From the Guidelines
Kidney failure emergencies require immediate medical attention and typically include severe symptoms like sudden decreased urine output, extreme shortness of breath, chest pain, seizures, or confusion, as defined by the KDIGO guidelines 1. Other emergency signs include severe fluid overload causing significant swelling, dangerously high potassium levels (hyperkalemia) that can cause heart rhythm problems, severe acidosis, and uremic encephalopathy (brain dysfunction from toxin buildup). If you experience these symptoms, especially with known kidney disease, go to an emergency room immediately, as these conditions can be life-threatening and represent acute kidney injury or acute-on-chronic kidney failure where the kidneys cannot filter waste products, maintain electrolyte balance, or regulate fluid levels 1. Emergency treatment often involves dialysis to temporarily take over kidney function, medications to control dangerous electrolyte levels, and supportive care while addressing the underlying cause of kidney failure, as outlined in the ESPEN guideline on clinical nutrition in hospitalized patients with acute or chronic kidney disease 1. The rapid intervention in these situations is critical because kidney failure can quickly lead to multi-organ dysfunction if left untreated, and the KDIGO classification system provides a framework for identifying and staging acute kidney injury (AKI) and acute kidney disease (AKD) 1. Some key indicators of kidney failure emergency include:
- Sudden decreased urine output
- Extreme shortness of breath
- Chest pain
- Seizures
- Confusion
- Severe fluid overload
- Dangerously high potassium levels (hyperkalemia)
- Severe acidosis
- Uremic encephalopathy (brain dysfunction from toxin buildup) It is essential to seek immediate medical attention if you experience any of these symptoms, especially with known kidney disease, to prevent further complications and improve outcomes 1.
From the Research
Definition of Kidney Failure Emergency
Kidney failure can be considered an emergency in certain situations, including:
- Acute kidney injury (AKI) with hemodynamic compromise, as commonly observed in critically ill patients 2
- Electrolyte abnormalities, such as anion gap or non-anion-gap metabolic acidosis, which can be a clinical manifestation of AKI 3
- Uremia, which is a consequence of renal failure 2
- Fluid status and electrolyte issues that require dialysis, particularly in intensive care units 2
Indications for Emergent Dialysis
Emergent dialysis may be indicated in the following situations:
- Failure of conservative management for patients with AKI 3
- Presence of specific conditions where AKI is common, such as hepatorenal syndrome, cardiorenal syndrome, rhabdomyolysis, and tumor lysis syndrome 2
- Need for renal replacement therapy to manage metabolic derangements, fluid status, and electrolyte issues 2
Management of Kidney Failure Emergency
Management of kidney failure emergency may involve:
- Identification of the cause of AKI using clinical history and laboratory data 3
- Targeted treatment of the underlying cause to avoid further insults 3
- Conservative management as the first line of treatment for patients with AKI 3
- Renal replacement therapy or hemodialysis if conservative management fails 3