We are gaining an insight into the recommendations for the management of the acute complications sickle cell disease. Today, we look at acute renal failure.
A rapid decline in renal function defines acute renal failure alias acute kidney injury. A rise in serum creatinine occurs. Glomerular filtration rate decreases with or without a decline in urine output.
You pity a clinician handling such a patient in a setting where there’s barely a chemistry machine within a 100km radius.
Acute kidney injury among people living with SCD often results from dehydration.
It can also be due to,
– an obstruction like renal stone,
-an insult to the filtering mechanism of the kidneys (glomerulus)
– It can also occur during an acute vaso-occlusive crisis.
When the sickle red cells obstruct the blood supply in the vas recta, the tissues in the renal medulla die – forming infarcts. It then culminates in renal papillary necrosis. The patients often present with pain in the flanks associated with hematuria. It affects up to 30% of the people living with SCD.
Many remote areas in the country lack opioid analgesics. Clinicians often resort to using diclofenac, ibuprofen and paracetamol. Diclofenac can damage the kidneys, so patients with sickle cell disease are at a substantiated risk for acute kidney injury. It is even higher in the setting of dehydration. These drugs are commonplace when managing a vaso-occlusive crisis. In other centres, the use of contrast media can also damage the kidneys leading to acute renal failure.
In general, people living with SCD tend to have some inherent inability to concentrate urine. It is a challenge because clinicians cannot reliably detect acute kidney injury among people living with sickle cell disease. It is because the serum creatinine levels do not rise until substantial kidney damage has occurred. It is caused by increased secretion of creatinine by the renal tubules.
All that said, it is paramount to consider other causes of acute renal failure among these patients. Multisystem organ failure isn’t far from occurring if a diagnosis isn’t prompt.
Visit KIDGO for a further understanding of acute renal failure. Let’s summarize the recommendations governing the management of acute renal failure in sickle cell disease. It is worth mentioning that we derived them from a panel of experts on evidence-based management of sickle cell disease. Access more information here.
- In the setting of an acute rise in serum creatinine of ≥0.3 mg/dL, monitor renal function daily. Monitor serum creatinine and fluid intake/output. Avoid all potential nephrotoxic drugs and imaging agents. Evaluate the patient thoroughly for all possible causes in consultation with a nephrologist as needed. Do not give blood transfusions to treat acute renal failure unless there are other indications for transfusion.
- Use renal replacement therapy like hemodialysis when needed for acute renal failure.
If a patient presents with a fever amidst acute renal failure, infection is highly likely. Investigate it to rule out severe bacteremia.
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