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Encyclopedia > Uremic poisoning
Acute renal failure
ICD-10 N17.2
ICD-9 584

Acute renal failure (ARF) is a rapid loss of renal function due to damage to the kidneys, resulting in retention of nitrogenous (urea and creatinine) and non-nitrogenous waste products that are normally excreted by the kidney. Depending on the severity and duration of the renal dysfunction, this accumulation is accompanied by metabolic disturbances, such as metabolic acidosis (acidification of the blood) and hyperkalaemia (elevated potassium levels), changes in body fluid balance, and effects on many other organ systems. It can be characterised by oliguria or anuria (decrease or cessation of urine production), although nonoliguric ARF may occur. It is a serious disease and treated as a medical emergency. The following codes are used with International Statistical Classification of Diseases and Related Health Problems. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... In medicine (nephrology) renal function is an indication of the state of the kidney and its role in physiology. ... Human kidneys viewed from behind with spine removed The kidneys are bean-shaped excretory organs in vertebrates. ... In medicine, metabolic acidosis is a state in which the blood pH is low (under 7. ... Hyperkalemia (hyper is high, kalium is the Latin name for potassium) is an elevated blood level (above 5. ... To meet Wikipedias quality standards, this article or section may require cleanup. ... Renal failure is when the kidneys fail to function properly. ... Oliguria and anuria are the decreased or absent production of urine, respectively. ... A medical emergency is an injury or illness that poses an immediate threat to a persons health or life which requires help from a doctor or hospital. ...

Contents


Causes

Renal failure, whether chronic or acute, is usually categorised according to pre-renal, renal and post-renal causes: Renal failure is the condition where the kidneys fail to function properly. ... Chronic renal failure (CRF, or chronic kidney failure, CKF) is a slowly progressive loss of renal function over a period of months or years and defined as an abnormally low glomerular filtration rate, which is usually determined indirectly by the creatinine level in blood serum. ...

In physiology and medicine, hypotension refers to an abnormally low blood pressure. ... In medicine, shock (hypoperfusion) is a life-threatening medical emergency characterized by inability of the circulatory system to supply enough oxygen to meet tissue requirements. ... Dehydration is the removal of water (hydor in ancient Greek) from an object. ... A myocardial infarction occurs when an atherosclerotic plaque slowly builds up in the inner lining of a coronary artery and then suddenly ruptures, totally occluding the artery and preventing blood flow downstream. ... Atheroembolic disease is medical conditions caused by the embolization of ruptured atheromatous plaques into distal blood vessels. ... Renal vein thrombosis (RVT) is the formation of a clot or thrombus obstructing the renal vein, leading to a reduction in drainage of the kidney. ... Coagulation is the thickening or congealing of any liquid into solid clots. ... Infection is also the title of an episode of the television series Babylon 5, and the English title of the Japanese film Kansen. ... The venom of the black widow spider is a potent latrotoxin. ... Oral medication A medication is a licenced drug taken to cure or reduce symptoms of an illness or medical condition. ... Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAIDs, are drugs with analgesic, antipyretic and anti-inflammatory effects - they reduce pain, fever and inflammation. ... Aminoglycosides are a group of antibiotics that are effective against certain types of bacteria. ... Amphotericin B (Fungilin®, Fungizone®, Abelcet®, AmBisome®, Fungisome®, Amphocil®, Amphotec®) is a polyene antimycotic drug, used intravenously in systemic fungal infections. ... iodinated contrast is an intervenous radiographic die containing iodine, which enhances vascular structures and organs. ... Lithium salts are chemical salts of lithium used primarily in the treatment of bipolar disorder as mood stabilizing drugs. ... Rhabdomyolysis is the breakdown of skeletal muscle due to injury, either mechanical, physical or chemical. ... Myoglobin is a single-chain protein of 153 amino acids, containing a heme (iron-containing porphyrin) group in the center. ... Injury is damage or harm caused to the structure or function of the body caused by an outside agent or force, which may be physical or chemical. ... Lovastatin, the first statin to be marketed The statins (or HMG-CoA reductase inhibitors) form a class of hypolipidemic agents, used as pharmaceuticals to lower cholesterol levels in people at risk for cardiovascular disease because of hypercholesterolemia. ... ecstasy and religious ecstasy MDMA, most commonly known today by the street name ecstasy, is a synthetic entactogen of the phenethylamine family whose primary effect is to stimulate the brain to rapidly secrete large amounts of serotonin, causing a general sense of openness, empathy, energy, euphoria, and well-being. ... Hemolysis (alternative spelling haemolysis) literally means the excessive breakdown of red blood cells. ... Human red blood cells Red blood cells are the most common type of blood cell and are the vertebrate bodys principal means of delivering oxygen from the lungs or gills to body tissues via the blood. ... 3-dimensional structure of hemoglobin. ... Sickle-shaped red blood cells Sickle cell disease is a general term for a group of genetic disorders caused by sickle hemoglobin (Hgb S). ... Multiple myeloma (also known as MM, myeloma, plasma cell myeloma, or as Kahlers disease after Otto Kahler) is a malignant neoplasm of plasma cells, the cells of the immune system that produce antibodies. ... Hypercalcaemia is an elevated calcium level in the blood. ... Glomerulonephritis is a primary or secondary autoimmune renal disease featuring inflammation of the glomeruli. ... Goodpasture’s syndrome (also known as Goodpasture’s disease and anti-glomerular basement membrane disease or anti-GBM disease) was first described by Ernest Goodpasture in 1919. ... In medicine (rheumatology), Wegeners granulomatosis is a form of vasculitis that affects the lungs, kidneys and other organs. ... Urinary retention is a lack of ability to urinate. ... Oral medication A medication is a licenced drug taken to cure or reduce symptoms of an illness or medical condition. ... Benign prostatic hyperplasia (BPH) is the increase in size of the prostate in middle_aged and elderly men. ... Kidney stones are solid accretions (crystals) of dissolved minerals in urine found inside the kidneys or ureters. ... Pyelonephritis is an ascending urinary tract infection that has reached the pyelum (pelvis) of the kidney (nephros in Greek). ... Ovarian cancer is a malignant ovarian neoplasm (an abnormal growth located on the ovaries). ... Colorectal cancer, also called colon cancer or bowel cancer, includes cancerous growths in the colon, rectum and appendix. ...

