Acute Renal Failure: Pathophysiology, Treatment, and Prevention

This article provides an overview of Acute Renal Failure (ARF), including its pathophysiology, treatment, and prevention. It discusses the causes, symptoms, and risk factors of ARF, as well as ways to prevent and treat the condition. The article also highlights the importance of lifestyle modifications and healthy habits in reducing the risk of ARF.

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Introduction (Criteria 1 & 2):
Acute Renal Failure is very common among the elderly population although its incidence
and prevalence vary in accordance with the population. Acute Renal Failure (ARF) presents with
a rapid reduction in the rate of glomerular filtration and it clinically manifest as a sustained and
abrupt rise in the levels of creatinine and urea. Life-threatening outcomes of ARF include
hyperkalemia, volume overload, and metabolic acidosis. ARF is both costly and common and it
carries a high rate of mortality and morbidity in the society. ARF is always preventable if
patients at risk are timely identified and appropriate preventive strategies applied. According to
the research studies conducted, age-related prevalence of ARF has increased from 17 million in a
year among the adults who are aged less than 50 years.
ARF has three major phases namely intrarenal, prerenal, and postrenal with prerenal
being the most common by accounting for about 55 % of the cases of ARF. ARF refers to the
inability of the patient’s kidneys to properly function as expected. Occurrence of ARF results in
the loss of the ability of the kidneys to excrete waste materials from the body and maintain
balance between electrolytes and fluids in the body. ARF is caused by multiple conditions,
diseases, and medications which results in kidney dysfunction. The structural and functional
changes associated with ARF involve nephrons function, renal hemodynamics, and cell
metabolism (Saeed et al., 2014).
Normal anatomy of the major body system effected (Criteria 3):
Acute Renal Failure affects the urinary system particularly the kidney. The major organs
comprising the urinary system include the kidney, the urinary bladder, the renal pelvis, the
ureters, and urethra. The kidneys are always bean-shaped and their anatomy play a fundamental
role in urine formation and body hemodynamics. The frontal portion of the kidney has the renal

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cortex and a medullar. There are extensions of connective tissues known as renal columns
radiating towards downwards from the cortex via the medulla separating the renal papillae and
the renal pyramids. The renal pyramids and columns make up the kidney lobes (Kriz, & Elger,
2014).
The kidney has renal hilum which acts as the point of exit and entry for the structures
which service the kidneys: nerves, vessels, ureters, and lymphatics. The kidney has the nephrons
which act as the functional units. The afferent arterioles form the glomerulus which is a tuft of
capillaries with high pressure. The second arteriole after the renal corpuscle is efferent arteriole
which forms the vasa recta and peritubular capillaries. The kidney also has the cortex which is
composed of renal corpuscles, Distal Convoluted Tubule, Proximal Convoluted Tubule, and the
Loop of Henle (Tortora, & Derrickson, 2017).
Normal physiology of the major body system effected (Criteria 4):
The primary functions of the kidneys include maintenance of the overall balance of body
fluid, blood purification, filtering and regulation of minerals from the blood, removal of waste
products from the medications, food materials, and other harmful substances, and the formation
of hormones which are useful in the production of Red Blood Cells, regulation blood pressure,
and promotion of bone health. The nephrons take in the blood and metabolize the nutrients while
excreting the waste materials which are filtered from the blood during the process of
ultrafiltration. The glomerulus is responsible for the absorption of proteins from the blood
passing via the renal corpuscle (Smoter et al., 2014).
The Bowman’s capsule acts as a passage for the capsular urine into renal tubules. The
Proximal Convoluted Tubule facilitates the re-absorption of water, glucose, and sodium into the

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blood stream. The Loop of Henle facilitates the absorption of potassium, sodium, and chloride
into the blood system. The Distal Convoluted Tubule is also allow the absorption of additional
sodium ions into the blood system while taking in acid and potassium. In general, the major
functions of the kidneys include removal of wastes materials from the blood, regulation of the
volume of plasms, concentration of hydrogen ions in the plasma, plasms ionic content, plasma
osmolarity, and hormone secretion (Tortora, & Derrickson, 2017).
Mechanism of Pathophysiology (Criteria 5):
ARF is usually characterized with a sudden loss of the kidneys’ ability to regulate
electrolytes, remove wastes, maintain balance of body fluid, and concentrate urine. The first
cause of ARF is the impairment of the flow of blood to the kidney. Some of the conditions and
diseases which are associated with impaired flow of blood to the kidney include fluid or blood
loss, heart attack, antihypertensive medications, cardiac diseases, liver failure, infections,
prolonged use of NSAIDS, severe dehydration, severe burns, and anaphylaxis (Zarbock, Gomez,
& Kellum, 2014).
The second cause of ARF is kidney damage by formation of blood clots in arteries and
veins around and in the kidneys, and deposition of cholesterol which blocks the flow of blood to
the kidneys. Kidney damage is attributed to glomerulonephritis, infections, Hemolytic Uremic
Syndrome, medications like chemotherapy drugs, Lupus, toxins like heavy metals, alcohol, and
cocaine, breakdown of muscle tissue, and tumor cells breakdown. The ARF is also caused by
urine blockage in the kidney due to formation thrombi in the urinary tract, bladder cancer, kidney
stones, prostate cancer, enlarged prostate, and damage of the nerves innervating the urinary
bladder (DiPiro et al., 2014).

