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Kidney failure occurs when the kidneys lose their ability to function. To treat kidney failure effectively, it is important to know whether kidney disease has developed suddenly (acute) or over the long term (chronic). Many conditions, diseases, and medicines can create situations that lead to acute and chronic kidney disease.
Acute Renal Failure
Acute Renal Failure is defined as an abrupt (within 48 hours) reduction in kidney function based on an elevation in serum creatinine level, a reduction in urine output, the need for renal replacement therapy (dialysis), or a combination of these factors
The term Acute Kidney Failure can be applied to :
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All causes of Acute Kidney Failure
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Drugs related kidney injury
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Post-operative kidney failure
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Intensive care patients with kidney disorders
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Post-Angiogram associated kidney injury
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Optimal management of acute kidney injury requires close collaboration among primary care physicians, nephrologists, hospitalists, and other subspecialists participating in the care of the patient. After acute kidney injury is established, management is primarily supportive.
Patients with acute kidney injury generally should be hospitalized unless the condition is mild and clearly resulting from an easily reversible cause. The key to management is assuring adequate renal perfusion by achieving and maintaining hemodynamic stability and avoiding hypovolemia.
Maintenance of volume homeostasis and correction of biochemical abnormalities remain the primary goals of treatment and may include the following measures:
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Correction of fluid overload with furosemide
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Correction of severe acidosis with bicarbonate administration, which can be important as a bridge to dialysis
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Correction of hyperkalemia
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Correction of hematologic abnormalities (eg, anemia, uremic platelet dysfunction) with measures such as transfusion
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Chronic kidney failure
Chronic kidney disease (CKD) is usually caused by a long-term disease, such as high blood pressure or diabetes that slowly damages the kidneys and reduces their function over time.
Symptoms of chronic kidney disease may not develop until very little kidney function remains. Other problems may develop with chronic kidney disease, such as anemia and increased levels of phosphates in the blood (hyperphosphatemia), along with complications caused by kidney failure. These complications often do not develop until kidney disease has been present for some time.
Management of Chronic Renal Failure includes :
Evaluation of all causes of chronic kidney failure
Management of its associated complication eg. anemia and renal bone diseases
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Early diagnosis and treatment of the underlying cause and/or the institution of secondary preventive measures are imperative in patients with chronic kidney disease (CKD). These steps may delay, or possibly halt, progression of the disease. Early referral to a nephrologist is of extreme importance.
The medical care of patients with CKD should focus on the following :
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Delaying or halting the progression of CKD
Diagnosing and treating the pathologic manifestations of CKD
Timely planning for long-term renal replacement therapy