Kidney Failure

Overview

Definition

The kidneys remove waste in the form of urine from the body. They also balance the water and electrolyte content in the blood by filtering salt and water. When one or both of the kidneys are not able to perform these functions, kidney failure may result.

Kidney failure is divided into 2 categories:

  • Acute kidney injury—sudden loss of kidney function
  • Chronic kidney failure—slow, gradual loss of kidney function
Anatomy of the Kidney
Glomerulonephritis
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Causes

Kidney disease occurs when nephrons lose their ability to function normally. Nephrons are cells in the kidney that filter the blood. Damage to the nephrons may occur suddenly after an injury or poisoning. Many kidney diseases take years or even decades to cause damage that is noticeable.

The 2 most commons causes of kidney disease are:

  • Diabetes—high blood sugar can damage nephrons
  • High blood pressure—severe high blood pressure can damage blood vessels in the kidneys

Others causes include:

  • Kidney infection—pyelonephritis
  • Glomerulonephritis
  • Genetic disorders, such as polycystic kidney disease
  • Bilateral renal artery stenosis
  • Birth defects
  • Abnormal build-up of substances within the kidneys such as amyloidosis and protein build-up
  • Toxic reaction to drugs or injections of contrast material used for imaging studies, such as CT scans

Risk Factors

Factors that increase your chance of kidney failure include:

  • Chronic diseases that affect kidney function
  • Genetic abnormalities or birth defects that affect kidney function
  • Autoimmune disorders, such as systemic lupus erythematosus, polyarteritis , and Wegeners granulomatosis
  • Cancer
  • Severe trauma
  • Viral infections, such as hepatitis B, hepatitis C, and HIV
  • Long-term use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs), especially in high doses
  • Conditions that affect blood volume, such as burns, pancreatitis, peritonitis, bleeding, and dehydration
  • Conditions that make it difficult to urinate such as enlarged prostate, kidney stones, and tumors
  • Recent heart surgery, such as open heart surgery or abdominal aortic aneurysm repair

SymptomsandDiagnosis

Symptoms

Some kidney diseases begin without any symptoms. As the disease progresses, some of the following symptoms may develop:

  • Fluid retention
  • Swollen and numb hands and feet, itchy skin
  • Fatigue and/or insomnia
  • Low or no urine output
  • Frequent urination
  • Altered consciousness
  • Loss of appetite, malnutrition
  • Sores, bad taste in the mouth
  • Nausea, vomiting
  • Muscle cramps and twitches
  • Shortness of breath
  • High blood pressure
  • Low temperature
  • Seizures, coma
  • Breath smelling like urine
  • Yellowish-brownish skin tone

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done.

Your bodily fluids and tissues may be tested. This can be done with:

  • Blood tests
  • Urine tests
  • Biopsy

Images may be taken of your kidneys, bladder, and ureters. This can be done with a renal ultrasound or CT scan.

Treatments

Treatment

Most chronic kidney diseases are not reversible, but there are treatments that may be used to help preserve as much kidney function as possible. In the case of acute kidney injury, treatment focuses on the illness or injury that caused the problem.

General Measures

  • Restricting fluids
  • Doing daily weight checks
  • Eating a high-carbohydrate, low-protein diet

Medications

Medications used in acute or chronic kidney failure may include:

  • Diuretics —to flush out the kidneys, increase urine flow, and rid the body of excess sodium
  • Blood pressure medications
  • Medications to treat anemia
  • Sodium polystyrene sulfonate or insulin in dextrose to control high potassium levels
  • Medications to control high phosphorus levels

Talk to your doctor about other medications you are taking. These include prescribed and over-the-counter medications, as well as herbs and supplements. Since the kidneys are no longer working properly, waste can build up in your body.

Dialysis

Dialysis is a process that takes over for the kidneys and filters waste from the blood. This may be needed until kidney function improves or a kidney transplant is done.

Kidney Transplant

This may be the right option for some people. Having a successful transplant depends on many factors, such as what is causing the kidney damage and overall health.

Lifestyle Changes

You can take the following steps to help your kidneys stay healthy longer:

  • Have your blood pressure checked regularly. Take medication to control high blood pressure.
  • If you have diabetes, control your blood sugar. Ask your doctor for help.
  • Avoid the chronic use of pain medications.
  • Depending on the severity of kidney disease, there may be dietary restrictions on protein, cholesterol, sodium, or potassium.

Prevention

In some cases, you cannot prevent kidney failure, but there are some steps you can take that will lower your risk:

  • Maintain normal blood pressure.
  • If you have diabetes, control your blood sugar.
  • Avoid long-term exposure to toxic substances, such as lead and solvents.
  • Do not abuse alcohol or over-the-counter pain medication.
  • If you have chronic kidney failure, talk to your doctor before you become pregnant.

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Edits to original content made by Denver Health.

a (Renal Failure; Renal Insufficiency)

RESOURCES

National Institute of Diabetes and Digestive and Kidney Diseases  http://www.niddk.nih.gov 

National Kidney Foundation http://www.kidney.org 

CANADIAN RESOURCES

Canadian Diabetes Association http://www.diabetes.ca 

The Kidney Foundation of Canada http://www.kidney.ca 

References

Chronic kidney disease (CKD) in adults. EBSCO DynaMed Plus website. Available at:  http://www.dynamed.com/topics/dmp~AN~T115336/Chronic-kidney-disease-CKD-in-adults . Updated August 23, 2016. Accessed September 28, 2016.

Johnson CA, Levey AS, Coresh J, Levin A, Lau J, Eknoyan G. Glomerular filtration rate, proteinuria, and other markers. Am Fam Physician. 2004;70(6):1091-1097.

Johnson CA, Levey AS, Coresh J, Levin A, Lau J, Eknoyan G. Clinical practice guidelines for chronic kidney disease in adults: part I. Definition, disease stages, evaluation, treatment, and risk factors. Am Fam Physician. 2004;70(5):869-876.

Kidney Disease Outcomes Quality Initiative. K/DOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease. Am J Kidney Dis. 2004;43(5 Suppl 1):S1-S290.

Kidney Disease Outcomes Quality Initiative. Kidney disease outcomes quality initiative (K/DOQI) clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39(2 Suppl 1):S1-S266.

National Kidney Foundation. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis. 2003;42(4 Suppl 3):S1-S201.

Snivel CS, Gutierrez C. Chronic kidney disease: prevention and treatment of common complications. Am Fam Physician. 2004;70(10):1921-1928.

Use of herbal supplements in chronic kidney disease. National Kidney Foundation website. Available at: https://www.kidney.org/atoz/content/herbalsupp. Published 2015. Accessed June 1, 2016.

The kidneys and how they work. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/health-information/health-topics/Anatomy/kidneys-how-they-work/Pages/anatomy.aspx. Updated May 2014. Accessed June 1, 2016.

1/4/2011 DynaMed Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Deved V, Poyah P, James MT, et al. Ascorbic acid for anemia management in hemodialysis patients: A systematic review and meta-analysis.. Am J Kidney Dis. 2009;54(6):1089-1097.

10/10/2013 DynaMed Systematic Literature Surveillance http://www.ebscohost.com/dynamed Di lorio B, Molony D, Bell C, et al. Sevelamer versus calcium carbonate in incident hemodialysis patients: Results of an open-label 24-month randomized clinical trial. Am J Kidney Dis. 2013;62(4):771-778.