ACUTE KIDNEY FAILURE

Just like we agreed last week,today we shall have a quick look on this sudden fail of kidneys.One of you told me that doctors give wrong diagnosis by saying that a person has to live on dialysis for the rest of their lives.Her argument was based on her sister had had a few sessions of dialysis and had her kidneys fully recovered.

Now friends,two major forms of kidney failure exist.The first is what I have discussed in various Wednesdays here and on Facebook where it all begun. That is Chronic Kidney Disease .Type #KidneyWednesday on my Facebook profile Cate Mimi and it will bring up all the series we have had since last year..The other is what is called Acute kidney injury mostly called by many acute kidney failure.

This is a reversible,temporary shut down of kidneys’ ability to produce urine.It means that if we intervene as soon as possible,we will help the kidneys to get back to their full potential.That explains why the lady’s sister received a few hemodialysis sessions and recovered.

It is important for me to highlight that if acute kidney injury is not treated in good time,it has a high chance of progressing to Chronic kidney injury.I will tell you of a story next week on Wednesday in relation to this.Something that breaks my heart to date.

A sudden reduction in the amount of urine production is usually the first sign of acute kidney injury.It means that you have been drinking water and other fluids normally(2000mls at the minimum) but somehow the amount of urine you have produced in the last 24hours can not even measure up to 500mls.

let me say that slowly…reduction of urine production not attributed to a reduction in fluid intake.That is what I am talking about.

What follows is fluid retention.The skin under your eyes start swelling and you will more often than not attribute it to lack of enough sleep.What surprises me in my not-so-old practice as a Renal nurse is how assuming Kenyans are in matters kidney health.We had a client who came to the unit in acute pulmonary edema.On history taking she said it was three days since she passed urine and that was alright to her.It still bothers me how we as a people do not pay attention to our bodies.

Maybe that is why I keep writing and hoping that you will stay informed.

There are many causes of acute kidney injury.In a nutshell,any factor causing a reduction in blood supply to the kidneys will impair its abilities to produce urine.If blood supply is not restored fast enough,the renal tubules will become acidic and fail to filter as they should.A good case is a severe hemorrhage as from a road traffic accident or commonly,post postpartum.That is after child delivery.

Postpartum hemorrhage accounts for many cases of acute kidney injury in Kenya.The statistics were released just last week by one of the Kenyan dailies.Besides reduced blood flow,direct injury to the kidneys is enough to cause a sudden shutdown of the same.This could be physical like from blunt trauma ,sharp objects or in the form of poisons to the kidneys.

Case on point is alcohol poisoning where large doses of alcohol metabolites clog the kidney tubules rendering them useless.That explains why your doctor will recommend urgent hemodialysis in cases of severe alcohol poisoning.That also happens with organophosphate poisoning like in the case of attempted suicide or poisoning with the common pesticide Malathion in Kenya.

These chemicals directly hurt kidney tubules and her blood vessels and we must remove them as soon as possible by way of dialysis.Usually hemodialysis.

In infants and children,Kenyatta National Hospital among other private hospitals,offers peritoneal dialysis which is a very child friendly mode of dialysis.In the aforementioned population,acute failure of kidneys is caused by severe dehydration mostly as a result of diarrhea and vomiting or other infections which will cause dehydration.Neonatal sepsis causes a generalized state of toxicity in the bloodstream and the tiny baby kidneys are unable to cope with the increased work of filtration,hence they shut down.

Doctors will prescribe aggressive medications as the neonatal and nephrology nurses focus on dialyzing the tiny weeny baby to remove the excessive wastes.

In all cases,it takes a matter of days (most of the times) for the kidneys to open up and make as much urine as the fluid you’re ingesting.It takes stages which I promise to not exhaust you with.Full recovery is progressively expected within six months.We must monitor patients lab values until we are happy with them.

What you should know is that any unexplained reduction in urine production is a cause for alarm.The other signs follow later like legs swelling and all that.Pay attention to your urinary elimination patterns.

When a lady is pregnant and they get diagnosed with a high blood pressure,it is very important for her to follow the advise of the doctor on taking the blood pressure medication.Sometimes it may mean an early delivery to save her life.

please stop treating yourself.Do not term it normal stress of pregnancy.A high blood pressure in pregnancy IS NOT NORMAL.I know I am shouting here.

As usual I will be happy to answer your questions.

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