Management of Acute Renal Failure - American Family Physician

A cute renal failure is an acute loss of kidney function that occurs over days to weeks and results in an inability to appropriately excrete nitrogenous wastes and creatinine. Electrolyte disturbances and loss of fluid homeostasis may occur. In spite of this rapid decline in kidney function, patients with acute renal failure often have few symptoms. A strict definition of acute renal failure is lacking. Accepted diagnostic criteria include an increase in the serum creatinine level of 0.5 mg per dL (44.2 μmol per L) or a 50 percent increase in the creatinine level above the baseline value, a 50 percent decrease in the baseline-calculated glomerular filtration rate (GFR), or the need for acute kidney replacement therapy.1-3 Oliguria is defined as a urine output of less than 400 mL in 24 hours, and anuria is defined as a urine output of less than 100 mL in 24 hours. Acute renal failure is present in 1 to 5 percent of patients at hospital admission. The condition affects 15 to 20 percent of patients in intensive care units (ICUs); reported mortality rates range from 50 to 70 percent in these patients.1-3 Infection and cardiorespiratory complications are the most common causes of death in patients with acute renal failure.