Patients who develop ARF are often in hospital for another condition that puts them at risk for the condition. This includes major surgery, heart attack, crush injury and severe burns. Urine and blood tests are done and the volume of urine produced is monitored. An abrupt rise in the blood levels of urea and creatinine characterises ARF. Urine production may be slowed down but often patients continue to pass more than one litre of urine per day. Sophisticated urine and blood tests are done to determine the renal function.
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It is important to determine if the patient might have underlying chronic kidney failure that can slowly progress for years, without causing symptoms. In this case, acute deterioration of the chronic condition can be difficult to differentiate from ARF. Small scarred kidneys on sonar or special X-rays of the kidneys, suggest the disease is of a chronic nature.
Taking a thorough history, careful physical examination, urine and special tests will help the doctors establish whether the cause is pre-renal, renal or post-renal. Obstruction of the urine flow is an important post-renal cause and should be excluded because the management is different from the other forms of ARF. Dehydration is a common cause of pre-renal ARF and correcting the patient’s fluid balance is a priority.
Written by Dr K. Coetzee, reviewed by Dr R. Moosa, head of the Renal Unit, Tygerberg Academic Hospital.
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