Hopkins 24/7

Back to ABC News

This Thursday at 10/9c

This content requires javascript and flash player version 8.

Johns Hopkins Symptoms and Remedies

Johns Hopkins Medicine

Close Article Browser

Renal Failure, Acute

What is it?

Acute renal failure—or kidney failure—occurs when both kidneys suddenly stop functioning. The kidneys regulate the chemical and fluid balance in the body and filter waste products out of the blood and into the urine. Acute renal failure may occur via a number of different mechanisms, including kidney disorders, partial or complete blockage of the passage of urine, and a decrease in the blood volume, following severe blood loss for example. Symptoms may develop over several days: the amount of urine passed may be greatly reduced, and fluid that should be excreted accumulates in bodily tissues, producing weight gain and swelling, especially in the ankles. Acute renal failure is a life-threatening condition, as excessive amounts of water, minerals like potassium, and waste products, all normally eliminated in the urine by the kidneys, accumulate in the body. The disorder usually responds well to treatment; kidney function may be fully regained within days to weeks if the cause is correctly identified and treated. However, acute renal failure due to a kidney disorder may occasionally progress to chronic renal failure, and the long-term outlook ultimately depends upon the response of the underlying disorder to treatment.

What Causes It?

  • Depletion of blood volume from severe injury with associated blood loss or dehydration is a common cause of acute renal failure. Reduced blood flow to the kidneys due to diminished blood volume may damage the kidneys.
  • Other kidney disorders, such as acute glomerulonephritis, may cause acute renal failure (see Glomerulonephritis, Acute for more information).
  • Tumors, kidney stones, or an enlarged prostate gland may obstruct both ureters or the urethra, impeding urine flow and damaging the kidneys.
  • Other disorders may cause the kidneys to fail, including polycystic kidney disease, systemic lupus erythematosus, diabetes mellitus, congestive heart failure, heart attack, liver disease, acute pancreatitis, and multiple myeloma (see specific disorders for more information).
  • Poisoning with heavy metals such as cadmium, lead, mercury, or gold may lead to kidney damage.
  • Chemotherapeutic agents and certain antibiotics such as gentamicin may lead to kidney failure, especially in those with underlying kidney disease.
  • High doses of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, may cause kidney damage.
  • The radiographic contrast materials used to highlight blood vessels or organs in some x-ray procedures may induce kidney failure in those at risk.
  • The release of the protein myoglobin from the muscles because of muscle injury, heat stroke, drug or alcohol overdose, or severe infection may lead to acute kidney failure.
  • Rarely, women may develop acute renal failure as a complication of childbirth.

Prevention

  • Treatment of potential underlying causes may prevent acute renal failure.

Diagnosis

  • Patient history and physical examination.
  • Ultrasound.
  • Blood and urine tests.
  • A kidney biopsy may be done. After local anesthesia is administered to the patient, the doctor inserts a needle into the kidney through the back to extract a small sample of tissue for microscopic examination.

How to Treat It

  • The underlying cause of kidney failure must be treated. Emergency medical treatment may be necessary in the event of severe injury and may include surgery to repair damaged tissues, intravenous fluids to reverse dehydration, and blood transfusion to replace extensive blood loss.
  • Surgery may be necessary to remove an obstruction of the urinary tract.
  • Diuretics may be prescribed to reduce fluid retention and increase urine output.
  • There are a number of postemergency measures that are important to a full recovery. For example, fluid restriction may be recommended.
  • Antibiotics may be prescribed to treat associated bacterial infections and should be taken for the full term indicated.
  • Antihypertensive drugs may be prescribed to treat associated high blood pressure.
  • Glucose, sodium bicarbonate, and other substances may be given intravenously until kidney function is regained, in order to maintain proper levels of these substances in the bloodstream.
  • Temporary dialysis, an artificial blood-filtering process, may be necessary until kidney function is regained. There are several types of dialysis. In hemodialysis, blood is pumped from the body into an artificial kidney machine, or dialyzer, where it is filtered before being returned to the body. Hemodialysis is usually performed for about three to four hours three times a week. The first two treatments are two to three hours on consecutive days.
  • Peritoneal dialysis is rarely used with acute renal failure. In this procedure a catheter is inserted into the abdomen, and a special fluid, known as dialysate, is circulated through the peritoneum, the membrane lining the abdominal cavity, to draw impurities out of the bloodstream. Acute peritoneal dialysis must be performed for 24 hours a day. (See Renal Failure, Chronic for more information.)
  • Contact your local chapter of the National Kidney Foundation for more information.

When to Call a Doctor

  • EMERGENCY Call a doctor immediately if you develop symptoms of acute renal failure, including decreased urine output, nausea, shortness of breath, and swollen ankles.