ACUTE KIDNEY FAILURE: Am I At Risk?

KB, a 33-year old wrestler, uses herbal concoction to boost his sexual drive. This practice started a month ago. He recently began to notice a gradual reduction in urine volume, swelling of his face, and legs. He became alarmed when he passed out dark coloured urine. His kidneys have failed. After a thorough evaluation by the doctor, it was concluded that herbal concoction caused his kidney damage.

The kidney serves as one of the organs responsible for passing out toxic waste products from the body. Its function in making urine also facilitates this process. It helps to conserve necessary salts in the body amongst other functions.

Acute kidney failure reflects a sudden impairment in kidney function. This failure is often reversible. It means that the individual can regain the full function of the kidneys after a period. The duration of this impaired function is variable, depending on the extent of the damage. This medical condition has numerous impacts on the individual, the family, and the community at large.

WHAT CAUSES ACUTE KIDNEY DAMAGE OR FAILURE? Broadly speaking, it can be caused by any condition that

A. Reduces the supply of blood to the kidneys: Kidney functions can shut down in conditions where the volume of blood flow to it is not enough. This will occur in any situation that causes excessive loss of water or blood from the body. Examples of these conditions that cause loss of water include severe vomiting, diarrhoea, and severe burns.

Excessive sweating in extremely hot weather without adequate intake of water can also reduce blood flow to the kidneys. Excessive blood loss can occur following ghastly road traffic accidents, internal bleeding, et cetera.

B. Causes actual damage to the kidney tissue: Some infections or harmful substances in the blood can cause direct damage to the kidneys themselves. Some orthodox medications, when used in excess or without prescription, can cause direct damage. Some of such medications include diclofenac, piroxicam, gentamicin, et cetera.

The use of herbal concoction is popular in Nigeria and other sub-Saharan countries. They make up a large percentage of harmful substances that can cause damage to the kidneys. Mercury-containing creams and soaps used for skin lightening have also been identified as potential causes of direct damage to the kidneys.

Infections that have been identified in causing actual damage include poorly treated and severe bacterial infections, severe malaria, etc. In some individuals, a combination of infection and abuse of the above-mentioned medications or herbal concoctions may be present. Such persons may likely suffer prolonged damage before recovery, if at all.

C. That prevents the free flow of urine from the kidneys through the bladder: Presence of stone in the ureter, which transports urine from the kidney to the bladder, can cause series of changes that lead to kidney damage. Prostate enlargement may cause urine retention. Accumulated urine may cause backward pressure on the kidneys, damaging them.

HOW CAN AN INDIVIDUAL TELL THAT THE KIDNEYS ARE DAMAGED OR FAILING? The evidence of acute kidney failure may not be initially noticeable. Some non-specific evidences include

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  • early morning facial swelling,
  • swelling of the feet
  • decreased urinary volume,
  • change in colour of urine sometimes to dark coloured urine,               
  • blood in urine, 
  • elevated blood pressure and                           
  • sometimes confusion.

Generally, diagnosing acute kidney failure lies with tests carried out in a health facility. These include blood test, urinary test, and sometimes may involve an ultrasound of the abdomen.

HOW IS THE AFFECTED INDIVIDUAL MANAGED? The management varies based on the causes (see above) of the failure. The chances of recovery of kidney function also influence the type of treatment given to the patient. One or a combination of the following is essential in the care of individuals with acute kidney failure

A. Replacement of lost body fluids, salt, or blood.

B. Certain medications – antibiotics, antimalarials, antihypertensives, et cetera

C. Dialysis may be necessary. Dialysis gives artificial support of carrying out the affected function while the patient’s kidneys recover.

D. Immediate discontinuation of harmful substances (herbal concoction, skin lightening creams, etc)

FATE OF THE INDIVIDUAL: If the problem is discovered early, and the cause is an easily reversible one, the kidney damage is temporary. This means that the individual recovers full functions. In some cases, the disease progresses to chronic kidney failure, which is nonreversible.

PREVENTION OF ACUTE KIDNEY FAILURE: This is key. Ensuring adequate water intake in people who are rapidly losing fluid is very vital. Early blood transfusion in people with massive blood loss is also important. The use of herbal concoctions and indiscriminate use of orthodox medications should be frowned at. A prompt visit to the hospital when any of the earlier listed symptoms becomes noticeable is life-saving.

Consider the above discussion and ask yourself, “am I at risk of acute kidney failure?”

Written by Dr. Femi Afolayan.

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