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Decreased kidney functioning is indicated by elevated levels of creatinine and Blood
Urea Nitrogen (BUN) secondary to a decline in the rate of Glomerular Filtration. The risk factors
for ARF include old age, hospitalization secondary to conditions requiring intensive care,
hypertension, diabetes, kidney diseases, heart failure, liver diseases, and cancers. Abnormal
kidney functioning results in its inability to regulate the acid-base balance of the body fluid, cell
production irregularities, regulate and maintain blood pressure which consequently affects the
filtration of waste materials from the blood (Saeed, Adil, Piracha, & Qureshi, 2015). The
prerenal cause of ARF includes inadequate kidney blood profusion which prevents it from
purifying the blood in the entire body. The manifestations of ARF include nauseas, vomiting,
metallic taste, fatigue, confusion, body swelling or edema, and reduced urine output. The second
stage of ARF presents with nocturia, anemia, hypertension, anorexia, and dyspnea (Pazhayattil &
Shirali, 2014).
Prevention (Criteria 6):
ARF can be prevented using multiple ways which involve the modification of our life
habits and lifestyles. Some of the general rules of keeping the kidneys health and safe include
working with the healthcare personnel for management of hypertension and diabetes. Secondly,
one should live healthy by consuming diet with low fat and salt content, ensuring regular
physical activity, and limiting alcohol intake. We should ensure adequate fluid intake (Prowle,
Kirwan, & Bellomo, 2014). to enhance kidney functioning since inadequate body fluids may
alter its functioning due to the strain its subjected to. Lastly, we should also be careful with the
consumption of medicines from the counter especially ibuprofen and aspirin since they can hurt
the kidneys thus causing ARF (Joannidis et al., 2017).
Treatment (Criteria 7):

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The primary step in the treatment of ARF is the identification and treatment of the
underlying cause of kidney damage for example hypertension, diabetes, blood loss, formation of
blood clots in arteries and veins supplying the kidneys. The second step would be the prevention
or management of the signs and symptoms to prevent further complications. The treatment
modalities should therefore include provision of Intravenous fluids to ensure fluid balance
(Goldstein, 2014).
The patient may also be given antidiuretic medications to treat swelling in the legs and
arms due to fluid overload on the body which is caused by ARF. The patient may be given
medications for controlling the levels of potassium in the blood since its high levels can result in
cardiac arrhythmias and weakness of body muscles. The patient may also be calcium infusion to
restore the levels of calcium in the blood. Lastly, the patient may be put on hemodialysis for
removal of excess fluids and toxins from the blood system (Angeli et al., 2015).
Clinical Relevance (Criteria 8):
The condition is quite common among the aged people and its typically characterized
with reduced kidney functioning. Knowledge about ARF is essential in the implementation of
most appropriate measures of reducing the incidence of ARF in the society. Temporary
hemodialysis is one of the most recommendable approach of managing ARF. Lifestyle
modification and healthy eating have proven to be the key measures of reducing the risk of
development of ARF (Saeed et al., 2014).
Conclusion:
Acute Renal Failure presents with the inability of the kidney to maintain fluid balance,
purify the blood, control electrolytes, and concentrate urine. Some of the indicators of ARF
include decreased rate of glomerular filtration, high levels of creatinine and Blood Urea

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Nitrogen, reduced urine output, fatigue, confusion, edema on the legs and arms, metallic taste,
nausea, vomiting, dyspnea, and anorexia. The pathophysiological mechanisms of ARF includes
kidney damage, blockage of urine, and inadequate or blockage of blood supply to the kidneys.
The risk factors for ARF include ageing, hypertension, diabetes, liver diseases, heart failure, and
use of medications such as aspirin and ibuprofen. The prevention and treatment of ARF includes
lifestyle medication though consumption of healthy diet, increased and regular physical activity,
intravenous fluid therapy, hemodialysis, and medications to control potassium and calcium levels
in the blood.

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