Acute Kidney Failure

2023 Author: Wallace Forman | [email protected]. Last modified: 2023-11-27 18:19

Acute kidney failure

Renal failure (renal insufficiency, renal insufficiency) leads to a deterioration in renal function. This increases the concentration of urinary substances in the blood (substances that have to be excreted via the kidneys), e.g. creatinine and urea. The regulation of the water, electrolyte and acid-base balance is impaired. After the kidneys also produce hormones or activate vitamins, blood formation disorders and changes in bone metabolism can occur.

The kidneys can be damaged by inflammatory processes, vascular calcification and various other diseases (high blood pressure, diabetes mellitus, genetic factors).

In acute kidney failure, the kidneys lose their functionality relatively suddenly - usually within a few hours or days. The disease is life-threatening if left untreated. The extent to which kidney function is subsequently recovered depends very much on the triggering cause.

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What are the causes of acute kidney failure?

Acute kidney failure can be triggered by numerous factors. These are divided into three groups.

The cause lies "in front of" the kidneys (prerenal kidney failure):

The kidneys are no longer supplied with sufficient blood. Possible triggers for this most common form of acute kidney failure include:

• Heart disease (e.g. heart failure, heart attack),
• Pulmonary embolism,
• Massive bleeding (e.g. as part of an injury or surgery),
• Burns,
• severe inflammation with circulatory failure.

The cause lies in the kidneys (intrarenal kidney failure):

Pathological changes occur in the kidney vessels, the kidney filter bodies or in the kidney connective tissue. Possible triggers include:

• Inflammation (e.g. glomerulonephritis, but also infections),
• Medication,
• Poisoning,
• Immune system disorders.

The cause lies "behind" the kidneys (postrenal kidney failure):

An obstruction of the drainage in the ureter or in the urinary bladder causes urine to back up. The following causes are possible:

• Urinary stones,
• Enlargement of the prostate,
• Tumors.

What consequences & complications can occur?

In the case of acute kidney failure, the blood is no longer adequately filtered. This causes the salt and fluid balance to get out of balance. Possible consequences include:

• Water retention in the tissue (edema),
• High blood pressure, with a risk of stroke, heart attack or pulmonary edema,
• Heart failure,
• Cardiac arrhythmias,
• Inflammation of the heart sac (pericarditis),
• Increase in the level of potassium in the blood,
• Acidification of the blood,
• Bleeding disorders with the risk of bleeding in the gastrointestinal tract,
• Muscle spasms.

How is the diagnosis made?

The symptoms of acute kidney failure are often uncharacteristic, especially in the early stages, such as nausea or fatigue. After the medical history and physical examination, various laboratory parameters are determined:

• Blood: creatinine, urea, creatinine clearance, C-reactive protein (CRP) etc.
• Urine: protein, urine sediment, etc.

Ultrasound and tissue removal (biopsy) using kidney puncture may also be necessary.

How is acute kidney failure treated?

There is no special therapy for acute renal insufficiency. If possible, prophylaxis is in the foreground. The underlying disease that triggers the disease is treated, for example antibiotics or immunosuppressants are administered in the case of inflammatory infections and urinary stones are removed by surgery or crushed using shock waves. Furthermore, the consequences of kidney weakness are treated, e.g. edema formation reduced or blood pressure adjusted. Intensive care monitoring is sometimes necessary. If the disease is severe, renal replacement therapy must be carried out at least temporarily. The blood is cleaned by dialysis until the kidneys start working again.

Depending on the triggering cause, kidney function recovers to different degrees. However, more recent data indicate that patients with acute kidney failure are at higher risk of developing chronic kidney disease later. Acute renal failure is potentially life-threatening. On the one hand, this is of course due to the fact that the triggering causes are often serious illnesses per se. On the other hand, the urine poisoning itself sometimes causes serious complications (e.g. disturbances in the electrolyte balance).

Whom can I ask?

For the treatment of acute kidney weakness, you can contact the following offices:

• Specialist in internal medicine,
• Specialist in nephrology,
• Emergency doctor in urgent cases.

Hospitalization is often required.

Note Patients with existing chronic kidney disease have a particularly high risk of suffering acute kidney failure. You should inform every treating doctor accordingly so that, for example, drugs that could potentially damage the kidneys are avoided as far as possible.

How are the costs going to be covered?

All necessary and appropriate diagnostic and therapeutic measures are taken over by the social security agencies. Your doctor will generally settle accounts directly with your health insurance provider. With certain health insurance providers, however, you may have to pay a deductible (BVAEB, SVS, SVS, BVAEB).

However, you can also use a doctor of your choice (ie doctor without a health insurance contract) or a private outpatient clinic. For more information, see Costs and Deductibles.

If a hospital stay is required, the hospital costs will be invoiced. The patient has to pay a daily contribution to the costs. Further medication treatment at home takes place by prescription from the general practitioner or specialist.

For more information, see What does a hospital stay cost?