Acute Kidney Failure: Symptoms, Diagnosis, and Concerns

Kidney problems

Hello, doctor.
Recently, I have been drinking a lot of water, but the amount I urinate is very little.
I usually exercise a lot and sweat a lot, but lately, my sweat has had a very sour smell, somewhat like ammonia.
Additionally, I have been experiencing a dull pain in my lower back that prevents me from continuing my workouts.
After researching online, I am concerned that I might be suffering from acute kidney failure due to the oliguria.
A few days ago, I first visited a urologist, who suggested that my discomfort might be caused by varicocele.
However, I still have my doubts, so I also consulted an internist and had blood tests done to check my kidney and liver function.
I am currently waiting for the results.
Last night, I felt very unwell, and this morning I went to another hospital's urology department for a urinalysis.
The doctor said that all my urine indices were normal, and I also had blood drawn for further testing.

This summarizes my experiences over the past few days.
I would like to ask how acute kidney failure can be detected and how I can express my concerns to the doctor.
When I mentioned my worries, they seemed to think I was overreacting, but the oliguria and lower back pain are making me very anxious.
Also, does having normal urine indices indicate that kidney function is normal? How long does it take for symptoms to appear after the onset of acute kidney failure? Thank you for your help!

Xiao Mi, 20~29 year old female. Ask Date: 2012/05/03

Dr. Wu Jiyu reply Internal Medicine

1.
Regarding acute renal failure (acute renal failure, also known as acute kidney injury): It is essential to understand the functions of the kidneys in the body.
The kidneys primarily eliminate toxins produced from protein metabolism (commonly referred to as uremia) and regulate fluid, electrolytes, and acid-base balance (through the excretion of water, potassium, and acids).
If kidney function fails, toxins can accumulate in the body, along with excess fluid, potassium, and acids.
Acute kidney injury refers to a rapid decline in kidney function, and the presence of symptoms depends on the severity of the decline.
Severe cases typically present with weakness, loss of appetite (due to rising uremia), and shortness of breath (from fluid and acid accumulation), while milder cases may be asymptomatic.
Diagnosis is made through blood tests to assess kidney function.
2.
Oliguria and flank pain: As mentioned earlier, the kidneys regulate fluid balance.
If urine output decreases, several scenarios may be at play: kidney function may be impaired, preventing adequate water excretion (leading to edema), other routes of fluid loss may increase (such as diarrhea or sweating), or urine may accumulate in the body without being excreted (as in bladder distension or hydronephrosis).
However, it is crucial to remember that these conditions are predicated on "oliguria." It is advisable to try recording the amount of food and fluids consumed throughout the day, as well as the volume of urine produced, to determine if true oliguria is present (theoretically, the intake should equal the output, with output being slightly more due to unrecorded bowel movements and insensible fluid loss through the skin).

Reply Date: 2012/05/03

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 within 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. This condition can arise from various causes, including dehydration, medication toxicity, infections, urinary obstruction, or underlying chronic kidney disease.

In your case, you mentioned experiencing decreased urine output despite increased fluid intake, along with a change in the odor of your sweat and discomfort in your lower back. These symptoms can indeed be concerning and may warrant further investigation. The fact that you have already consulted with urology and internal medicine specialists is a good step. It’s essential to communicate your symptoms clearly to your healthcare providers, emphasizing your concerns about potential acute kidney failure.
To diagnose acute kidney failure, doctors typically rely on blood tests to measure kidney function, including serum creatinine and BUN levels. A urinalysis may also be performed to assess urine concentration and the presence of any abnormalities. In your case, the normal urine indices and the blood tests you mentioned suggest that your kidney function may not be severely impaired at this time. However, it’s crucial to monitor these parameters regularly, especially if you continue to experience symptoms.

Acute kidney failure can develop rapidly, sometimes within hours, depending on the underlying cause. Symptoms may vary widely; some individuals may not exhibit noticeable symptoms until the kidney function is significantly compromised. Common symptoms of AKI include decreased urine output, swelling due to fluid retention, fatigue, confusion, and nausea. However, in some cases, individuals may remain asymptomatic until the condition progresses.

Given your concerns about decreased urine output and back pain, it’s advisable to keep a detailed record of your fluid intake and urine output. This information can help your healthcare provider assess whether you are genuinely experiencing oliguria (decreased urine output) or if other factors are at play. Additionally, if you notice any worsening of symptoms, such as increased swelling, persistent back pain, or changes in mental status, seek medical attention promptly.

In summary, while your current test results may indicate normal kidney function, it’s essential to remain vigilant and continue monitoring your symptoms. Open communication with your healthcare providers about your concerns is vital. If you feel that your symptoms are not being taken seriously, consider seeking a second opinion or asking for a referral to a nephrologist, a specialist in kidney diseases. Regular follow-ups and monitoring will help ensure that any potential issues are addressed promptly, reducing the risk of complications associated with acute kidney failure.

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