Introductions Throughout our body we have many majors organs and each organ has a major function on our body. One of the major organs of the urinary system is the kidneys. We have 2 reddish brown, fist size, bean shaped kidneys in our body located on the anterior side by the lower edge of the ribs on either side of the spinal cord. The major function of your kidneys is to filter the blood to remove waste products, helps balance water, salt, electrolytes and forms urine. There must be an adequate blood supply in order for the kidneys to function properly. When your kidneys suddenly shut down and stop working it’s called acute renal failure. Acute renal failure is the most common leading deaths in hospitals today.
Pathophysiology There are three different stages of acute renal failure; prerenal, intrarenal, and post renal. Prerenal failure is a result from an illness or injury that causes obstruction of blood flow to the kidneys, called hypoperfusion. Hypotension, hypervolemia and inadequate cardiac output are all examples that could cause prerenal failure. According to Lippincott Williams and Wilkins (2009), “prerenal azotemia, excess nitrogenous waste products in the blood, account for 40% to 80% of all cases of acute renal failure” (p. 307). Intrarenal is when there is direct damage to the kidney tissue by either inflammations, drugs, infections or a reduction in the blood supply to the kidney. Post renal is when there is an obstruction of the urine flow. Causes of obstruction could be enlarged prostate gland, kidney stones, bladder tumor or injury. There are four phases of acute renal failure; onset, oliguria, diuresis and recovery. The onset phase can last hours or up to days. The BUN and creatinine levels may start to increase. Oliguria phase begins with renal insults and last up to 1 to 3 weeks. There is an increase in BUN and creatinine and an electrolyte imbalance happens. At this stage the urine output is 100 to 400 mL a day. During the diuresis phase happens when the kidneys start to recover. This phase may last 2 to 6 weeks and there is a high output phase with diluted urine at about 10 L per day. At around 12 months the recovery phase starts and this is where full renal function is restored.
Diagnostic Exams There are several ways to test if you have acute renal failure. The most accurate way for checking if a patient has acute renal failure is biopsy. The doctor may order lab testing to test your blood urea nitrogen, complete blood count, creatinine, sodium, potassium, calcium and phosphorus. Arterial blood gas analysis shows metabolic acidosis. A urinalysis may be ordered to reveal any abnormalities of the kidney. A computerized tomography provides 3 dimensional information about the kidneys. An ultrasound applies sound waves to structures of different densities to produce images. Or the amount of urine you excrete in a day may also help the doctor determine the cause of the acute renal failure.
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