Diagnosis

Renal failure is generally diagnosed either when creatinine or blood urea nitrogen tests are markedly elevated in an ill patient, especially when oliguria is present. Previous measurements of renal function may offer comparison, which is especially important if a patient is known to have chronic renal failure as well. If the cause is not apparent, a large amount of blood tests and examination of a urine specimen is typically performed to elucidate the cause of acute renal failure, medical ultrasonography of the renal tract is essential to rule out obstruction of the urinary tract. Creatinine is a breakdown product of creatine phosphate in muscle, and is usually produced at a fairly constant rate by the body (depending on muscle mass). ... The blood urea nitrogen (BUN) test is a measure of the amount of nitrogen in the blood that comes from urea. ... Blood tests are laboratory tests done on blood to gain an appreciation of disease states and the function of organs. ... Urine is liquid waste excreted by the kidneys and is produced by the process of filtration. ... Medical ultrasonography (sonography) is an ultrasound-based diagnostic imaging technique used to visualize internal organs, their size, structure and any pathological lesions. ...


Consensus criteria[1][2] for the diagnosis of ARF are:

  • Risk: serum creatinine increased 1.5 times OR urine production of <0.5 ml/kg body weight for 6 hours
  • Injury: creatinine 2.0 times OR urine production <0.5 ml/kg for 12 h
  • Failure: creatinine 3.0 times OR creatinine >355 ╬╝mol/l (with a rise of >44) or urine output below 0.3 ml/kg for 24 h
  • Loss: persistent ARF or more than four weeks complete loss of kidney function

Kidney biopsy may be performed in the setting of acute renal failure,to provide a definitive diagnosis and sometimes an idea of the prognosis, unless the cause is clear and appropriate screening investigations are reassuringly negative. A biopsy (in Greek: bios = life and opsy = look/appearance) is a medical test involving the removal of cells or tissues for examination. ... ...


Treatment

Acute renal failure is usually reversible if treated promptly and appropriately. The main interventions are monitoring fluid intake and output as closely as possible; insertion of a urinary catheter is useful for monitoring urine output as well as relieving possible bladder outlet obstruction, such as with an enlarged prostate. In both hypovolemia and intrinsic causes (acute tubular necrosis) administering intravenous fluids is typically the first step to improve renal function. If a central venous catheter is used, a central venous pressure of 15 cmH2O (1.5 kPa) is often used as a target for increasing circulatory volume.[3] If the cause is obstruction of the urinary tract, surgical relief of the obstruction (with a nephrostomy or suprapubic catheter) may be necessary. Metabolic acidosis and hyperkalemia, two prime complications of renal failure, may require medical treatment with sodium bicarbonate administration and antihyperkalemic measures, respectively. In urinary catheterization, a urinary catheter, like foley catheter, a slender plastic tube, is pushed up a patients urinary tract into their bladder. ... An intravenous drip in a hospital Intravenous therapy or IV therapy is the administration of liquid substances directly into a vein. ... In medicine, a central venous catheter (CVC or central (venous) line) is a catheter placed into a large vein in the chest or groin. ... The title given to this article is incorrect due to technical limitations. ... The pascal (symbol Pa) is the SI unit of pressure. ... A nephrostomy is an artificial opening created between the kidney and the skin which allows for the drainage of urine directly from the upper part of the urinary system (renal pelvis). ... A suprapubic cystostomy is a surgically-created connection between the urinary bladder and the skin which is used to drain urine from the bladder in individuals with obstruction of normal urinary flow. ... In medicine, metabolic acidosis is a state in which the blood pH is low (under 7. ... Hyperkalemia (hyper is high, kalium is the Latin name for potassium) is an elevated blood level (above 5. ... Sodium bicarbonate NaHCO3, or sodium hydrogen carbonate, also known as baking soda and bicarbonate of soda, is a soluble white anhydrous or crystalline chemical compound, with a slight alkaline taste resembling that of sodium carbonate. ...


