| Acute renal failure (ARF), also known
as acute kidney failure or acute kidney injury, is a rapid loss
of renal function due to damage
to the kidneys, resulting in retention
of nitrogenous (urea
and creatinine) and non-nitrogenous
waste products that are normally excreted by the kidney. Depending
on the severity and duration of the renal dysfunction, this accumulation
is accompanied by metabolic disturbances, such as metabolic
acidosis (acidification of the blood) and hyperkalaemia (elevated potassium
levels), changes in body fluid balance, and effects
on many other organ
systems. It can be characterised by oliguria or anuria (decrease or cessation of urine
production), although nonoliguric ARF may occur. It is a serious
disease and treated as a medical
emergency.
Acute (sudden) kidney failure is the sudden loss
of the ability of the kidneys to remove waste and concentrate urine
without losing electrolytes.
EIOLOGY
Pre-renal (causes in the blood supply):
• Hypovolemia (decreased blood volume), usually from shock
or dehydration and fluid loss or excessive diuretics use.
• Hepatorenal syndrome in which renal perfusion is compromised
in liver failure.
• Vascular problems, such as atheroembolic disease and renal
vein thrombosis (which can occur as a complication of the nephrotic
syndrome).
• Infection usually sepsis, systemic inflammation due to
infection.
• Severe burns.
• Sequestration due to pericarditis and pancreatitis.
• Hypotension due to antihypertensives and vasodilators.
• Trauma & severe haemorrhage.
• Severe vomiting & diarrhoea causing dehydration.
Intrinsic (damage to the kidney itself):
• Toxins or medication (e.g. some NSAIDs, aminoglycoside
antibiotics, iodinated contrast, lithium, phosphate nephropathy
due to bowel preparation for colonoscopy with sodium phosphates).
• Rhabdomyolysis (breakdown of muscle tissue) - the resultant
release of myoglobin in the blood affects the kidney; it can be
caused by injury (especially crush injury and extensive blunt
trauma), statins, stimulants and some other drugs.
• Hemolysis (breakdown of red blood cells) - the hemoglobin
damages the tubules; it may be caused by various conditions such
as sickle-cell disease, and lupus erythematosus.
• Multiple myeloma, either due to hypercalcemia or "cast
nephropathy" (multiple myeloma can also cause chronic renal
failure by a different mechanism).
• Acute glomerulonephritis which may be due to a variety
of causes, such as anti glomerular basement membrane disease/Goodpasture's
syndrome, Wegener's granulomatosis or acute lupus nephritis with
systemic lupus erythematosus.
• Acute pyelonephritis.
• Acute tubular necrosis.
• Blood incompatibility
Post-renal (obstructive causes in the urinary tract) due
to:
• Medication interfering with normal bladder emptying
(e.g. anticholinergics).
• Benign prostatic hypertrophy or prostate cancer.
• Kidney stones.
• Due to abdominal malignancy (e.g. ovarian cancer, colorectal
cancer).
• Obstructed urinary catheter.
• Drugs that can cause crystalluria and drugs that can lead
to myoglobinuria & cystitis.
OTHER CAUSES
• Malignant hypertension.
• Disorders associated with child birth; PPH, placenta previa.
Symptoms
• Anorexia.
• Bloody stools.
• Breath odor.
• Brusing easily.
• Changes in mental statusor mood.
• Decreased appetite.
• Decreased sensation, especially in the hands or feet.
• Dyspnoea.
• Fatigue.
• Flank pain (between the ribs and hips).
• Haematuria.
• Hand tremor.
• Headache.
• High blood pressure.
• Lethargy.
• Metallic taste in mouth.
• Nausea or vomiting, may last for days.
• Nosebleeds.
• Palpitation.
• Persistent hiccups.
• Prolonged bleeding.
• Seizures.
• Slow, sluggish movements.
• Swelling - generalized (fluid retention).
• Swelling of the ankle, feet, and leg swelling.
• Urination changes:
o Decrease in amount of urine.
o Excessive urination at night.
o Urination stops completely.
COMPLICATIONS
• Cardiac arrhythmia.
• Congestive cardiac failure.
• Pulmonary oedema.
• Uraemic coma.
• Secondary infection.
GENERAL MANAGEMENT
• Correct cause.
• Maintain fluid, electrolyte balance.
• Bed rest.
• Restrict fluid to an amount equal to the volume of urine
produced.
• Salt intake is also restricted.
• Protein, sodium & potassium intake is restriction.
• Diet should be high in carbohydrate content.
• Correct anaemia.
• Maintain daily record of
o Body weight.
o Fluid intake.
o Urine output.
o Blood urea.
o Serum electrolytes
• Dialysis is not necessary in all the cases. It is indicated
& life saving particularly when; serum potassium is very high,
deranged mental status, precarditis, anuria, fluid overload, serum
creatinine > 10mg/dl.
Homeopathic Treatment for Acute Renal Failure
Homeopathy treats the person as a whole. It means that homeopathic
treatment focuses on the patient as a person, as well as his pathological
condition. The homeopathic medicines are selected after a full individualizing
examination and case-analysis, which includes the medical history
of the patient, physical and mental constitution etc. A miasmatic
tendency (predisposition/susceptibility) is also often taken into
account for the treatment of chronic conditions. The medicines given
below indicate the therapeutic affinity but this is not a complete
and definite guide to the treatment of this condition. The symptoms
listed against each medicine may not be directly related to this
disease because in homeopathy general symptoms and constitutional
indications are also taken into account for selecting a remedy.
To study any of the following remedies in more detail, please visit
our Materia Medica
section. None of these medicines should be taken without professional
advice.
Homeopathic Remedies
Aconite
Incipient stage of post scarlatinal nephritis, pain
in loins, scanty urine without blood.
