Acute renal failure

You might be pleasantly surprised to learn that almost all of our intensive care patients with renal damage end up leaving us safely without any residual effects. That’s because the kidney recovers perfectly, you just need a little help and don’t interfere with its recovery. Some people are helped by this drug:

What is the problem with renal failure?
So, acute renal failure is a sudden loss of function of both kidneys.

Some people think that kidney failure manifests itself as if a valve is turned off and there is no fluid (urine). No, renal failure is manifested by a decreased rate of diuresis. In adults, the rate of diuresis decreases to less than 50 milliliters per hour, and in children, less than 2 ml per kilogram of weight per hour.

In this case, substances formed as a result of metabolism (urea, creatinine, etc.) accumulate, and as a result, normal functioning of the body is impaired. However, urea, creatinine and other “toxins” the body tolerates to the last, but electrolyte disorders, especially high potassium in plasma, can quickly lead to cardiac arrest.

I was an intern. A young man with signs of poisoning by an unknown poison (presumably ethylene glycol) was admitted to the department of a regional hospital in the evening. He was already unconscious; we had to put him on controlled ventilation at once. There was no urine, urea and creatinine were above all limits. All attempts to stimulate the kidneys with medications were unsuccessful. He was scheduled for dialysis in the morning. However, the same morning the guy died. His potassium was 1.5 times normal.

Causes of renal failure
But a case of acute renal failure as a result of poisoning is rather rare. Much more often renal dysfunction occurs as a result of a complication of an underlying disease. The kidneys are always the second to be affected, but in the end it is often kidney problems that come first among the causes of death or disability. The development of kidney damage occurs for three reasons:

1. Pre-renal cause – prerenal cause. This is when some event has occurred that results in blood not flowing to both kidneys (because the blood in the kidney not only filters, but also feeds the organ itself) or not flowing in sufficient quantity. Squeeze the faucet in front of the filter, that’s it – the filter does not work. Why does this happen?

Myocardial infarction. Damaged heart muscle can’t cope with its function, doesn’t create the necessary pressure to push blood into the kidney tubules, ready – kidney failure. But if you put a stent in the damaged artery, spur myocardium with substances similar to adrenaline, and voila – the heart beats merrily, renal failure is solved.
Elemental dehydration. No water, blood gets thicker, the heart has trouble pushing through the thick slurry. You probably figured out how to treat it without me.
Anaphylactic shock. As a result of the body’s reaction to the allergen, the blood vessels have relaxed, the heart has become sluggish, and there is virtually no blood flow in the periphery. Well – adrenaline and plenty of fluids will save the situation.
In general, failure associated with prerenal causes is not difficult to treat. However, if you drag out the treatment for a long time, it is easy to get damage, ischemia of the renal tissue, and then there will be:

2. The actual renal cause is renal. In this case, the kidneys are affected directly from a nephrotoxic factor that affects the renal functional unit – the nephron (the formation where blood filtration occurs). The most basic factors are as follows:

Acute renal failure: poisons
Industrial poisons (e.g. ethylene glycol).
Medications (antibiotics like aminoglycosides, especially x-ray contrast agents are famous in this case).
Renal vascular damage, more often autoimmune. This is when there is a systemic disease like scleroderma, vasculitis, systemic lupus erythematosus, etc.: the body forms antibodies to its own tissues, including the inner lining of blood vessels (including kidney damage).
Severe renal trauma.
Diabetes mellitus.
Myoglobinuria. For example, after prohibitive for this individual physical activity, when there are damages of muscle cells with a massive release of myoglobin protein. Or in another situation – for example, in earthquakes, when people are crushed by a heavy beam, compressed tissues lose blood flow, swell, cells are destroyed, and when people are taken out from under the rubble, blood flow is restored and their own poisons, including myoglobin, enter the system.
3. Post-renal causes (post-renal) of acute renal failure. Here, some physical cause that prevents urine from flowing down the tubule (ureter) below the kidney is to blame. This is, for example, narrowing of the ureter of the single kidney, stones, tumors and other possible causes that do not allow the urine to enter the bladder. As a result, pressure increases in the renal tissue, vessels are compressed, blood circulation is impaired, and tissues die.