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Kidney anatomy

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Overview	Symptoms	Treatment	Prevention

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Acute kidney failure

Alternative Names

Renal failure - acute; Kidney failure; Kidney failure - acute; Renal failure; ARF

Symptoms

• decreased urine output
  • decreased urine volume (oliguria)
  • no urine output (anuria)
• urination, excessive at night (can occur in some types of renal failure)
• ankle, feet, and leg swelling
• generalized swelling, fluid retention
• decrease in sensation, especially the hands or feet
• decreased appetite
• metallic taste in mouth
• persistent hiccups
• changes in mental status or mood
  • agitation
  • drowsiness, lethargy
  • delirium or confusion
  • coma
  • fluctuating mood
  • difficulty paying attention (attention deficit)
  • hallucinations
• slow, sluggish, movements
• seizures
• hand tremor
• nausea, vomiting
  • may persist for days
  • morning sickness
  • vomiting blood
• prolonged bleeding, bruising easily
  • stools, bloody
  • nosebleed
  • growth, slow (child 0-5 years)
• flank pain
• fatigue
• ear noise/buzzing
• breath odor
• breast development in males
• blood pressure, high

Exams and Tests

Examination and testing can reveal acute renal failure and help rule out other disorders that affect kidney function. In this condition, there is generalized swelling caused by fluid retention.

With a stethoscope, a heart murmur or other sounds related to increased fluid volume may be heard and crackles may be heard from the lungs. Also, if inflammation of the heart lining (pericarditis) is present, a pericardial friction rub may be heard with a stethescope over the heart.

Lab values may change suddenly (within a few days to 2 weeks):

• Urinalysis may be abnormal.
• Serum creatinine may increase by 2 mg/dL or more over a 2-week period.
• Creatinine clearance may be decreased.
• BUN may increase suddenly.
• Serum potassium levels may be increased.
• Arterial blood gas and blood chemistries may show metabolic acidosis.
• Kidney or abdominal ultrasound is usually the best test, but abdominal X-ray, abdominal CT scan or abdominal MRI may also reveal the cause of acute renal failure. Kidney size is usually normal or slightly large.
• Chemical tests of blood and urine may also help to distinguish the causes. A clean catch urine specimen will indicate if the cause is infection within the urinary tract. Renal angiography (renal arteriography) may be used to diagnose causes within the blood vessels of the kidney.

This disease may also alter the results of the following tests:

• 25-hydroxy Vitamin D
• amylase
• amylase, urine
• AST
• calcium (ionized)
• CO2
• creatinine - urine
• ESR
• nerve conduction velocity
• platelet aggregation test
• protein electrophoresis - urine
• RBC indices
• RT3U
• serum calcium
• serum chloride
• serum phosphorus
• serum sodium
• sodium, urine
• T4
• urea nitrogen; urine
• uric acid
• urinary casts
• urine 24h volume
• urine concentration test
• urine pH
• urine specific gravity

Review Date: 7/22/2004
Reviewed By: Ari Mosenkis, M.D., Department of Nephrology, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network.

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