Case Study Acute Renal Failure

Injury to the glomerulus and the tubules presents the onset of Intra-renal failure (Matzke, 2011). Some of the frequent causes for Intra-renal failure are glomerulonephritis; pyelonephritis; and tubular injury. Post-renal failure develops from things like ureteroliths, tumors, or anatomic impediments. Opposite of the acute form, the chronic form has a slow onset that has no early stage symptoms. It is important to know that following an acute episode a chronic renal episode often follows, and at this juncture the damage is irreversible. Glomerulonephritis and pyelonephritis combined, has been reported to be the forerunner in as much as half the cases from acute to chronic renal failure. Diabetes mellitus, renal vascular disease, such as atherosclerosis, hypertension, polycystic kidney disease, drug damage, and nephrolith are all examples of other causes of CKD (Pradeep, 2014). Biopsies of kidneys that suffered with CKD reveal smaller kidneys with scarring on the tubules.

Acute renal failure condition is diagnosed and retitled as acute kidney injury. The purpose of the change of terminology was to encompass the full spectrum of the clinical manifestations associated with the syndrome. This includes a range from a small decline in kidney function to a severe impairment. Furthermore, the acute condition is characterized by a rapid loss of kidney function. In addition, associated manifestation(s) may be displayed as a rise in serum creatinine or a reduction in urine output. As a result of increase of serum creatinine or decline in urine output may developed and aggress to the clinical manifestation azotemia.

As previously stated Rhabdomyolysis can be caused from numerous injuries but it is ultimately the breakdown of muscle tissue that leads to life threatening conditions such as Acute Renal Failure. The process of muscle breakdown leads to depletion of Adenosine Triphosphate, which is where muscles receive their energy, and increased levels of potassium, creatine kinase, urate and myoglobin (Sauret, 2002). In addition to electrolyte disturbances causing toxicity leading to the breakdown of muscle tissue, the increase number of neutrophils from the inflammatory process amplifies muscle damage (Muscal, 2013). Acute Kidney Failure occurs because the increased levels of myoglobin, a large protein, that precipitates in the kidney tubules leading to obstruction that eventually leads to necrosis (Sauret, 2002).

Both of our kidneys functions to filter and excrete waste products and toxins by regulating fluids, electrolytes, and acid based balance. If the Renal blood flow is altered then the glomerular filtration rate will be altered as well. A decrease in systemic pressure stimulates the sympathetic nervous system to constrict the renal artery and decreases filtration and secretion in the kidney. In addition, a tubular obstruction can lead to the reduction of Glomerular filtration rate. An elevated intracellular calcium level due to tubular damage may alter cellular level that increases tubuloglomerular feedback and diminishes GFR. This may be prerenal, intrarenal, or postrenal. The prerenal will result from any condition outside of the kidney that disables the blood to flow to the renal vasculature causing a decrease in perfusion in the glomerulus leading to oliguria. However, both of the kidneys can still return to its full normal function on this stage. Second of the three is intrarenal, where anything can cause a direct damage to both of the kidneys such as infections, toxins, reduce blood supply, hypertension, diabetes, and even glomerulonephritis. The most common intrarenal condition is Acute Tubular Necrosis, where the epithelial layer of the nephrons are damaged causing a change in the concentration of urine, waste filtration, and an imbalance in electrolytes and acid

No one is certain about exactly what triggers ARDS, but it normally happens when you are previously ill or severely injured. Examples of conditions that may cause ARDS include: drug overdose, bacterial infection in the blood (sepsis), pneumonia, aspiration, near drowning, breathing in poison, multiple blood transfusion and severe injury. ARDS usually develops very rapidly, normally within 12 to 48 hours after the circumstance that caused it (Mancini, 2013).

Pre-renal failure has to do with inadequate fluid in the body, which leads to inadequate perfusion, or blood circulation in the body. This disables the kidney from properly filtering out the blood. Patients have low blood pressure, feel very ill and can go into shock. This may lead to multiple organ failure.

This physical damage can result from _____________. Mechanical ventilation can also cause the development of AKI by alteration of systemic and renal hemodynamics through changes to cardiac output. Studies have shown that PPV, by increase intrathoracic pressure, can decrease cardiac output (CO), which has been correlated with a decrease in renal plasma flow (RPF), GFR and UO (25). This correlation is supported in a canine study done by Qvist et al., in which they found that when CO was not altered during PPV, there was no decrease in GFR or UO (26). In addition to the hemodynamic effects seen in PPV, there are also marked neurohormonal effects of mechanical ventilation resulting in AKI. These include the increase of antidiuretic hormone (ADH) secretion, suppression of atrial naturitic peptide release, as well as alteration of the renin-angiotensin-aldosterone-axis (RANA) through the increase in sympathetic flow, and the accompanying increase in renin activity. These changes result in decreased renal blood flow, GFR, and UO. There is also an increase in fluid retention, however, there is some evidence that this occurs as a result of the release of vasoactive substances, which shift intrarenal blood flow from the cortex to the medulla, resulting in greater fluid retention, regardless of the level of renal

