Acute Renal Failure Is a Serious Medical Essay

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Acute renal failure is a serious medical condition. The gravity of the condition is manifested itself in the fact that the survival rate for renal failure has not improved for more than forty years. It occurs in 5% of all hospitalized patients and dialysis treatment is required in approximately .5 of cases. Dialysis is required to sustain "fluid and electrolyte balances, minimize nitrogenous waste production and sustain nutrition Infection accounts for 75% of deaths in patients with acute renal failure, and cardiorespiratory complications are the second most common cause of death" (Agrawal & Swartz 2000). Pathophysiology can vary depending upon the type: "patients who develop AKI can be oliguric or nonoliguric, have a rapid or slow rise in creatinine levels, and may have qualitative differences in urine solute concentrations and cellular content.... Oliguria is defined as a daily urine volume of less than 400 mL/d and has a worse prognosis, except in prerenal failure. Anuria is defined as a urine output of less than 100 mL/d and, if abrupt in onset, suggests bilateral obstruction or catastrophic injury to both kidneys" (Workeneh, 2011).

The three types of acute renal failure are categorized as prerenal, intrinsic and postrenal failure. Prerenal acute renal failure or acute tubular necrosis "a type of intrinsic acute renal failure that is usually caused by ischemia or toxins" is the most common form of the illness (Agrawal & Swartz 2000). In acute renal failure the excretion of nitrogenous waste is reduced, and the patient's fluid and electrolyte balances are disturbed. "The glomerular filtration rate decreases over days to weeks" (Agrawal & Swartz 2000). Often, the patient is asymptomatic. However, symptoms, when presents may include a lack of urine output despite drinking adequate fluids, edema in the extremities, anorexia, nausea, vomiting, disorientation, or fatigue.

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There may also be pain in the kidney area or back pain (Epstein 1997; Agrawal & Swartz 2000).

"Diagnoses are usually given based upon elevations of blood urea nitrogen (BUN) and serum creatinine levels. Most authorities define the condition as an acute increase of the serum creatinine level from baseline (i.e., an increase of at least 0.5 mg per dL [44.2 µmol per L]). Complete renal shutdown is present when the serum creatinine level rises by at least 0.5 mg per dL per day and the urine output is less than 400 mL per day (oliguria)" (Agrawal & Swartz 2000).

However, not all BUN and serum creatinine elevations are caused from acute renal failure. The side effects of corticosteroids, gastrointestinal tract bleeding and other intestinal diseases can produce abnormal results. However, a negative reaction to corticosteroids is also a common cause of the most prevalent form of the disease, prerenal acute failure. For this reason, a thorough battery of tests must be ordered. Blood and urine tests as well as BUN and serum electrolyte, creatinine, calcium, phosphorus and albumin levels, and a complete blood count with differential are recommended when all forms of acute renal failure are suspected (Agrawal & Swartz 2000).

The patient's lifestyle should also be evaluated as a factor when screening for the likelihood of acute renal failure. Alcoholism, for example, can put the patient at increased risk. The side effects of excessive alcohol consumption can disrupt a cell's retention of sodium, potassium, calcium, and phosphate, and this intensifies over time (Epstein 1997). Alcohol directly affects the kidneys by altering the form and structure of the organs. Significant kidney enlargement is commonly noted in chronic alcoholic-afflicted cirrhosis of the liver (Epstein 1997). Other demographics more.....

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