The kidneys normally regulate red blood cell production, activate vitamin D, control blood pressure, excrete metabolic waste material through urine and regulate electrolytes, notes the text "Medical-Surgical Nursing." According to the Mayo Clinic, the symptoms of acute kidney failure are fatigue, decreased urine output, swelling in the legs and feet, confusion and chest pain. Although acute renal failure and chronic renal failure display similar symptoms, their causes differ, as do their treatment options.
Prerenal Causes of Acute Renal Failure
Hypoperfusion, or kidneys lacking circulation, which is called a prerenal condition, occur as a result of blood loss, heart failure, dehydration, as well as any other condition, disrupting circulation to the kidneys. A prerenal condition does not mean kidney damage, but the lack of circulation to the kidneys causes waste materials to accumulate in the bloodstream, thereby preventing the kidneys from functioning properly. When this happens, the display of evidence occurs through symptoms such as decreased urine output, fatigue and swelling in the legs.
Intrarenal Causes of Acute Renal Failure
Damage occurring within the kidneys, called an intrarenal condition, occurs as a result of medications such as nonsteroidal anti-inflammatories and a class of blood pressure medication called ACE-inhibitors, according to "Medical-Surgical Nursing." Skeletal muscle damage, due to burns or trauma, can also cause an intrarenal condition because of the subsequent increase in myoglobin. Myoglobin stores oxygen within skeletal muscle; however, when abnormally increased, myoglobin can cause renal toxicity.
Postrenal Causes of Acute Renal Failure
Postrenal damage to the kidneys occurs as a result of an obstruction distal to the kidneys such as a urinary tract obstruction and an enlarged prostate, which would cause pressure to rise within the kidneys, according to "Medical-Surgical Nursing."
Causes of Chronic Renal Failure
Chronic renal failure occurs gradually over the course of several years, and may be initiated by another preexisting condition such as diabetes or hypertension, according to "Medical-Surgical Nursing." Unlike acute renal failure, chronic renal failure is irreversible and requires ongoing treatment.
Treatment of Acute Renal Failure
Treatment of acute renal failure depends on the cause, and must begin as quickly as possible to preserve renal function. If the acute renal failure was caused by severe dehydration, consuming large amounts of fluids either orally or intravenously should begin as quickly as possible to prevent permanent damage to the kidneys. Maintaining a urine output greater than 400 ml per day ensures proper response to treatment, notes "Medical-Surgical Nursing." Medications causing acute renal failure, such as ACE-inhibitors and nonsteroidal anti-inflammatories, should be discontinued. An influx of high amounts of fluid can flush out the myoglobin accumulating within the kidneys. Preserving renal function by treating the cause as quickly as possible is the goal of treating acute renal failure.
Treatment of Chronic Renal Failure
Treatment of chronic renal failure involves an ongoing process of balancing sodium and water intake, dietary modification such as measuring protein and potassium intake, blood pressure management and treating anemia. In severe cases, dialysis, a medically invasive procedure in which a man-made machine functions as the kidneys, may be necessary. Dialysis may also serve as a short-term treatment for those diagnosed with acute renal failure.
References
- MayoClinic.com: Acute kidney failure
- "Medical-Surgical Nursing: Volume 2, 10th Edition"; Suzanne Smeltzer, RN, EdD, and Brenda Bare, RN, MSN; 2004