As simple as this urinary system may sound there are also complication such as acute renal failure or acute kidney failure, this occurs when the kidneys suddenly are unable to filter waste products from the blood. When kidneys lose their filtering ability, dangerous levels of wastes may accumulate and the blood 's chemical makeup may get out of balance (mayo clinic, 1998). Acute renal failure is categories into three different stages prerenal, intrarenal, and postrenal.

Acute renal failure is when the kidneys suddenly are unable to filter the blood of the waste products. Acute renal failure is alternatively called acute kidney failure or acute kidney injury. The causes of acute renal failure are divided into three categories based on their point of origin: prerenal, intrarenal, and post renal. The most common type of acute renal failure is prerenal, which can be described as a sudden drop in blood pressure or an interruption in blood flow to the kidneys. The common causes of prerenal AFR include hypovolemia, reduced renal perfusion, and septic shock. "Prerenal AFR is generally reversible when renal perfusion pressure is restored" (Liu, pg.98). Intrarenal, or intrinsic, acute renal failure is caused by acute tubular necrosis, renal artery obstruction, renal vein obstruction, interstitial nephritis, and glomerulonephritis. Postrenal occurs between the kidney and the urethral meatus. The major causes to postrenal AFR are tubular precipitation, urethral obstruction and bladder obstruction. Acute renal failure has four phases: onset, oliguria, diuresis and recovery. Onset begins with onset of the event and lasts for hours to days. The oliguria stage doesn't always occur in certain patients; however it lasts for 8-15 days. Oliguria deals with multiple acid-base balance diseases. The diuresis stage begins when the kidneys start to recover

As a result of renal failure there is an accumulation of urea in the blood leading called Uremia. If there are other nitrogenous waste products in the blood it is called azothemia. Azotemia is a condition wherein an excess of nitrogenous end products of protein and amino acids are found in the blood. Ureamia and azotemia may produce inflammation of the pericardium of the heart, pleuritis, or pnuemonitis. As blood flows through your entire body the poisons that your kidneys are unable to excrete

Chronic renai failure is the most significant long term complication. Chronic is caused by deposition of amyloid protein in the kidneys. Amyloid could be deposited in the GI tract, liver, spleen, heart, testes, and thyroid.

Acute renal failure, although caused by a sudden seizure of blood to the kidneys which

Mr. Armstrong has a history of renal insufficiency and uncontrolled hypertension, along with symptoms of fatigue, pedal edema, and occasional shortness of breath. He does not have a history of trauma or obstruction to his kidneys, but his creatinine and BUN levels are currently at 3.5 mg/dl and 40 mg/dl. Normal creatinine concentration values are 0.7 to 1.2 mg/dl and normal BUN values are 10 to 20 mg/dl; this reveals that Mr. Armstrong’s kidneys are not removing wastes properly (McCance, Huether, Brashers, & Rote, 2014).  Mr. Armstrong’s history of renal insufficiency and uncontrolled hypertension is commonly found in patients diagnosed with intrarenal (intrinsic) acute renal failure. Intrarenal acute renal failure can be categorized as

One of the diseases is diabetes mellitus which is a major cause of renal failure. This disease can be defined as an increase of fasting blood glucose that is affected by a deficiency in insulin hormone. The normal range for glucose (fasting) in the blood is 2.8-6.0 mmol/L. It is classified into two groups, type 1 (insulin-dependent diabetes mellitus) and type 2 (non insulin-dependent diabetes mellitus). Stein (2008, p.6) points out that kidney failure happens most often when patients have suffered from diabetes mellitus for more than 10 years. According to United States Renal Data System (USRDS) report in 2007, approximately 44% of primary causes of renal failure is diabetes mellitus in the United States in 2005. Also, Stein (2008) indicates that 15% of dialysis patients are influenced by diabetes mellitus in the United Kingdom. Diabetes mellitus has negative affects throughout the kidneys where the increase of the range of blood sugar causes the damages to the cells in the kidneys. This leads to the presence of the glucose in the urine which is known as glycosuric.

Acute renal failure is the sudden loss of the ability of kidneys to remove waste and concentrate urine without losing electrolytes. It is classified into three categories prerenal, intrarenal and postrenal. According to Health Communities.com, the signs and symptoms of acute renal failure are: dizziness, dry mouth, low blood pressure, rapid heart rate, slack skin, thirst, weight loss, and a decrease in urine output.