Acute Kidney Failure

Written by Bree Normandin and Winnie Yu | Published on August 16, 2012
Medically Reviewed by George Krucik, MD


Most people who develop acute kidney failure are already in the hospital. Acute kidney failure is the sudden loss of your kidneys’ ability to eliminate excess salts, fluids, and waste materials from the blood. When kidneys lose their filtering ability, body fluids can rise to dangerous levels. The condition will also cause electrolytes and waste material to accumulate in your body.

Acute kidney failure, also called acute kidney injury, is common in patients who are already in the hospital. It may develop rapidly over a few hours. Or it may develop more slowly over a few days. People who are critically ill and need intensive care are at the highest risk of developing acute kidney failure.

Acute kidney failure can be fatal and requires intensive treatment. However, it may be reversible. If you are in good health otherwise, recovery is possible.

Causes of Acute Kidney Failure

Acute kidney failure can occur for many reasons. Among the reasons are:

  • acute tubular necrosis (ATN)
  • autoimmune kidney diseases such as acute nephritic syndrome and interstitial nephritis
  • urinary tract obstruction

Low blood pressure can reduce blood flow and cause damage to your kidneys. These health problems can decrease blood flow to your kidneys:

  • burns
  • dehydration
  • hemorrhage
  • injury
  • septic shock
  • serious illness
  • surgery

Certain disorders can cause clotting within your kidney’s blood vessels:

  • hemolytic uremic syndrome
  • idiopathic thrombocytopenic thrombotic purpura (ITTP)
  • malignant hypertension
  • transfusion reaction
  • scleroderma

Some infections can directly injure your kidneys, such as:

  • septicemia
  • acute pyelonephritis

Pregnancy can cause complications that harm the kidneys:

  • placenta previa (in pregnancy)
  • placenta abruption (in pregnancy)

Risk Factors for Acute Kidney Failure

Chances of acquiring acute renal failure are greater if you are elderly or have the following long-term health problems:

  • kidney disease
  • liver disease
  • diabetes
  • high blood pressure
  • heart failure
  • obesity

If you are ill or are being treated in a hospital intensive care unit, you are at an extremely high risk for acute kidney failure. Being the recipient of heart surgery, abdominal surgery, or a bone marrow transplant can also increase your risk .

Symptoms of Acute Kidney Failure

  • bloody stools
  • breath odor
  • slow, sluggish movements
  • swelling - generalized (fluid retention)
  • fatigue
  • pain between ribs and hips
  • hand tremor
  • bruising easily
  • changes in mental status or mood, especially if you are elderly
  • decreased appetite
  • decreased sensation, especially in your hands or feet
  • prolonged bleeding
  • seizures
  • nausea
  • vomiting
  • hiccups that won’t resolve
  • elevated blood pressure
  • metallic taste

Diagnosing Acute Kidney Failure

If you have acute kidney failure you may have generalized swelling. The swelling is caused by fluid retention.

Using a stethoscope, your physician may hear crackling in the lungs. These sounds can signal fluid retention.

Results of laboratory tests may also show sudden changes. Some of these tests include:

  • blood urea nitrogen (BUN)
  • serum potassium
  • urinalysis
  • creatinine clearance
  • serum creatinine

An ultrasound is the preferred method for diagnosing acute kidney failure. However, abdominal X-ray, abdominal CT scan, and abdominal MRI can determine if there is a blockage in your urinary tract.

Certain blood tests may also reveal underlying causes of acute kidney failure..

Treating Acute Kidney Failure

Treatment will depend on the cause of your acute kidney failure. The goal is to restore normal kidney function. Preventing fluids and wastes from building up in your body while your kidneys recover is important.

Your doctor will restrict your diet and the amount of liquids you eat and drink. The goal is to reduce the buildup of toxins that are normally eliminated by the kidneys. A diet high in carbohydrates and low in protein, salt, and potassium is usually recommended.

Antibiotics may be prescribed to treat or prevent any infections that occur at the same time. Diuretics may be used to help your kidneys eliminate fluid. Calcium and insulin can be given to help avoid dangerous increases in your blood potassium levels.

Dialysis might be needed, but is not always necessary. Dialysis involves diverting blood out of your body into a machine that filters out waste. The clean blood is then returned to your body. If potassium levels are dangerously high, dialysis can save your life. Dialysis is used if there are changes in your mental status, or if you stop urinating. You may also need dialysis if you develop pericarditis, inflammation of the heart. Dialysis can help eliminate nitrogen waste products from your body.

What is Expected in the Long Term

Acute kidney failure can be a life-threatening illness. Intensive treatment may be required. But if you are in good health otherwise, chances of recovery are good.

Chronic renal failure or end-stage renal disease can develop. Death is more common if kidney failure is caused by severe infection, trauma, or surgery. Lung disease, recent stroke, advanced age, blood loss, and progressive kidney failure also increase your risk of death.

Some of the complications of acute kidney failure may be:

  • chronic kidney failure
  • heart damage
  • nervous system damage
  • end stage renal failure
  • high blood pressure

Preventing Acute Kidney Failure

Preventing and treating illnesses that can lead to acute kidney failure is the best method for avoiding the disease.

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