Acute Kidney Failure: Symptoms, Diagnosis, and Management

Q: Acute Kidney Failure: Symptoms, Diagnosis, and Management

Hello： In response to your question, acute renal failure refers to a rapid decline in kidney function due to factors such as medications, infections, urinary obstruction, sepsis, or other influences on renal function, resulting in elevated kidney function indices (BUN and creatin

Kidney function

Hello, Director Yang:
1.
What is acute renal failure?
2.
I was hospitalized on September 6 due to swelling in my left knee (I had been taking anti-inflammatory pain medication from Chang Gung Memorial Hospital for some time prior, and my kidney function was normal as of June 15).
On September 9, blood tests revealed: BUN: 40, CREATININE: 3.4, NA: 137, K: 4.5.
The doctor indicated that my kidney function was severely impaired and advised me to stop all medications.
I was instructed to collect urine for 24 hours starting at 7:00 AM on September 10.
Additionally, I had two more blood tests for kidney function on the mornings of September 11 and September 13, with both results returning to normal levels (BUN: 8, CREATININE: 0.7), and urine tests also showed normal results.
Does this indicate that there is something wrong with my kidney function? I am still very concerned.
What should I do, doctor?

Shuangyu, 30~39 year old female. Ask Date: 2004/09/16

Dr. Yang Jun reply Internal Medicine

Hello: In response to your question, acute renal failure refers to a rapid decline in kidney function due to factors such as medications, infections, urinary obstruction, sepsis, or other influences on renal function, resulting in elevated kidney function indices (BUN and creatinine).
If kidney function indices can return to baseline after the underlying cause is removed, it is classified as acute renal failure.
In your case, you mentioned that after taking certain medications that affect kidney function (anti-inflammatory drugs and analgesics), your creatinine level rose to 3.4, but decreased to 0.7 after discontinuation of the medication; this is indeed acute renal failure.
To prevent recurrence and protect kidney function, it is advisable to avoid long-term use of such medications and to have regular follow-up examinations.

Reply Date: 2004/09/16

More Info

Acute kidney failure, also known as acute kidney injury (AKI), is a sudden decline in kidney function that occurs over a short period, typically hours to days. It is characterized by an increase in serum creatinine and blood urea nitrogen (BUN) levels, indicating that the kidneys are not effectively filtering waste products from the blood. AKI can result from various causes, including dehydration, medications (especially non-steroidal anti-inflammatory drugs or NSAIDs), infections, urinary obstruction, and other underlying health conditions.

In your case, the timeline of events is crucial. You were hospitalized for knee swelling and had been taking anti-inflammatory medications, which can adversely affect kidney function, particularly in susceptible individuals. The initial blood tests indicated elevated BUN (40) and creatinine (3.4), suggesting significant kidney impairment. However, after discontinuing the medications and conducting further tests, your kidney function returned to normal levels (BUN: 8, creatinine: 0.7). This rapid recovery is a hallmark of acute kidney injury, as opposed to chronic kidney disease, where kidney function declines progressively over time and does not typically recover.

The fact that your kidney function normalized after stopping the offending medications is reassuring. It indicates that the acute kidney injury was likely reversible and primarily related to the medications you were taking. It is essential to avoid long-term use of NSAIDs or other nephrotoxic drugs without medical supervision, especially if you have risk factors for kidney disease.

To manage your concerns moving forward, consider the following steps:
1. Regular Monitoring: Continue to have your kidney function monitored regularly through blood tests, especially if you have any underlying conditions or are taking medications that could affect your kidneys.

2. Hydration: Ensure you maintain adequate hydration, as dehydration can exacerbate kidney issues. Drinking enough fluids helps the kidneys function properly and flush out toxins.

3. Medication Review: Discuss with your healthcare provider about the medications you are taking. If you need pain management, ask for alternatives that are less likely to impact kidney function.

4. Lifestyle Modifications: Adopt a kidney-friendly lifestyle, which includes a balanced diet low in sodium and protein, regular exercise, and avoiding excessive alcohol consumption.

5. Awareness of Symptoms: Be vigilant for any symptoms that may indicate kidney problems, such as decreased urine output, swelling, fatigue, or changes in blood pressure. If you notice any concerning symptoms, seek medical attention promptly.

6. Follow-Up Care: Schedule follow-up appointments with your healthcare provider to discuss your kidney health and any necessary lifestyle or medication adjustments.

In summary, your kidney function appears to have returned to normal, which is a positive outcome following an episode of acute kidney injury. By taking proactive steps to monitor your health and manage your medications, you can help prevent future episodes and maintain optimal kidney function. If you have any lingering concerns or questions, do not hesitate to reach out to your healthcare provider for further guidance.

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