Post Date April, 15 2023
Acute renal failure can often recover, while chronic renal failure is often irreversible, so it is important to distinguish between the two.
Identify by medical history
1. Do you have a history of nocturnal polyuria? Nocturnal urination refers to nocturnal urine volume exceeding 1/2 of daily urine volume, indicating dysfunction of distal renal tubular concentration. People with a history of this disease are mostly chronic renal failure.
2. Is there early oliguria? Oligouria refers to a daily urine volume of less than 400 milliliters. Some patients with acute renal failure may develop oliguria if their condition is not severe, while chronic renal failure does not develop oliguria until the end stage (creatinine clearance<10ml/min=). Therefore, if oliguria occurs early in renal failure, it indicates acute renal failure
3. Is anemia present? Chronic renal failure is almost always accompanied by anemia. Glomerular, renal vascular, and interstitial acute renal failure are also frequently accompanied by anemia, while tubular necrosis type acute renal failure is often accompanied by no or only mild anemia.
Although these data have significant limitations in differentiating acute and chronic renal failure, they still have reference value and should not be ignored.
1、 Identification by imaging examination
Although various imaging examinations can detect the size of the kidney, B-mode ultrasound is commonly used in clinical practice
In chronic renal failure, glomerulosclerosis, tubular atrophy, and interstitial fibrosis often reduce the size of both kidneys. For this reason, the patients with increased volume of both kidneys are mostly acute renal failure ARF (early stage of chronic renal failure caused by renal amyloidosis or diabetes nephropathy, sometimes the volume of both kidneys is also large, which should be differentiated), while those with decreased volume of both kidneys are chronic renal failure.
However, it must be noted that sometimes in the early stages of ARF and CRF, the patient's renal volume does not increase or decrease. At this time, imaging examinations are not helpful in differentiating acute and chronic renal failure, and other pathological examinations such as renal biopsy must be relied on.
2、 Laboratory examination
1) Nail creatinine test is mainly used to identify acute and chronic renal failure. In recent years, there have been reports of hair creatinine test. Nail (hair) creatinine testing is often used only when renal imaging is not helpful in identifying acute or chronic renal failure (i.e., when the size of the kidney is normal). The nail (hair) with normal creatinine and significantly increased SCr indicates ARF; The increase of both nail (hair) creatinine and SCr indicates CRF.
2) Low serum calcium, phosphorus, and parathyroid hormone levels support chronic renal failure.
Understanding of acute renal failure
"Your kidneys can suddenly stop functioning for one or more reasons. Generally speaking, the main reasons are the immune response of three toxic substances to drugs, as well as infections or diseases such as acute glomerulonephritis, which can seriously damage the kidneys to the point where they can collapse. In the event of severe burns, the blood pressure suddenly decreases and severe bleeding occurs."
Your kidneys may suddenly stop functioning for one or more reasons. Generally speaking, there are three main reasons for this: toxic substances, immune responses to drugs, and infections or diseases such as acute glomerulonephritis, which can seriously damage the kidney to the point where it can fail; Sudden decrease in blood pressure during severe burns, severe bleeding (such as crushing trauma), or a major heart attack can lead to abnormal blood supply and damage to the kidneys; The last cause is a blockage in the urinary tract that suddenly and completely blocks the flow of urine.
The dysfunction caused by this disease can prevent your kidneys from producing urine, causing waste products to accumulate in the blood. The water in your body can no longer be effectively discharged, resulting in water accumulation. Finally, under normal circumstances, dangerous imbalances in the concentration of chemicals in the body that are constantly regulated by the kidneys can also occur.
Mild episodes of acute renal failure are common, but more severe acute renal failure (such as acute renal failure caused by glomerulonephritis) is extremely rare.
The most obvious symptom is that you urinate less than usual, and may urinate less than half a liter per day. In a short period of time, you will lose your appetite, feel more and more nausea, and begin to vomit. If not treated promptly, symptoms such as drowsiness, insanity, spasms, and coma can occur. In most cases, the symptoms that cause acute renal failure are initially more pronounced than the symptoms of renal failure itself.
Acute renal failure is a potentially dangerous disease whose harm depends on the severity of the underlying cause of renal failure. Even with the use of artificial kidney machines for treatment, patients may not necessarily recover.
If you have acute renal failure, you urgently need to be hospitalized for treatment, preferably in a hospital with a special treatment unit for kidney disease. "If the cause of acute renal failure is unknown, you may have to undergo a series of diagnostic tests, including blood and urine sampling, intravenous kidney radiography, and kidney biopsy.".
If acute renal failure is caused by severe bleeding or a heart attack, it usually requires urgent treatment. The form of treatment depends on the situation. If a diagnostic test shows that the cause of acute renal failure is obstruction, you may need to undergo abdominal surgery to remove the obstruction. If the cause of the disease is a disease of the kidney itself, even if the basic cause of renal failure is successfully treated, but the kidney continues to suffer serious damage (this situation often occurs), the treatment method is different.
