OVERVIEW OF ACUTE RENAL FAILURE

Definition

Acute renal failure (ARF) is a sudden loss of the kidney functions in term of glomerulus filtration rate (GFR), blood pressure (BP) and urinalysis. 

Risk factors

ARF can be categorized into three general groups:

1.       Pre-renal

Sudden and severe drop in BP due to shock (accident, severe injuries, illness) or interruption of blood flow to the kidneys.

2.       Intra-renal

Direct damage to the kidneys by inflammation, toxins, drugs, infection or reduced blood supply.

3.       Post-renal

Sudden obstruction of urine flow due to enlarged prostate, kidney stones, bladder tumor or injury.

KALIUM DALAM MAKANAN

Pesakit dengan kegagalan buah pinggang kronik (CRF) biasanya mempunyai hyperkalaemia atau kalium tinggi dalam darah. (Normal ialah 3.5 hingga 5.5 mEg / L). Kalium adalah penting untuk denyutan jantung dan air, pH dan keseimbangan elektrolit.

Contoh makanan rendah, sederhana dan tinggi kalium

JENIS MAKANAN	Rendah kalium (<50 mg/serving)	Sederhana kalium (50-100mg/serving)	Tinggi kalium (>100 mg/serving)
produk tenusu		Non-dairy whipped topping	Susu Susu soya yogurt ais krim coklat
Roti dan bijirin	White bread, white rice, cereal, noodle and oat	Bran bread, muffin.
Buah- buahan	Strawberry, Plum, Tembikai, Beri, Buah Koktel, Lemon dan Epal jambu,	Nanas, pic, Limau dan Rambutan	Avocados, pisang durian, Cempedak Nangka, Mata kucing Buah kering, tembikai susu, Kiwi, Mangos, betik and jus prun.
Sayuran	petola, peria, timun, kangkung, kubis, ketola, and lobak putih	Semua pelbagai jenis kacang, asparagus, tomato, dan labu	Batang pisang, jantung pisang, petai, sawi, cendawan, kentang, brokoli, ubi, Bayam dan kailan
makanan berprotein tinggi		mentega kacang, telur, ayam, ikan, daging babi, daging lembu.	Produk soya, dan kekacang.
minuman	sirap	Barli, teh Cina dan  jus tebu	Jus dalam tin, minuman coklat, kopi, air kelapa

Apa yang penting untuk and ingat adalah bahawa hampir semua makanan mengandungi kalium. Saiz hidangan akan menentukan sama rendah, sederhana, atau tinggi nilai kalium. Satu saiz hidangan makanan yang rendah kalium boleh menjadi makanan kalium yang tinggi jika diambil dalam kuantiti yang banyak.

POTASSIUM CONTENT IN FOOD

Patient with chronic renal failure (CRF) usually have hyperkalaemia or high potassium in the blood. (Normal is 3.5 to 5.5 mEg/L) .Potassium is importance for heart beat and fluid, pH and electrolyte balance.

Example low, moderate and high potassium foods

TYPE OF FOOD	Low potassium (<50 mg/serving)	Moderate potassium (50-100mg/serving)	High potassium (>100 mg/serving)
dairy product		Non-dairy whipped topping	milk soy milk yogurt ice cream chocolate
bread and cereal	white bread, rice, cereal, noodle, and oat	Bran bread , muffin.
Fruits	Strawberry, Plums, Watermelon, Berries, Fruit Cocktail, Lemon and guava	Apples, Pineapple, Peaches, Oranges and Rambutan	Avocados, Bananas Durian, Cempedak Nangka, Mata kucing Dried fruit, Honeydew, Kiwi, Mangos, Papaya and Prune juice
Vegetables	Bean sprout, bitter groud, cucumber, kangkung, cabbage, ketola, and white radish.	All variety of bean, asparagus, tomato, and pumpkin	Banana stem, jantung pisang, petai, sawi,mushroom, potato, broccoli, tuber, bayam and kalian.
Protein rich food		Peanut butter, egg, poultry, fish, pork, beef and veal	Soy product, nut, dried bean and peas
beverages	Syrup drink	Barley, Chinese tea, sugar cane juice.	Canned fruits juice, chocolate drink, coffee, coconut water.