Apis mellifica
Apis is not so much a remedy for chronic Bright's
disease as for the acuter forms. There are oedematous swellings
of the face and extremities, paleness, ascites, oedema pulmonum,
pains in the head, back and limbs. Albuminuria following scarlatina.
It may be of use in any form of Bright's disease when there are
dull pains in the kidneys, scanty urine and frequent Micturition.
The urine is heavily charged with albumen and contains blood corpuscles.
The oedema appears quickly, there is general dropsy and suppression
of urine and perhaps an eruption of the skin like a nettle rash.
The patient is drowsy, apathetic and has a bruised feeling all
over. Apis in such cases acts best in trituration; do not depend
on the tincture or dilutions. Hepar is recommended by Kafka in Bright's
disease following scarlatina. A valuable symptom for Apis is the
feeling of suffocation. He does not see how he is get another breath.
Apocynum
Palliative in dropsical conditions where the urine
is scanty. Also useful for coma & convulsions in the nephritis
of pregnency.
Arsenicum
This remedy corresponds to all stages of Bright's
disease, bearing a closer resemblance than any other remedy. It
comes in later in the disease where there is dropsy, pale skin,
waxen appearance, watery diarrhoea and great thirst. The urine is
dark, casts are abundant, and it contains much albumen. There are
attacks of dyspnoea when lying down in the evening and after midnight,
relieved by an expectoration of
mucus. It may come in immediately after Aconite in
many cases. "Blood boils" make a special indication for
this remedy. Baehr, Millard and Hale question the usefulness of
Arsenicum in kidney affections. However, it seems a simile to the
large white kidney; in fact, one could hardly wish for a closer
correspondence. Hughes considers it a favorite with anxiety and
sinking of vital forces will call for Arsenicum. Calcarea arsenica
has been used in the anaemia, progressive emaciation and debility
of this disease with success.
Aurum muriaticum
Morbus Brightii from gout, suppurations or syphilis.
Interstitial nephritis in its incipiency with digestive and nervous
phenomena, hypochondriasis, irritability and vertigo.
Belladonna
Simple albuminuria, here it seems to occupy a place
midway between Aconite and Arsenicum. Belladonna is of the greatest
service in inflammation of the kidneys with piercing burning pains
in the lumbar region, returning periodically with increased severity.
Cantharis
This remedy pictures nephritis with cutting pains
in the lumbar region; the urine is passed in drops and is mixed
with blood, with much urging. Post scarlatinal and post diphtheric
kidney diseases with dropsy may indicate Cantharis.
Convallaria
Nephritis from heart disorders. It affords relief
when there is extreme rapid & irregular action of the heart,
and in general anasarca & ascites from mitral insufficiency.
Cuprum arsenicum
Cuprum arsenicum is also useful in uraemic conditions
and is praised highly by Goodno. Cuprum is a valuable remedy for
uraemic eclampsia.
Digitalis
This remedy has an irritant action on the kidneys.
It is homoeopathic to granular degeneration. Heart symptoms, feeble
pulse, scanty, dark, turbid urine, faintness at the stomach, rheumatic
pains will indicate it. It is especially useful when the circulation
is weak. Rheumatic pains, pulmonary catarrh with profuse expectoration
are marked symptoms.
Glonoine
Glonoine has albuminous urine and will sometimes
be found useful in acute and haemorrhagic nephritis.
Kali chloricum
This remedy is said to be the most homoeopathic of
all remedies in Bright's disease. It has scanty, dark, albuminous
urine containing casts. It excites a violent nephritis.
Mercurius corrosivus
This remedy corresponds to the large white kidney.
There is an albuminous, scanty and red urine; pale waxen color of
the body; there are lumbar pains, great dyspnoea and excessive strangury.
It takes the first rank among all the mercurials for nephritis,
and it comes in the later stages. Syphilitic complication further
indicate it. There is an expression of uneasiness on the face. Dr.
Ludlam considers it our best remedy for the albuminous nephritis
of pregnancy and Baehr lauds it in suppurative nephritis.
Plumbum
Granular degenerations of the kidneys, with tendency
to uraemic convulsion. Dropsy, sallow face, emaciation, oedema about
the ankles. It seems to corresponds to the contracted or cirrhotic
form of nephritis, holding the same relation here that Arsenic and
Mercury do in chronic nephritis. Royal emphasizes this remedy saying
that it arrested the progress in many cases and permanently cured
not few for him.
Phosphorus
Phosphorus produces as marked a nephritis as any
drug. It is one of the most important remedies in Bright's disease;
the characteristic symptoms are: lassitude of the whole body, hands
and feet icy cold, sleepiness. The fatigue is greatest in the morning,
and there is heat in the body without thirst, especially in the
evening. The patient is indisposed to work, is giddy, forgetful
and has a heavy headache, particularly in the forehead; there is
oedema of the upper eyelids, a mist before the eye, a yellowish
fray complexion, a sickly oedema of the face, want of appetite,
pressure and burning in the stomach, and a light colored painless
diarrhoea which is very weakening. It suits well fatty or waxy casts,
is dark brown, scanty and albuminous, or covered with an iridescent
film. Pulmonary complications will call for Phosphorus; and inability
to lie on the left side is a prominent symptom in these cases. Vomiting
and gastric symptoms are usually present. A small dose of Phosphorus
will act much safer and better in eclampsia than a large dose of
Morphine.
Terebinth
One of our reliable and most frequently indicated
remedies in the early stages of renal diseases when congestion is
prominent, when there is much pain in the back of a dull character
extending along the ureters. The great characteristic of dark smoky
urine will be present. There is anasarca, and of course, the urine
is bloody and albuminous. It is recommended in post scarlatinal
renal affections. The prostration is not accompanied by the restlessness
of Arsenicum.
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