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Thursday, November 30, 2023

Acute renal failure

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By Ebrima Jobarteh

The human body is a sophisticated compound of organs that function collaboratively to run its day-to-day routine. Organs such as the brain, liver, kidney and heart are always functioning in unison to ensure that the fine mechanism of the body is maintained. Damage to any single organ most definitely affects the normal body metabolisms. Damage to an organ can occur spontaneously (and by that it is described as acute) or it can be long-lasting (and by that it is described as chronic). Most organs especially the kidney, are also subject to the above organ damage description.


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Damage to the kidney is referred to as kidney failure. Kidney failure can be acute or chronic depending on the latency of the damage. There is also another type of kidney failure referred to as End State Renal Disease (ESRD) which is the nonfunctioning of the kidneys for more than three months. The theme of this article is Acute Kidney Failure. Acute kidney failure (or acute kidney infection (AKI) or acute renal failure) as the name suggests, occurs when the kidney(s) suddenly cease(s) to function. The reason for this topic is specifically due to the alarming cases of this disease in The Gambia’s main referral hospital, Edward Francis Small Teaching hospital (EFSTH). Throughout this article, we will go through the factors that can cause this condition, the duration in which this disease develops, the symptoms and clinical signs of the disease, possible complications (i.e. the risk factors) that might arise from the disease, the devastating outcomes that result from the disease, the treatment of the disease, its prevention, and a quick word of advice.
The kidneys are paired organs on the lateral sides of the body’s abdomen.

The kidneys primarily function in filtering blood. The kidneys absorb the good elements needed by the body such as glucose and secrete waste products such as urea basically in the form of urine. The kidneys also function in maintaining water balance, blood pressure and acid levels of the body. In acute kidney failure, the kidney loses its ability to perform the above tasks.

Causes of Acute kidney failure
Acute kidney failure is caused by a lot of factors. However, these factors can be grouped as prerenal, renal and postrenal (with ‘pre’ and ‘post’ meaning before and after respectively and renal meaning the kidney).
Prerenal factors are associated with low blood flow to the kidney. These could result from various abnormalities such dehydration, vomiting, diarrhea and heart failure. These factors cause a decreased blood supply to the kidney. The kidneys cannot filter enough blood thus leading to the accumulation of toxic waste in the blood. Anti-hypertensive drugs such as Enalapril, Captopril, Losartan, Valsartan, Propanolol, Hydralazine, and Nifedipine could also cause acute kidney failure since these drugs impair renal perfusion through the dilation of the efferent arterioles and decrease in intraglomerular pressure. Prerenal acute kidney failure is treated by regulating the blood flow to the kidneys to normal and stopping the administering of the drug.

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Renal factors are those that affect the structures in the kidney. Those that affect the functional unit of the kidney, the Nephron, are caused by ischemia (i.e. low blood flow) to the kidney. This will cause some of the cells in the kidney to lose function and become necrotic (i.e. dead). This medical condition is what is referred to as acute tubular necrosis. Inflammation of the blood-filtering machinery of the kidneys known as glomeruli (i.e. Glomerulonephritis) also causes acute kidney failure. This impairs the kidneys’ ability to properly filter blood.

To asses for cases of glomerulonephritis, a biopsy of the kidney tissue is required. Patients who have a history of catheterization are also prone to acute kidney failure of this type.
Postrenal are those factors that cause acute kidney failure due to obstruction of the urinary tract. Obstruction is usually due to the presence of solidified blood (stones) in the urinary tract. It can occur in the ureters, bladder and urethra. Obstruction can also be caused by prostatic cancer which mostly occurs in elderly men. Blockage leading from the kidney can cause an increase in pressure in the kidney. The kidney will filter waste products such as urea, but these waste products will be trapped in the kidney or along the urinary tract exerting their toxic effects and thus damaging the kidney.


How long does it take for someone to develop acute kidney failure?
Although different people have different physiological variables, and that what is normal for one might not be normal for another (as in the case of an athlete and old man), acute kidney failure develops in about two days to a week.


What are the signs and the symptoms of acute kidney failure?
Although the signs of acute kidney failure remain the same, different patients present divergent symptoms depending on the gravity of the condition. Albeit, the most common symptoms of AKI include: fatigue, nausea, vomiting, weight-gain, loss of appetite, anemia, bloody stool, and confusion. Clinical signs are usually done by taking the urine and blood sample of the suspected patient. The levels of urea, creatinine and Blood Urea Nitrogen (BUN) test are assessed alongside Potassium levels during clinical diagnoses. Patients with acute kidney failure usually have a marked increase in Urea, Creatinine and Potassium levels. Also renal biopsy is done to assess acute kidney failure as noted earlier.


Complications of acute kidney failure
Acute kidney failure results in a series of abnormalities. These include hypertension, diabetes mellitus, and pulmonary edema, metabolic acidosis resulting from the vomiting, and hyperkaelemia which can impair the cardiac rhythm and thus causing the heart failure.


What are the outcomes of acute kidney failure?
Well, the prognoses of this disease are highly dangerous and life-threatening. Untreated acute kidney failure can lead to chronic kidney failure, heart damage which is usually due to the staggering increase of blood Potassium levels which permanently stop the heart from beating, and nervous system disorder due uremia. The increase amount of urea in the blood causes urea to go to the brain and insert its toxic effects by depleting some essential metabolites of various metabolic pathways such as glycolysis. These effects cause mayhem in thought, memory, vocalization, emotional and motivational drives. The most severe outcome of untreated acute kidney failure is End State Renal Disease (ESRD). This is the most common type of kidney disease in EFSTH. The last complication of untreated acute kidney disease is death.


Treatment of acute kidney failure
Acute kidney failure is treated using a dialysis machine. The function of this machine is to clean the blood (i.e. Serve as a kidney substitute). Patients with acute kidney failure must present with certain signs before they can be considered for dialysis. These include when the fluid content of the body cannot be regulated with just administering diuretics, when there is too much Potassium in the body, or when there is excess urea in the blood (uremia). The prime aim of the treatment for acute kidney failure is to restore the renal perfusion and blood-filtering mechanism of the kidney. This is mainly coordinated with the diet. Patients with acute kidney failure are encouraged to eat less of proteins and more of carbohydrates. This is because protein content contributes to the amount of urea in the blood.

How do I save myself from getting acute kidney failure?
Knowing what acute kidney failure is one thing, but preventing it is another. It all comes down to diet. Although the disease is most common in elderly persons above seventy five years of age, the foods we eat and the lifestyle we take contribute a lot to the acquisition of this disease. Since diabetes mellitus is a risk factor for acute kidney failure, regulation of our daily food intake combined with exercise can go along to preventing this disease.

Final say
At EFSTH, there are only twelve dialysis machines which are responsible for cleaning the blood of End State Renal Disease patients. And with over fifty patients queuing up for these machines, you my dear reader can make a difference by following the above guidelines and by spreading this piece to all friends and family so as to put an end acute kidney failure.

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