Acute renal failure

Alternative names:

A.R.F.; acute kidney failure; kidney failure; kidney failure - acute; renal failure; renal failure - acute

Symptoms:

• decreased urine output (There may be none.)
  • decreased urine volume (oliguria)
  • no urine output (anuria)

• urination, excessive at night (can occur in some types of renal failure)
• ankle, feet, and leg swelling
• generalized swelling, fluid retention
• decrease in sensation, especially the hands or feet
• changes in mental status or mood
  • agitation
  • drowsiness, lethargic, hard to arouse
  • delirium or confusion
  • coma
  • fluctuating mood
  • difficulty paying attention (attention deficit)
  • hallucinations

• slow, sluggish, lethargic movement
• seizures
• hand tremor
• nausea, vomiting
  • may persist for days
  • morning sickness
  • vomiting blood

• prolonged bleeding, bruising easily
  • stools, bloody
  • nosebleed - symptom

• growth, slow (child 0-5 years)
• flank pain
• fatigue
• ear noise/buzzing
• breath odor
• breast development in males
• blood pressure, high

Signs and tests:

Examination and testing may reveal acute renal failure rather than other disorders that affect kidney function. There is generalized edema (swelling) from fluid retention. Auscultation of the heart may show a murmur or other abnormal sounds caused by increased fluids. Auscultation of the lungs may show crackles.

Lab values may change suddenly (within a few days to 2 weeks):

• Urinalysis may be abnormal.
• Serum creatinine may increase by 2 mg/dL or more over a 2 week period.
• Creatinine clearance may be decreased.
• BUN may increase suddenly.
• Serum potassium levels may be increased.
• Arterial blood gas and blood chemistries may show metabolic acidosis.
• Kidney or abdominal ultrasound is usually the best test, but abdominal X-ray, abdominal CT scan, or abdominal MRI may also reveal the cause of the acute renal failure. Kidney size is usually normal or slightly large.
• Chemical tests of blood and urine (such as fractional excretion of sodium or fractional excretion of urea) may help to distinguish the causes. A clean catch urine specimen will indicate if the cause is infection within the urinary tract. Renal angiography (renal arteriography) may be used to diagnose causes within the blood vessels of the kidney.

This disease may also alter the results of the following tests:

• 25-hydroxy vitamin D
• amylase
• amylase, urine
• AST
• calcium (ionized)
• CO2
• creatinine - urine
• ESR
• nerve conduction velocity
• platelet aggregation test
• protein electrophoresis - urine
• RBC indices
• RT3U
• serum calcium
• serum chloride
• serum phosphorus
• serum sodium
• sodium, urine
• T4
• urea nitrogen; urine
• uric acid
• urinary casts
• urine 24h volume
• urine concentration test
• urine pH
• urine specific gravity