Acute renal failure is the sudden inability of the kidneys to remove waste products from the body and concentrate urine without losing electrolytes and causing dysfunction in the organ systems. This can happen because of an autoimmune disease, burns, septic shock, serious illness or surgery, malignant hypertension, transfusion reactions or as a secondary effect of pregnancy. The three stages of failure begin with acute renal failure, followed by chronic failure and end-stage renal failure.
Fluid and Electrolyte Balance
The American Academy of Family Physicians recommends when patients are dehydrated they are given normal saline intravenous solutions to replace the fluids. If there is too much fluid in the body, furosemide is given through the intravenous every six hours to help the body excrete fluid. Electrolyte and pH imbalances that are common are too much calcium in the blood and acidosis. Both calcium and pH levels will negatively affect the way the heart pumps blood and will be an indicator to the doctor of how aggressive treatment should be.
Nutritional Support
Acute renal failure places the patient in a catabolic state in which muscles are burned for fuel, unless additional calories are provided. Physicians at the American Academy of Family Physicians recommend total calorie intake between 30 to 45 kilocalories per kilogram per day. To maintain adequate metabolism, most of the calories should come from a combination of carbohydrates and lipids. Because metabolism of protein will result in more waste products, it should be restricted unless the patient is on dialysis.
Medication Adjustment
The type of medication adjustments will be determined by the type of kidney damage and failure. If the kidneys aren’t filtering potassium, the doctor may prescribe glucose, calcium or sodium polystyrene sulfonate to prevent potassium buildup in the blood stream. Physicians at the Mayo Clinic advise patients that too much potassium can cause dangerous irregular heartbeats. If levels of calcium fall, it may be infused through an intravenous line. Other medications for underlying medical conditions may be adjusted if they are metabolized and excreted through the kidneys to reduce the workload of the renal system.
Dialysis
Dialysis will help patients to feel better because it filters the waste products and toxins from the blood stream. When the kidneys are no longer able to perform their function, potassium levels will rise and patients will find they retain too much fluid, cannot urinate or eliminate nitrogen waste, develop pericarditis or mental status changes, according to the U.S. National Library of Medicine.
