Renal failure is a medical condition where the normal functionality of the kidneys are lost suddenly. In this condition, the kidneys are incapable of removing waste and concentrating urine thereby leading to the loss of electrolytes from the body. This leads to accumulation of toxins and waste products in the blood. Glomerular filtration rate decreases when the kidneys fail.
There are three forms of renal failure namely acute renal failure, chronic renal failure, and acute-on-chronic renal failure.
Acute renal failure occurs where there is a sudden interruption to the blood flow thereby leading to rapid loss of kidney function. The most common causes of acute renal failure are trauma, complications from surgery such as heart bypass surgery, injuries, drug overdoses, accidental overload such as the onset of crush syndrome, chemical overload of antibiotics and chemotherapeutic agents, bladder tumor, renal calculi, acute glomerulonephritis, acute tubular injury, enlarged prostate, fluid depletion, sun stroke, cardiac failure, septic infections, and hemorrhage.
Chronic renal failure is a condition which develops slowly and is characterized by irreversible impairment of the renal function. It may be a part of disease progression. The causes of chronic renal failure are infectious diseases such as hantavirus, diabetes mellitus, high blood pressure, polycystic kidney disease, overload of drugs such as aspirin and paracetamol, glomerulonephritis, tuberculosis, congenital anomalies, kidney stones, nephrotoxins, and autoimmune diseases.
Acute-on-chronic renal failure is a condition where acute renal failure is superimposed on chronic renal failure. The causes of this disease are acute tubular necrosis, acute nephritic syndrome, hemolytic uremic syndrome, interstitial nephritis, transfusion reaction, idiopathic thrombocytopenic thrombotic purpura, scleroderma, acute pyelonephritis, placenta abruptio, septicemia, urinary tract obstruction, and placenta previa.
The common symptoms of renal failure are bad taste in mouth, hematochezia, hematuria, oliguria, easy bruising, mood swings, loss of appetite, numbness and tingling sensation, fatigue, flank pain, shakes and chills, vomiting, nosebleeds, prolonged bleeding, persistent hiccups, seizures, edema, pulmonary edema, nocturia, diarrhea, difficulty urinating, itching, damage to bones, muscle cramps, arrhythmia, shortness of breath, skin darkening, proteinemia, hypertensive crisis, hyperkalemia, and acidosis.
Physical examination, blood chemistries, BUN and creatinine level, arterial blood gas, urinalysis, and abdominal ultrasound are all used to identify renal failure.
There are various methods of treatment available for renal failure. In general, drugs which require renal excretion are avoided. Some of the treatment methods for initial stages are maintaining fluid intake and fluid output balance, high-carbohydrate diet, low-protein diet, amino acid replacement, intake of glucose to maintain necessary blood glucose levels, reduction of salt and potassium in diet, prevention of infection, vitamin supplements, maintain an appropriate body mass index, monitoring of electrolytes, and monitoring of cardiac status, mental status, and vital signs. Drug therapy is administered if the renal failure is due to other diseases such as hypertension, diabetes, etc. Antihypertensives, diuretics, antibiotics, phosphate binders, anticonvulsants, antiemetics, and laxatives are used to treat the root causes of renal failure. When other modes of treatment fail, dialysis is used. It is also opted when there is an abnormal increase in potassium level, when there is change in mental status, when the person has stopped urinating, and when there is increased fluid retention. If the person has end-stage renal disease, then peritoneal dialysis or hemodialysis can be undergone to provide relief and reverse the condition. A procedure called kidney transplantation also can be used to treat renal failure. This procedure is better than dialysis procedure since it offers a good survival rate. Persons with end-stage renal disease are often supported by support groups to relieve stress.
Blood pressure control, smoking cessation, abstinence from alcohol and recreational drugs, physical exercise, and proper diet also plays an important role in preventing this disease.
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