Acute renal failure, or ARF, occurs from a rapid and sudden loss of kidney function leading to subsequent buildup of waste products and excess fluid in the body. Although ARF occurs abruptly, the condition is reversible through supportive intravenous drug and fluid therapy. According to Drs. Agrawal and Swartz in "American Family Physician," approximately 20 to 60 percent of ARF patients require short-term dialysis therapy. Dialysis is prescribed when other modes of treatment fail to reverse presenting conditions.
Fluid Overload
As kidney function declines, the body suddenly decreases its urine output at the onset of ARF. Excess fluids begin building up and cause increased blood pressure, or hypertension, and generalized swelling, known as edema. Fluid may also back up into the lungs, causing shortness of breath and decreased oxygenation. If the use of "water pills," such as intravenous furosemide, do not decrease fluid overload, dialysis treatment is initiated as a last resort, state Agrawal and Swartz.
Hyperkalemia
Electrolyte disturbances occur as a consequence of ARF and the most significant disturbance is hyperkalemia, or excess potassium. According to the University of Maryland Medical Center, uncontrolled hyperkalemia is life-threatening and, in the case of ARF, dialysis must be employed if other measures cannot control the increasing potassium levels. Symptoms of hyperkalemia include muscle weakness, irregular heartbeat, difficulty breathing, tingling and numbness leading to paralysis in severe cases. Dialysis is also indicated for unmanageable metabolic acidosis, which occurs from excessive acidity within the body's fluids due to the buildup of hydrogen ions.
Uremia
As nitrogenous waste products, or urea, build up within the body due to ARF, a toxic condition called uremia occurs. Signs of uremia include loss of appetite, nausea, vomiting, generalized weakness and itching of the skin. According to the Merck Manual, as excessive urea affects the brain, symptoms such as seizures, confusion and drowsiness may occur. Without intervention, these neurological changes will progress to disorientation and, eventually, coma. Dialysis is indicated for rapidly developing uremia in order to prevent ARF complications. Uremia can also affect the heart and cause pericarditis, an inflammation of the sac-like pericardium surrounding the heart. Signs of pericarditis include chest pain, especially when breathing in, friction rubbing between the pericardium and the heart, and low-grade fever.
