Advice on kidney problems

Acute kidney failure is a sudden deterioration of kidney function. This alteration causes the blood's filtering capacity to be altered and, consequently, nitrogenous substances, such as urea, ions such as potassium, accumulate in the blood, whose accumulations can produce cardiological and neurological alterations. If he kidney failure It is not diagnosed and it is treated in time, it can progress to chronic kidney failure or irreversible failure whose only solution is dialysis or kidney transplantation.

How is it produced and what are the causes?

The blood reaches the kidney to be purified and the remains that are produced in this filtering are eliminated through the urinary tract. An alteration in any of these three levels (blood supply, kidney tissue or urinary tract) can lead to a acute kidney failure.

The alteration of the blood supply to the kidney produces an acute prerenal renal failure. Is the main cause of acute renal failure, more than 50% of cases acute kidney failure. The kidney itself functions properly but not having an adequate blood supply it cannot perform its function. The main causes of a decrease in blood flow to the kidney are bleeding, fluid loss in large burns, heart failure, liver cirrhosis, or occlusion of the renal artery or aorta.

About a 40% of cases of acute renal failure are due to a injury to the kidney tissue itself. In these cases the arrival of blood to the kidney is adequate, but as the organ is damaged it cannot perform its purification function well.

A 85% of these acute kidney failures are due to acute tubular necrosis, to a death of the tubular cells, in general due to a sustained lack of blood supply, although sometimes it can also be produced by the effect of external toxic substances, such as certain antibiotics, metals or iodinated contrasts, or those of the organism (hemoglobin, bilirubin), which when accumulated can damage kidney tissue. Less frequently a injury to the glomeruli, capillaries, or surrounding tissue of the glomerular structures can trigger acute renal failure.

In a not very high percentage, a 10% of cases, the cause of kidney failure is by urinary tract obstruction. blood reaches the kidney and it purifies it well, but since it cannot expel urine, the kidney must work at a higher rate and overcome a higher pressure, so that in the long run the kidney tissue ends up suffering and the organ fails. The main causes are ureteral stones (the first cause of unilateral obstructive renal failure), bladder carcinomas, hyperplasia or prostate cancer (the first causes of bilateral obstructive renal failure) or urethral trauma that prevents the expulsion of the bladder. urine.

Symptoms

When the kidney cells are damaged, the blood is not cleaned well and nitrogenous substances accumulate in it, such as urea, which will be elevated in the blood analysis with values ​​greater than 40 mg / dl. Likewise, creatinine will also appear elevated, with figures above 1.2 mg / dl. The accumulation of urea can lead to a picture of uremia, with symptoms such as:

• nausea and vomiting
• Dry tongue
• Swollen gums
• Breath smelling of urea
• Neurological disorders, such as torpor, lethargy, and even coma.

The retention of water and salts will produce edema that can become generalized and produce heart failure or lung edema. This same retention helps blood pressure to rise. An excess of potassium also accumulates in the blood, which is not eliminated in the urine and which can lead to heart, neurological and muscle rhythm disturbances.

Due to fluid retention and decreased erythropoietin production, a anemi statusto. Similarly, there are alterations in both platelets and clotting factors, which predispose to occurrence of bleeding (especially digestive) and bruises. The immune response is also altered and therefore the body is more susceptible to infection, which is the main cause of death in patients with acute kidney failure.

Initially, urine production decreases, with oliguria or even anuria. Later, when the body has established hormonal and nervous compensatory mechanisms, diuresis recovers and a phase of polyuria is entered, of increased daily urine production.

Diagnosis

The first thing to do is to differentiate if kidney failure is acute or chronic. A home clinic abrupt and less severe will suggest acute kidney failure. The renal ultrasound It will also be useful, since in chronic renal failure a diminished kidney is seen, something that is not observed in acute renal failure.

They should then be searched possible obstructive causes at the level of the urethra, bladder, prostate or gynecological apparatus. A correct physical examination as well as imaging tests such as ultrasound or computed tomography (CT) will allow to confirm or rule out the obstructive postrenal origin of acute renal failure.

Discarded the obstructive origin, the urine test It will allow difference between the prerenal or renal origin of the insufficiency. In the case of prerenal failure, the tissue works correctly, so urine sodium will be low and urea and creatinine levels will be high. On the contrary, in case of kidney tissue failure, urine sodium will be high and urea and creatinine will be low. Other alterations in urine sediment and proteinuria levels will guide the specific cause of kidney tissue damage.

The kidney biopsy It will provide a reliable diagnosis of the cause, but it should only be carried out if the cause cannot be determined by non-invasive methods, if there is oliguria or anuria lasting more than three weeks, when a systemic disease is suspected or for rule out other alterations.

Treatment

Treatment should be that of the cause whenever possible.

• If the origin is obstructive (tumors, lithiasis ...) the unblocking by surgery if required.
• In the event of prerenal failure,e increase blood volume to favor the arrival of irrigation to the kidney and if it is not enough, diuretics such as furosemide should be added.
• If the origin of the failure is in the kidney tissue itself, it should be restrict fluid intake, to correct edema and decreased sodium in the blood. furosemide will be given to treat high blood pressure, reduce edema, and force diuresis. Likewise, the caloric intake will be controlled, with a certain protein restriction, the excess of potassium in the blood will be corrected and, in case of anemia, erythropoietin will be administered or, in severe cases, the patient will be transfused.

The dialysis does not improve prognosis of acute renal failure, but should be performed if conservative treatments fail to correct fluid and salt alterations or if there are serious situations such as pericarditis, seizures or central nervous system involvement.

Precautionary measures

Should be sought avoid indiscriminate use and without medical supervision of medicines like anti-inflammatories and some antibiotics. In the same way, to ensure an adequate supply of blood to the kidney and its proper functioning, a balance diet, consume 1.5-2 liters of Water and do physical exercise on regular basis.