Acute Renal Failure- Treatment

Acute Renal Failure


Treatment Overview

The goals of treatment for acute renal failure are to:
Correct or treat the cause of kidney failure.
Support the kidneys until they have healed and can work properly.
Prevent or treat any complications caused by acute renal failure.

Treating the cause
Because treatment for acute renal failure (ARF) depends on what caused it, treatment can vary widely. Your doctor may need to:

Replace lost fluids, such as water, blood, and plasma, and restore blood flow to the kidneys. In cases of prerenal ARF caused by dehydration or blood loss, for example, kidney function may quickly return to normal after fluid and blood levels are corrected.

Discontinue any medications that may be causing the problem. These may include some antibiotics, common pain medicines (nonsteroidal anti-inflammatory drugs) such as aspirin or ibuprofen, blood pressure medicines, and medicines used to treat cancer (chemotherapy).
Treat kidney disease that is causing damage to the kidneys (intrinsic ARF) by using plasma exchange, glucocorticoids (such as cortisol), or other medicines, depending on the specific disease.

Use medicines to stop the immune system from working (immunosuppressants), such as cyclophosphamide, when an autoimmune disorder is causing acute renal failure. These disorders include lupus and other diseases that cause inflammation of the blood vessels (vasculitis).

Remove or bypass a blockage in the urinary tract (postrenal ARF). Kidney function often rapidly returns to normal after a blockage is removed and urine can flow out of the kidneys. Some blockages, such as kidney stones, can be removed. If the blockage cannot be removed, urine flow may be rerouted around the blockage using a catheter or another method. If the bladder is not emptying properly, placing a catheter in the bladder to empty it can quickly relieve symptoms and allow kidney function to return to normal.

Supporting your kidneys

Supporting your kidneys when you have acute renal failure can be complicated. Most people who develop acute renal failure are already in a hospital being treated for another medical problem and already may be critically ill before acute renal failure develops. Treating the primary medical problem may make acute renal failure worse.

As fluid and waste build up in the blood, acute renal failure can lead to severe, life-threatening complications, such as uremic syndrome (uremia) and infection (sepsis). It is important to control early complications, such as fluid overload, chemical imbalances, and anemia, so that more serious complications are less likely to develop.

Support for your kidneys so they can heal will include close management of:

Fluid intake. Fluids lost because of dehydration or blood loss must be restored, but fluid intake might also be limited, to avoid fluid buildup.

Nutrition. A specialized diet with restricted fluid intake may be used to meet nutritional needs without putting too much stress on failing kidneys.

Medications. Several medications are used to help relieve the fluid buildup that can occur in acute renal failure. Your doctor may adjust the dose of your medicines so that they work well for you. Many doctors use diuretics to improve urine output and remove excess water from the body. But some experts feel that they may not be helpful and may actually be harmful to people who are very ill.2 Depending on the cause and severity of your acute renal failure, your doctor may choose another method to get rid of extra fluids.

Causes of urinary blockage, if a blockage is present. If the blockage cannot be removed, urine flow may be rerouted around the blockage using a catheter or a small, flexible tube called a stent.