It is important to remember that almost all foods contain potassium. Serving size will determine whether foods are a low, moderate, or high potassium level. A large serving size of a low potassium food can become a high potassium food.

UJIAN UNTUK KEGAGALAN BUAH PINGGANG PERINGKAT AKHIR

Kegagalan renal akut biasanya dikesan menggunakan beberapa kaedah seperti:

1. ujian air kencing

2. ujian darah

3. ujian computer/ pengimejan .

4. biopsy

5. Anggaran Kadar Penapisan glomerular atau GFR

1.       1. Ujian air kencing

Ujian ini adalah penting untuk melihat jika buah pinggang berfungsi dengan betul. Peringkat akhir buah pinggang biasanya mengandungi protein (albumin). Dengan mengumpul air kencing dalam tempoh 24 jam kita dapat meramalkan jumlah air kencing yang dihasilkan. Pengeluaran air kencing Rendah biasanya berlaku kapada pesakit buah pinggang.

2.      2.  Ujian darah.

Ujian Darah biasa dilakukan contohnya kiraan darah lengkap, kalsium, fosforus, dan hormon paratiroid; dan tahap kalium. Selain daripada itu, ujian darah Elektrolit, kepekatan natrium, klorida, kalsium, dan kalium dalam darah akan menjadi tidak normal. Kalium, khususnya, dengan cepat boleh meningkat ke tahap yang berbahaya. Selain itu,  ujian lain seperti Nitrogen Urea darah (BUN) dan Kreatinin juga boleh dilakukan. Kegagalan renal peringkat akhir juga mungkin mempunyai creatinine berlebihan dan tahap urea dalam darah.

3.     3.   Renal Pengimejan-

penggunaan ultrabunyi, magnetic resonance imaging (MRI), atau computed tomography (CT scan) adalah penting untuk mengambil gambar-gambar buah pinggang. Gambar-gambar ini akan menunjukkan sama ada aliran air kencing tersumbat atau sama ada terdapat perubahan dalam saiz buah pinggang.

4.       4. Biopsi

Sekeping kecil buah pinggang boleh dibuang melalui pembedahan dan dihantar ke makmal untuk mencari punca kegagalan buah pinggang.

5.       5.  Anggaran Kadar Penapisan glomerular (GFR)

 Kiraan  Anggaran Kadar Penapisan glomerular  atau GFR berdasarkan jantina, umur, saiz badan, dan tahap kreatinin darah boleh dilakukan untuk menentukan peringkat pesakit.

Pesakit peringkat akhir juga boleh memuat turun kalkulator GFR oleh perisian muat turun dari softpedia.com. Atau pautan ini

http://www.softpedia.com/get/Windows-Widgets/System-Utilities/GFR-Calculator.shtml

DIAGNOSIS TEST FOR END STAGE

Diagnosis test for end stage renal failure are:

1. Urine test

2. Blood test

3. Imaginary test

4. Biopsy

5. Estimated Glomerular Filtration Rate 

URINE TEST

It is importance to see if the kidneys are working properly. End stage renal usually contains protein ( albumin) . By collect urine within 24-hour period we can predict amount of urine produced. Low urine output usually happens for end stage renal failure.


BLOOD TEST

Commonly Ordered Blood Tests done is complete blood count; calcium, phosphorus, and parathyroid hormone; and potassium levels. Other than that, Blood Electrolytes test, the concentration of sodium, chloride, calcium, and potassium in the blood will be abnormal. Potassium, in particular, can quickly rise to dangerous levels. Beside other test such as Blood Urea Nitrogen (BUN) and Creatinine also can be done. End stage renal failure may also have excess creatinine and urea level in the blood.


RENAL IMAGING

The use of ultrasound, magnetic resonance imaging (MRI), or computed tomography (CT scan) is importance to take pictures of the kidneys. These pictures will show whether urine flow is blocked or whether there is a change in the size of the kidneys.

KIDNEY BIOPSY

A small piece of kidney may be surgically removed and sent to a laboratory in order to find cause of kidney failure.


ESTIMATED GLOMERULAR FILTRATION RATE

Calculate the GFR based on gender, age, body size, and blood creatinine level can be done to determine which stage the patient are.

End stage patients also can download GFR calculator by download software from softpedia.com.  Or this link

http://www.softpedia.com/get/Windows-Widgets/System-Utilities/GFR-Calculator.shtml