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Acute Renal Failure

Acute kidney failure occurs when your kidneys suddenly become unable to filter waste products from your blood. When your kidneys lose their filtering ability, dangerous levels of wastes may accumulate, and your blood's chemical makeup may get out of balance.

acute renal failure

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Acute kidney failure can be fatal and requires intensive treatment. However, acute kidney failure may be reversible. If you're otherwise in good health, you may recover normal or nearly normal kidney function.

Oh MS, Briefel G. Evaluation of renal function, water, electrolytes, and acid-base balance. In: McPherson RA, Pincus MR, eds. Henry's Clinical Diagnosis and Management by Laboratory Methods. 23rd ed. St Louis, MO: Elsevier; 2017:chap 14.

Weisbord SD, Palevsky PM. Prevention and management of acute kidney injury. In: Yu ASL, Chertow GM, Luyckx VA, Marsden PA, Skorecki K, Taal MW, eds. Brenner and Rector's The Kidney. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 29.

Before the conference, we identified six topics relevant to the field of ARF: definition/classification system for ARF; clinical outcome measures for ARF studies; physiological end-points for ARF studies; animal models of ARF; techniques for assessing and achieving fluid balance in ARF; and information technology in acute dialysis. We selected these topics based on the level of possible clinical impact, the level of controversy, known or suspected variation in practice, potential importance for scientific outcome, potential for development of evidence-based medicine recommendations, and availability of evidence. For each topic we outlined a preliminary set of key questions. We then invited an international panel, predominantly from the fields of nephrology and intensive care, based on their expertise in the fields of analysis. Panelists were assigned to three-person workgroups, with each workgroup addressing one key topic. Each workgroup conducted literature searches related to their topic questions via Medline, PubMed, bibliography of review articles and participants' files. Searches were limited to English language articles. However, articles written in other languages were used when identified by workgroup members. During this stage, the scope of the conference was also more clearly defined.

The accuracy of a creatinine clearance measurement (even when collection is complete) is limited because as glomerular filtration rate (GFR) falls creatinine secretion is increased, and thus the rise in serum creatinine is less [12,13]. Thus, creatinine excretion is much greater than the filtered load, resulting in a potentially large overestimation of the GFR (as much as a twofold difference) [13]. However, for clinical purposes it is important to determine whether renal function is stable or getting worse or better. This can usually be determined by monitoring serum creatinine alone [14]. Like creatinine clearance, the serum creatinine will not be an accurate reflection of GFR in the non-steady-state condition of ARF. Nonetheless, the degree to which serum creatinine changes from baseline will reflect the change in GFR. Serum creatinine is readily and easily measured and it is specific for renal function, while urea (or blood urea nitrogen) is a nonspecific marker of renal function, making it a poor marker relative to creatinine. Urine output is far less specific, except when it is severely decreased or absent. Severe ARF can exist despite normal urine output (i.e. nonoliguric) but changes in urine output can occur long before biochemical changes are apparent.

In addition, we considered that the following features would be important in any definition of ARF: it should consider change from baseline; it should include classifications for acute on chronic renal disease; it should be easy to use and clinically applicable across different centres; and it should consider both sensitivity and specificity because of different populations and research questions. A classification system should therefore include and separate mild (or early) and severe (or late) cases. This will allow such a classification to detect patients in whom renal function is mildly affected (high sensitivity for the detection of kidney malfunction but limited specificity for its presence) and patients in whom renal function is markedly affected (high specificity for true renal dysfunction but limited sensitivity in picking up early and subtler loss of function). Accordingly, we advocate a multilevel classification system in which a wide range of disease spectra can be included.

