Acute Renal Failure
Treatment Overview
The goals of treatment for acute renal failure are to:
- Correct or treat the cause of kidney failure.
- Support the kidneys until they have healed and can work properly.
- Prevent or treat any complications caused by acute renal failure.
Treating the cause
Because treatment for acute renal failure (ARF) depends on what caused it, treatment can vary widely. Your doctor may need to:
- Replace lost fluids, such as water, blood, and plasma, and restore blood flow to the kidneys. In cases of prerenal ARF caused by dehydration or blood loss, for example, kidney function may quickly return to normal after fluid and blood levels are corrected.
- Discontinue any medications that may be causing the problem. These may include some antibiotics, common pain medicines (nonsteroidal anti-inflammatory drugs) such as aspirin or ibuprofen, blood pressure medicines, and medicines used to treat cancer (chemotherapy).
- Treat kidney disease that is causing damage to the kidneys (intrinsic ARF) by using plasma exchange, glucocorticoids (such as cortisol), or other medicines, depending on the specific disease.
- Use medicines to stop the immune system from working (immunosuppressants), such as cyclophosphamide, when an autoimmune disorder is causing acute renal failure. These disorders include lupus and other diseases that cause inflammation of the blood vessels (vasculitis).
- Remove or bypass a blockage in the urinary tract (postrenal ARF). Kidney function often rapidly returns to normal after a blockage is removed and urine can flow out of the kidneys. Some blockages, such as kidney stones, can be removed. If the blockage cannot be removed, urine flow may be rerouted around the blockage using a catheter or another method. If the bladder is not emptying properly, placing a catheter in the bladder to empty it can quickly relieve symptoms and allow kidney function to return to normal.
Supporting your kidneys
Supporting your kidneys when you have acute renal failure can be complicated. Most people who develop acute renal failure are already in a hospital being treated for another medical problem and already may be critically ill before acute renal failure develops. Treating the primary medical problem may make acute renal failure worse.
As fluid and waste build up in the blood, acute renal failure can lead to severe, life-threatening complications, such as uremic syndrome (uremia) and infection (sepsis). It is important to control early complications, such as fluid overload, chemical imbalances, and anemia, so that more serious complications are less likely to develop.
Support for your kidneys so they can heal will include close management of:
- Fluid intake. Fluids lost because of dehydration or blood loss must be restored, but fluid intake might also be limited, to avoid fluid buildup.
- Nutrition. A specialized diet with restricted fluid intake may be used to meet nutritional needs without putting too much stress on failing kidneys.
- Medications. Several medications are used to help relieve the fluid buildup that can occur in acute renal failure. Your doctor may adjust the dose of your medicines so that they work well for you. Many doctors use diuretics to improve urine output and remove excess water from the body. But some experts feel that they may not be helpful and may actually be harmful to people who are very ill.2 Depending on the cause and severity of your acute renal failure, your doctor may choose another method to get rid of extra fluids.
- Causes of urinary blockage, if a blockage is present. If the blockage cannot be removed, urine flow may be rerouted around the blockage using a catheter or a small, flexible tube called a stent.
You may need dialysis daily or every other day to support the kidneys until they recover. Dialysis uses a machine to filter wastes and remove extra fluid from the blood. Hemodialysis is the most common treatment for acute renal failure. It does not shorten or reverse acute renal failure, but it controls blood pressure and corrects life-threatening fluid and electrolyte imbalances that occur when the kidneys are not working properly. Peritoneal dialysis may also be used.1
Before you start dialysis, your doctor will need to create a dialysis access. The access is the site where the dialysis needles can be inserted to send the blood to and from the dialysis machine. For example, you might have a small tube (catheter) placed in a vein in your arm, leg, chest, or neck. The type of access will depend on the type of dialysis you have.
Recovery
Kidney function may quickly return to normal if the cause of acute renal failure is diagnosed and corrected. Acute renal failure may be corrected within a few days, or it may last for more than a month. Chances of recovery depend on many factors, including what caused the kidneys to fail, how severe the failure was and how long it lasted, how quickly the problem was found and treated, and what other medical conditions you have. For example, acute renal failure caused by dehydration, blood loss, or a blockage in the urinary system often can be reversed quickly without any permanent kidney damage.
About half of people who develop acute renal failure recover. Of those who recover, many have normal kidney function and do not need further treatment. But a few do not regain kidney function and need long-term dialysis or a kidney transplant.1
What To Think About
Palliative care
If your condition gets worse, you may want to think about palliative care. Palliative care is a kind of care for people who have illnesses that do not go away and often get worse over time. It is different than care to cure your illness, called curative treatment. Palliative care focuses on improving your quality of life—not just in your body, but also in your mind and spirit. Some people combine palliative care with curative care.
Palliative care may help you manage symptoms or side effects from treatment. It could also help you cope with your feelings about living with a long-term illness, make future plans around your medical care, or help your family better understand your illness and how to support you.
If you are interested in palliative care, talk to your doctor. He or she may be able to manage your care or refer you to a doctor who specializes in this type of care.
For more information, see the topic Palliative Care.
End-of-life issues
Acute renal failure is often progressive. After it has developed, you have a greater risk for developing serious problems with infection and heart disease. If you become dependent on dialysis to treat your kidney failure, you may wish to talk to your family and your doctor about health care and other legal issues that arise near the end of life.
You may find it helpful and comforting to state your health care choices in writing (with an advance directive such as a living will) while you are still able to make and communicate these decisions. Think about your treatment options and which would be best for you. You may wish to choose a health care agent to make and carry out decisions about your care if you become unable to speak for yourself. For more information, see the topics Writing an Advance Directive, Choosing a Health Care Agent, or Care at the End of Life.
A time may come when your goals or the goals of your loved ones may change from treating or curing an illness to maintaining comfort and dignity. Your nephrologist will be able to answer questions about your choices when cure is no longer an option. Hospice services focus on providing care and support to you and your loved ones. Hospice caregivers can help you stay as alert and comfortable as possible in a familiar place with family and friends. For more information, see the topic Hospice Care.
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| Author: | Robin Parks, MS | Last Updated: June 14, 2007 |
| Medical Review: | E. Gregory Thompson, MD - Internal Medicine D.C. Mendelssohn, MD, FRCPC - Nephrology | |
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