Dopamine or other inotropes may be given to improve cardiac output and renal perfusion, and diuretics (in particular furosemide) may be administered. If a Swan-Ganz catheter is used, a pulmonary artery occlusion pressure (PAOP) of 18 mmHg (2.4 kPa) is the target for inotropic support.[3] Dopamine is a chemical naturally produced in the body. ... An inotrope is an agent which increases or decreases the force or energy of muscular contractions. ... Cardiac output is the volume of blood being pumped by the heart in a minute. ... A diuretic is any drug that elevates the rate of bodily urine excretion. ... Furosemide (INN) or frusemide (former BAN) is a loop diuretic used in the treatment of congestive heart failure and edema. ... In medicine pulmonary artery catheterization is the insertion of a catheter into a pulmonary artery. ... One way of defining pressure is in terms of the height of a column of fluid that may be supported by that pressure; or the height of a column of fluid that exerts that pressure at its base. ...


Lack of improvement with fluid resuscitation, therapy-resistant hyperkalemia, metabolic acidosis or fluid overload may necessitate artificial support in the form of dialysis or hemofiltration. Depending on the cause, a proportion of patients will never regain full renal function and require lifelong dialysis or a kidney transplant. In medicine, dialysis is a type of renal replacement therapy which is used to provide an artificial replacement for lost kidney function in renal failure. ... Hemofiltration is the replacement of blood plasma with an electrolyte solution by filtering plasma out of the bloodstream. ... In medicine, dialysis is a type of renal replacement therapy which is used to provide an artificial replacement for lost kidney function in renal failure. ...


History

Before the advancement of modern medicine acute renal failure might be referred to as uremic poisoning. Uremia was the term used to describe the contamination of the blood with urine. Starting around 1847 this term was used to describe reduced urine output, now known as oliguria, that was thought to be caused by the urine mixing with the blood instead of being voided through the urethra. NLM (National Library of Medicine, contains resources for patients and healthcare professionals) Virtual Hospital (digital health sciences library by the University of Iowa) Online Medical Dictionary Collection of links to free medical resources Wikicities has a wiki about medicine: Medicine Categories: Medicine | Health ... Uremia is a toxic condition resulting from renal failure, when kidney function is compromised and urea, a waste product normally excreted in the urine, is retained in the blood. ... Human blood smear: a - erythrocytes; b - neutrophil; c - eosinophil; d - lymphocyte. ... Urine is liquid waste excreted by the kidneys and is produced by the process of filtration. ... 1847 was a common year starting on Friday (see link for calendar). ... Renal failure is when the kidneys fail to function properly. ... Female anatomy In anatomy, the urethra is a tube which connects the urinary bladder to the outside of the body. ...


Acute renal failure due to acute tubular necrosis (ATN) was recognised in the 1940s in the United Kingdom, where crush victims during the Battle of Britain developed patchy necrosis of renal tubules, leading to a sudden decrease in renal function.[4] During the Korean and Vietnam wars, the incidence of ARF decreased due to better acute management and intravenous infusion of fluids.[5] Acute tubular necrosis may be toxic or ischemic. ... // Events and trends World War II was a truly global conflict with many facets: immense human suffering, fierce indoctrination, and the use of new, extremely devastating weapons such as the atomic bomb. ... Combatants United Kingdom Germany Commanders Hugh Dowding Hermann Göring Strength Approx. ...


See also

Hepatorenal syndrome (HRS) is liver failure that results in concomitant renal failure. ...

References

  1. ^ Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P; Acute Dialysis Quality Initiative workgroup. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004 Aug;8(4):R204-12. Epub 2004 May 24. PMID 15312219 Full Text. Criteria for ARF (Figure).
  2. ^ Lameire N, Van Biesen W, Vanholder R. Acute renal failure. Lancet 2005;365:417-30. PMID 15680458.
  3. ^ a b Galley HF. Can acute renal failure be prevented? J R Coll Surg Edinb 2000;45(1):44-50. PMID 10815380 Fulltext.
  4. ^ Bywaters EG, Beall D. Crush injuries with impairment of renal function. Br Med J 1941;1:427-32. Reprinted in J Am Soc Nephrol 1998;9:322-32. PMID 9527411.
  5. ^ Schrier RW, Wang W, Polle B, Mitra A. Acute renal failure: definitions, diagnosis, pathogenesis, and therapy. J Clin Invest 2004;114:5-14. PMID 15232604. Full text.

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