(Renal Failure; Renal Insufficiency)
When you have kidney failure, one or both kidneys aren't able to work normally. 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.
Kidney failure is divided into two categories:
Kidney disease causes the tiny filters in the kidneys (called nephrons) to lose their ability to filter. Damage to the nephrons may occur suddenly after an injury or poisoning. But, many kidney diseases take years or even decades to cause damage that is noticeable.
The two most commons causes 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:
- ]]>Polycystic kidney disease]]>
- Birth defects
- ]]>Bilateral renal artery stenosis]]>
- