, such as lupus, IgA nephropathy and scleroderma
  • Kidney diseases
  • Liver diseases
  • Prostate gland enlargement
  • Bladder outlet obstruction

Acute kidney failure almost always occurs in connection with another medical condition or event. In fact, most people who experience acute kidney failure are already in the hospital for other reasons, such as severe injury, complicated surgery or overwhelming infection.

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Tests and Diagnosis

When signs and symptoms point to acute kidney failure, blood and urine tests pin down the diagnosis. Changes associated with acute kidney failure include:

  • Daily urine output usually falls to less than 2 cups (500 milliliters).

  • Blood urea and creatinine levels rise rapidly.

  • Blood electrolyte concentrations — levels of minerals such as sodium, potassium and calcium that regulate fluid balance and muscle function, plus many other vital processes — become unstable, causing swelling (edema) and lung congestion.

  • Blood potassium, in particular, rises rapidly, often to life-threatening levels.

Ultrasound is the imaging test most commonly used in diagnosing kidney failure, but your doctor may also order an abdominal computerized tomography (CT) or magnetic resonance imaging (MRI) scan.

In a few cases, your doctor may remove a small sample (biopsy) of kidney tissue and send it to a laboratory for microscopic examination to identify the cause of acute kidney failure.

Complications

The sooner the cause of your acute kidney failure is resolved, the more likely you'll be to recover your kidney function.

Occasionally, acute kidney failure causes permanent loss of kidney function, or end-stage renal disease. People with end-stage renal disease require either permanent dialysis — a mechanical filtration system for removing toxins and waste from your body — or a kidney transplant to survive.

Acute kidney failure may be fatal. Death rates are highest when the kidneys fail after surgery or trauma or in the context of severe, chronic medical problems.

Other factors that can adversely affect the outcome of acute kidney failure include multiorgan failure, multiple blood transfusions, a recent history of stroke or heart attack, or a postoperative stroke, advanced age, infection, gastrointestinal bleeding and pre-existing malnutrition.

Treatments and Drugs

The first goal is to treat the illness or injury that originally damaged your kidneys. Once that's under control, the focus will be on preventing the accumulation of excess fluids and wastes in your blood while your kidneys heal. This is best accomplished by limiting your fluid intake and following a high-carbohydrate, low-protein, low-potassium diet.

Your doctor may prescribe calcium, glucose or sodium polystyrene sulfonate (Kayexalate) to prevent the accumulation of high levels of potassium in your blood. Too much potassium in the blood can cause dangerous irregular heartbeats (arrhythmias).

Dialysis

Most of the time, you also need to undergo temporary hemodialysis — often referred to simply as "dialysis" — to help remove toxins and excess fluids from your body while your kidneys heal. Dialysis, which is a mechanical way of filtering waste from your blood, is an imperfect but lifesaving substitute for kidney function.

In acute kidney failure, dialysis is usually done at a hospital or dialysis center, not at home. The treatment relies on an artificial kidney (dialyzer) to take over kidney function.

Blood is pumped out of your body to the artificial kidney through one of two routes — a catheter placed surgically in one of your main blood veins, or a surgically created junction between a vein and artery in your arm.

Inside the artificial kidney, your blood moves across membranes that filter out waste before being returned to your body. Less than 1 cup (237 milliliters) of blood is outside your body in the dialyzer and tubing at any one time.

Hemodialysis

Prevention

Acute kidney failure is often impossible to prevent. But you may reduce your risk by following these suggestions:

  • Don't abuse alcohol or drugs, including over-the-counter pain medications such as aspirin, acetaminophen and ibuprofen.
  • Avoid long-term exposure to heavy metals, such as lead, as well as to solvents, fuels and other toxic substances.

Carefully follow all of your doctor's recommendations for managing any chronic medical condition that increases your risk of kidney failure.

If you're at high risk of kidney damage induced by contrast dye used for certain X-rays — for example, if you have diabetes or multiple myeloma — your doctor may prescribe a dose of acetylcysteine before the procedure. This medicine can help prevent acute kidney failure under these circumstances.

[SOURCE: Mayo Clinic.com ]
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