For example, drip blood or plasma from a vein, or add diuretics that increase urine volume, as well as other drugs that restore normal kidney function. In certain situations (such as the occurrence of acute glomerulonephritis), special and effective drugs are used for treatment. In other cases, doctors may replace your kidneys with artificial kidney machines until they return to normal function. This treatment is called dialysis. Dialysis therapy is painless, but if you have acute renal failure, you may have to be hospitalized for several weeks before kidney function returns to normal.
During treatment, you may need a special diet that is high in calories and low in protein, and should not consume more than half a liter of liquid per day. This diet can minimize the workload of your kidneys (or artificial kidneys).
Causes of renal failure: ten risk factors for inducing acute renal failure
In clinical practice, acute renal failure (ARF) has involved various disciplines such as internal, external, gynecological, pediatric, infectious, and trauma. Before the occurrence of acute renal failure, there are often some risk factors, and those with these risk factors can be referred to as high-risk groups prone to acute renal failure. Therefore, attention should be paid to the risk factors of acute renal failure, and in clinical practice, acute renal failure (ARF) has involved various disciplines such as internal, external, gynecological, pediatric, infectious, and trauma. Before the occurrence of acute renal failure, there are often some risk factors, and those with these risk factors can be referred to as high-risk groups prone to acute renal failure. Therefore, paying attention to the risk factors of acute renal failure and giving correct treatment can effectively prevent the occurrence of acute renal failure.
Nephropathy treatment 1. Elderly and young children: Elderly people have degraded renal function, decreased ability to detoxify drugs, high sensitivity to nephrotoxic drugs, and are prone to acute renal failure. Children are prone to dehydration, hypotension, and other blood volume deficiencies;
Nephropathy treatment II: low blood volume: massive bleeding caused by various reasons; Loss of fluid in the kidneys and gastrointestinal tract, loss of skin fluid (such as burns, excessive sweating), and other causes of insufficient blood volume. During low blood volume, renal blood flow perfusion decreases and GFR decreases. At the same time, sympathetic nerve stimulation and elevated vasopressin can cause intrarenal vasoconstriction, further reducing GFR, leading to acute renal failure;
Nephropathy treatment 3. Circulation insufficiency: Various causes of shock, heart failure, and other circulatory insufficiency can lead to insufficient renal perfusion and decreased GFR. Excessive use of antihypertensive drugs is also an inducing factor;
Nephropathy treatment 4. Severe infection and sepsis: Various severe infections, especially those with sepsis, can induce acute renal failure through renal ischemia and nephrotoxicity mechanisms; R6t Nephropathy Treatment Network
Treatment of kidney disease: Severe trauma: such as burns, crush injuries, severe fractures, etc., can easily lead to acute renal failure due to shock, infection, and myoglobin released from wound tissue. In severe burns, massive fluid loss and intravascular hemolysis are also prone to acute renal failure;
Nephropathy treatment 6. After surgery: Severe primary disease, use of anesthetic and sedative drugs, tissue trauma, fluid loss, blood loss, and other factors make acute renal failure prone to occur after major surgical operations. The chance of renal failure after cardiac surgery depends on the time of cardiopulmonary bypass and the recovery of cardiac function after surgery;
Obstetrical complications in the treatment of kidney disease: early pregnancy with contaminated abortion; late pregnancy with severe pregnancy induced hypertension, massive bleeding, pain and other complications are prone to induce acute renal failure;
Nephropathy treatment VIII. Liver cirrhosis and ascites: At this time, the plasma renin angiotensin aldosterone system has been activated, and the increase of vasopressin secretion will lead to the retention of water and sodium in the kidney. Abnormal liver function reduces the ability of drugs to detoxify. At this time, if the ascites are released too much or too quickly, it is easy to induce acute renal failure, and such patients are also prone to acute renal failure when using nephrotoxic drugs;
Nephropathy treatment 9. Application of nephrotoxic drugs: the use of nephrotoxic drugs, such as aminoglycosides, contrast agents and cephalosporins, is especially dangerous in the elderly, children, dehydration, diabetes, cirrhosis, and patients with existing kidney diseases, and is prone to induce acute renal failure. In addition, the use of anticholinergic drugs in elderly patients with prostate hypertrophy, the use of angiotensin converting enzyme inhibitors in renal vascular hypertension, the abuse of non steroidal anti-inflammatory drugs, cyclosporin overdose, and acute hyperuricemia induced by chemotherapy drugs are all prone to induce acute renal failure;
Treatment of kidney disease 10. Kidney disease: Chronic kidney disease can often affect the self-regulation function of the kidney, and can induce acute renal failure due to exacerbation of the disease or some additional factors, such as infection, urinary tract obstruction, water electrolyte disorders, and the use of nephrotoxic drugs. In recent years, attention has been paid to idiopathic acute renal failure in nephrotic syndrome. Acute renal failure can occur in nephrotic syndrome due to mechanisms such as insufficient effective circulating blood volume, proteinaceous tubular obstruction of renal tubules, renal interstitial edema compressing renal tubules, and renal vein thrombosis, indicating that renal disease itself should be considered as an independent risk factor.