Proposed classification scheme for acute renal failure (ARF). The classification system includes separate criteria for creatinine and urine output (UO). A patient can fulfill the criteria through changes in serum creatinine (SCreat) or changes in UO, or both. The criteria that lead to the worst possible classification should be used. Note that the F component of RIFLE (Risk of renal dysfunction, Injury to the kidney, Failure of kidney function, Loss of kidney function and End-stage kidney disease) is present even if the increase in SCreat is under threefold as long as the new SCreat is greater than 4.0 mg/dl (350 μmol/l) in the setting of an acute increase of at least 0.5 mg/dl (44 μmol/l). The designation RIFLE-FC should be used in this case to denote 'acute-on-chronic' disease. Similarly, when theRIFLE-F classification is achieved by UO criteria, a designation of RIFLE-FO should be used to denote oliguria. The shape of the figure denotes the fact that more patients (high sensitivity) will be included in the mild category, including some without actually having renal failure (less specificity). In contrast, at the bottom of the figure the criteria are strict and therefore specific, but some patients will be missed. *GFR = Glomerular Filtration Rate; ARF Acute Renal Failure

Because there are no pharmacotherapies that have been proven to alter clinical endpoints (dialysis, mortality) in patients with ARF, it cannot be discerned what changes in currently available serum GFR markers (urea, creatinine) are predictive in smaller phase II studies of success in subsequent phase III trials with clinical end-points. Thus, strategies for ARF prevention and therapy will need to continue to be based on results from studies (positive and negative) using surrogate end-points (creatinine, urea) until definitive studies demonstrating effectiveness in altering clinical end-points are available. However, clinical decisions based on such evidence should be made cautiously and limited to the use of true surrogates (those that correlate with clinical outcomes). For example, urine output and renal blood flow are not reliable surrogates for outcome in studies of ARF and should not be used as such.

In the first column a list of recognized models used for the study of acute renal failure is presented. Then, in each column, an evaluation is presented regarding whether a given model contains certain features. '+' Indicates the presence of a given feature; '' indicates only the partial presence of that feature; and the absence of any sign indicates the lack of such a feature. For example, warm ischemia is simple but does not match the dominant clinical scenario and is of limited clinical relevance. 1Reproduces the type of injury seen in humans. 2Cold ischaemia is more clinically relevant to renal transplantation, but it is less well characterized. 3Clinical relevance is limited because less toxic alternatives are now available. 4Resembles clinical rhabdomyolysis.

Context Although acute renal failure (ARF) is believed to be common in the settingof critical illness and is associated with a high risk of death, little isknown about its epidemiology and outcome or how these vary in different regionsof the world.

Design, Setting, and Patients Prospective observational study of ICU patients who either were treatedwith renal replacement therapy (RRT) or fulfilled at least 1 of the predefinedcriteria for ARF from September 2000 to December 2001 at 54 hospitals in 23countries.

Results Of 29 269 critically ill patients admitted during the study period,1738 (5.7%; 95% confidence interval [CI], 5.5%-6.0%) had ARF during theirICU stay, including 1260 who were treated with RRT. The most common contributingfactor to ARF was septic shock (47.5%; 95% CI, 45.2%-49.5%). Approximately30% of patients had preadmission renal dysfunction. Overall hospital mortalitywas 60.3% (95% CI, 58.0%-62.6%). Dialysis dependence at hospital dischargewas 13.8% (95% CI, 11.2%-16.3%) for survivors. Independent risk factors forhospital mortality included use of vasopressors (odds ratio [OR], 1.95; 95%CI, 1.50-2.55; P

Preventing and treating illnesses that can lead to acute kidney failure is the best method for avoiding the disease. According to the Mayo Clinic, having a healthy lifestyle that includes regular physical activity and a sensible diet can help to prevent kidney failure. Work with your doctor to manage existing medical conditions that could lead to acute kidney failure.

With proper treatment and diligence, your chances of recovery are good. Seek immediate and regular medical care for acute kidney failure, and ask your doctor questions about what you can do to heal faster.

What is renal failure?Renal failure refers to temporary or permanent damage to the kidneys that results in loss of normal kidney function. There are two different types of renal failure: acute and chronic. Acute renal failure has an abrupt onset and is potentially reversible. Chronic renal failure progresses slowly over at least three months and can lead to permanent renal failure. The causes, symptoms, treatments, and outcomes of acute and chronic are different.

The symptoms for acute and chronic renal failure may be different. The following are the most common symptoms of acute and chronic renal failure. However, each child may experience symptoms differently.

Acute kidney injury (AKI), previously called acute renal failure (ARF),[1][2] is a sudden decrease in kidney function that develops within 7 days,[3] as shown by an increase in serum creatinine or a decrease in urine output, or both.[4] 041b061a72


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