In patients who develop ATN, other features of disease or illness are often present: the patient may have dehydration, or the patient may be receiving treatment for infection or has been involved in an accident. In patients who develop glomerulonephritis, there is often acute onset of facial swelling and the presence of “coke” coloured urine. Urine production may slow down or (rarely) stop completely. The excess fluid leads to elevated blood pressure and fluid buildup in the lungs. This leads to shortness of breath especially when lying down. Distented neck veins and a fast or irregular heartbeat can be present. Depending on the cause of the renal failure, dehydration may be present and must
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be looked for and corrected promptly.
The toxic effects of the waste products on brain function can cause nausea, vomiting and tiredness. Patients lose their appetite and acid buildup in the blood leads to deep breathing and headaches. If untreated, the fluid and waste overload can lead to heart failure, altered brain functioning like lethargy, seizures and coma.
The chemical balance of the blood is derailed and high levels of electrolytes like potassium can be very dangerous and lead to abnormal heart rhythm. The heart may become inflamed from the toxins (pericarditis). This is a serious complication and can be treated by dialysis. Muscle cramps and confusion are often found.
Dialysis can be life saving when serious chemical abnormalities, fluid overload, congestive heart failure or severe hypertension are developed. Dialysis is when a sophisticated filter, connected to a machine, is used to take over the function of the failed kidneys temporarily.
Written by Dr K. Coetzee, reviewed by Dr R. Moosa, head of the Renal Unit, Tygerberg Academic Hospital.
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