Pharmacotherapy/Treatment Of Acute Kidney Failure (AKF)

Acute kidney failure (acute renal failure) is a condition whereby the kidney suddenly fails to filter waste products from the body. This waste accumulates in the body at dangerous levels. It's lust from 4 hours to 3 days. It can be fatter and reversible.

The kidney is an organ in the body responsible for removing extra fluid from the body. This helps to regulate blood pressure, electrolyte and activate vitamin D.

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Symptoms Of Acute Kidney Failure (AKF)

Acute kidney failure sometimes comes without symptoms. Some symptoms may include;

1. Reduce urine output

2. Fluid retention

3. Shortness of breath

4. Fatigue

5. Confusion

6. Nausea

7. Weakness

8. Irregular heartbeat

9. Chest pain or pressure

10. Seizures or coma

Acute Kidney Failure (AKF)

Complications

1. Fluid buildup in lungs can cause cough and difficulty breathing

2. Chest pain

3. Acidic blood

4. Muscle weakness

5. Chronic kidney damage

6. Death

Cause

1. Damage to the kidney cause by blood clot in kidney

2. Block ureter

3. Slow blood flow to the kidney due to fluid or blood loss or blood pressure lowering drugs, cholesterol deposits

4. Heart disease

5. Infection

6. Liver failure

7. Non steroidal antiinflammatory drugs (NSAIDs)

8. Severe allergic reaction (anaphylaxis)

9. Severe burns

10. Severe dehydration

11. Glomerulonephritis

12. Hemolytic anaemia syndrome (premature destruction of red blood cells)

13. Covid-19

14. Lupus

15. Medication e.g. chemotherapy, antibiotics

16. Dyes in imaging test

17. Toxins

18. Scleroderma

19. Thrombotic thrombocytopenic purpura

20. Muscles breakdown

21. Breakdown of tumor cells

22. Urine blockage caused by bladder cancer, cervical cancer, colon cancer, enlarged prostate (Prostate cancer), kidney stones

23. Nerve damage involving the nerves that control the bladder

Risk Factors

1. Age

2. Diabetes

3. Blood pressure

4. Kidney disease

5. Liver disease

6. Certain cancer and treatment

7. Blockage of peripheral artery

8. Hospitalised patient in serious condition like intensive care

9. Heart failure

Complications

1. Fluid buildup

2. Chest pain

3. Muscle weakness

4. Permanent kidney damage

5. Death

Prevention

1. Use of NSAID should be according to prescription

2. Manage kidney and other disease

3. Healthy diet

4. Exercise

5. Avoid alcohol

Diagnosis

1. Glomerular filtration rate (GFR) is the first test to determine if the kidney is functioning. It involves measuring the urine output under 24 hours

2. Urine test to determine the presence of protein

3. Blood test to determine the level of waste in it like creatinine, urea nitrogen, serum k and sodium

4. Imaging test to see if the kidney is losing its shape

5. Biopsy

Pathophysiology Of Acute Kidney Failure

The pathology of acute kidney failure or acute kidney injury (AKI) is as diverse as the entities causing it. It is a syndrome that rarely has a sole and distinct pathophysiology. The pathophysiology of AKI is multifactorial and complex. The three main way kidney failure start is blocking of blood flow to the kidney thereby reducing the amount of blood the kidney can filter. The second is the urine that gets filtered by the kidney is blocked from leaving. The last is any damage to the kidney by any means that can alter the kidney integrity and structure.

The most common cause of AKI is ischaemia. Physiological adaptations, in response to the reduction in blood flow can compensate to a certain degree, but when delivery of oxygen and metabolic substrates becomes inadequate, the resulting cellular injury leads to organ dysfunction. The kidney is highly susceptible to injury related to ischaemia, resulting in vasoconstriction, endothelial injury, and activation inflammatory processes. Following the reduction in effective kidney perfusion, the epithelial cells are unable to maintain adequate intracellular ATP for essential processes. This ATP-depletion leads to cell injury and if it is severe enough can lead to cell death by necrosis or apoptosis. During an ischaemic insult all segments of the nephrons can be affected but proximal tubular cells are the most commonly injured. In addition, the nephron’s natural function is to filter, concentrate and reabsorb many substances from tubular lumen, and the concentration of these substances may reach toxic levels for the surrounding epithelial cells.

The pathophysiology of septic-AKI is very complex and involves inflammation, oxidative stress microvascular dysfunction and amplification of injury via secretion of cytokines by tubular cells. Our knowledge is mainly obtained from animal studies where the ischaemia-reperfusion model has been extensively studied. Other models (toxic injury, septic model) are less studied. However, these latter models are quite extreme and are not representative of the clinical manifestations of AKI in humans, where renal blood flow never fully stops (except in certain surgical procedures i.e. abdominal aortic aneurysm repair) but less severe forms of low blood flow followed by reperfusion generally occur.

Pharmacotherapy/Treatment Of Acute Kidney Failure

There is no cure. Treatment is aimed at relieving symptoms and preventing complications. Treatment options are targeted at the symptoms and the cause of the disease causing kidney failure.

Read Also: Treatment of glomerulonephritis

1. Balance fluid: acute kidney failure results in change in fluid in the blood. When the fluid is not enough, intravenous fluid is use. But when there is excess fluid in the body, diuretic is use. Furosemide is a loop diuretics recommend for excess fluid in the body associated with AKF. Dose is between 20-80mg as a single dose daily until body fluid is adequately controlled.

2. Calcium is given to those with weak bones due to kidney failure. It also help to remove potassium from the body. Calcium is given with vitamin D3 to aid absorption of calcium. Dosage of calcium depends on the age and severity. 500mg to 1000mg calcium is the recommended dosage for a day. Glucose to replace lost glucose due to kidney failure. Drugs is given to remove excess potassium such as diuretic. Potassium sparing diuretic must be avoided. Avoid oranges and banana with high potassium content and eat more if apples and grapes that does not contain it. High potassium causes arrhythmias and muscle weakness. However, sodium is to be avoided in acute kidney failure even in low blood pressure. Drugs to regulate phosphorus is also use. Avoid oatmeal, nuts, peanut butter, whole grain bread that contain phosphorus.

3. Dialysis is the last resort. It involves removing waste from the body. There are two methods but the most common method is the use of machines to remove waste from the body. It is recommended that this should be done at least three times a week. But the higher the number of dialysis done, the better.