During acute renal failure, the kidneys may suddenly lose their ability to remove wastes, concentrate urine, and conserve water and essential nutrients. Urine production decreases or stops completely. Often there is blood in the urine. Protein waste products quickly accumulate in the blood, damaging tissues and reducing organ function throughout the body. This condition, known as uremia, can be fatal if kidney function is not restored promptly and if the blood is not filtered and cleansed. Symptoms of this toxic reaction include drowsiness, confusion, loss of appetite, nausea and vomiting, and seizures. The onset of symptoms is rapid, often occurring within days, but the condition can be reversed if diagnosed and treated quickly.
Disorders of the kidney itself also can lead to acute renal failure. These disorders include direct injury to the kidney, a urinary tract infection such as acute pyelonephritis (see page 286), kidney stones (see page 289), renal cell cancer (see "Kidney Cancer," page 293), and any obstruction of the urinary tract. Acute renal failure also can be caused by reduced blood flow, which can occur after an injury, during complicated surgery, when there is uncontrolled bleeding elsewhere in the body, following severe burns, or as a result of another serious illness. Exposure to poisons, solvents, certain medications, or a blood transfusion
Concerns can cause injury to the kidney tubules and, in turn, acute renal failure. Severe infections, autoimmune diseases, and uncontrolled high blood pressure are other possible causes of renal failure.
Both kidney failure and its underlying cause must be treated promptly. Dialysis (see box) may be required to cleanse the blood mechanically and prevent complications such as congestive heart failure (see page 233). If you experience acute kidney failure, you will be placed on a diet that is low in protein, potassium, and sodium, and your fluid intake will be closely matched to your fluid output. You may recover adequate kidney function within 2 months, although your kidneys will not return to full normal function for much longer, perhaps a year.
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