Acute Kidney Failure

Kidneys are one of the important organs in the body. Kidneys have many vital functions, namely filtering (filtration) metabolic waste products and toxins from the blood to be excreted through urine, maintaining the body's fluid and electrolyte balance. The kidneys also produce several hormones, namely erythropoietin which has a role in the formation of erythrocytes (red blood cells), renin which has a role in regulating blood pressure, and the hormone prostaglandin which is useful in various body mechanisms.

Acute kidney injury or acute kidney injury (AKI) is a syndrome characterized by impaired kidney function in regulating the composition of body fluids and electrolytes, as well as the production of metabolic waste products, which occur suddenly and rapidly. This condition is usually characterized by elevated levels of serum urea and creatinine and others. The glomerular filtration rate may decrease suddenly to below 15 mL/min. Acute kidney failure is reversible if it can be treated immediately and the cause is addressed.

The causes of acute renal failure are classically divided into 3 main groups based on the location of pathophysiological abnormalities, namely before the kidney (prerenal), in the renal parenchyma/intrinsic, and after the kidney (post-renal) (5%). In prerenal (55% of cases) common causes include severe infection (sepsis), lack of fluids due to conditions such as bleeding, dehydration, severe vomiting, cardiogenic shock, certain drugs such as cyclophorin and tacrolimus in high doses, and hypotension causing a decrease in blood pressure. blood flow to the kidneys resulting in decreased glomerular perfusion. Renal/intrinsic renal failure (40% of cases) is caused by diseases that can affect kidney function such as infections of the kidneys and autoimmune diseases that attack the kidneys, drugs that are nephrotoxic. Postrenal (5% of cases) occurs due to obstruction of urinary flow by several causes, including: benign prostatic hypertrophy, pelvic tumors, and the presence of stones in the urinary tract.

Clinical features of acute renal failure include changes in urine volume (reduced amount of urine or no urine output at all (anuria)), neurological disorders (weakness, fatigue, lethargy, headache, sleep disturbances, mental disorders, coma), skin disorders (itching, pigmentation, dry scaly skin), cardiopulmonary signs (shortness of breath due to pleural effusion, pulmonary edema, pleurisy, pericardial effusion, pericarditis), musculoskeletal (muscle cramps, loss of muscle strength) and gastrointestinal symptoms (nausea, decreased appetite, vomiting).

The main goals of management of acute renal failure are to prevent further kidney damage and to keep the patient alive until renal function returns to normal. There are two types of treatment in the management of AKI, namely conservative (supportive) therapy and renal replacement therapy (RRT), commonly known as dialysis. Conservative therapy can be done with drugs or fluids with the aim of preventing or reducing the progressive decline in renal function, morbidity, and mortality due to complications of AKI. If conservative therapy fails to treat any complications of AKI, consideration should be given to RRT (dialysis). The cause of acute kidney failure must also be sought and addressed so that kidney function can recover.