The clinical picture depends upon underlying causes, like acute GN (allergic disorder of kidneys), sudden acute rise in blood pressure (malignant hypertension), or it may be a case of acute infection of the kidneys (pyelonephritis), or an advanced case of dehydration (due to repeated vomiting, diarrhoea, etc.), or due to loss of blood as a result of sudden bleeding, or due to marked hypotension, i.e. fall in blood pressure in a case of heart attack, or acute kidney failure may manifest itself due to the use of toxic drugs, as explained earlier. Hence, the signs and symptoms vary with the basic disease the patient is suffering from.

Immediate treatment should be started whenever any of the above diseases/conditions occur, and a close watch should be kept on the daily output of urine. A general awareness is required on the part of everyone that whenever a kidney patient starts passing less urine, he/she should consider that the function of the kidneys is markedly threatened, and therefore, it is advisable that the amount of urine passed each day should be collected and measured. It may seem very simple, but since collection of 24-hour urine is somewhat cumbersome and distasteful, people may not like to follow it. As a result, excretion of urine goes on reducing day by day, till it becomes . around 400 ml, and at this volume of urine, kidney failure occurs. Even serum creatinine or blood urea does not run parallel to the initial damage the kidneys. Hence, it is vital to keep a close watch on the volume of the daily output of urine, in the various circumstances mentioned above, which are responsible for sudden kidney damage/failure.

Initially, during the first week of the disease, the signs and symtoms are of the primary disease, i.e. acute GN, dehydration, etc., and the patient starts passing less urine than normal. If the condition remains undetected, i.e. specific attention is not paid, or the patient does not report to his physician about the low output of urine, the vital period for saving the kidneys is wasted, and the volume of urine passed daily goes ondecreasing till it becomes less than 400 ml, when an acute kidney failure is said to have been initiated. Due to the retention of water, swelling of the face and other parts of body may develop. The patient will have marked symptoms of nausea/ vomiting, drowsiness and convulsions, and even death may occur. Both blood urea and serum creatinine will be raised.

Treatment

The patient should be treated in a hospital. Besides urgent measures, the underlying cause of the ARF should be simultaneously looked into. If blood pressure is markedly elevated, it should be lowered with suitable drugs. If infection is the sole reason, it needs to be treated on the lines of UTI, already discussed. And, if there is some obstruction in the urinary tract, say, as a result of an enlarged prostate, etc., it should be immediately dealt with in the hospital, by a team of doctors, including both physicians and surgeons. In case of loss of fluids/blood, measures should be taken accordingly. If drugs are the causative factors, they ought to be stopped immediately.

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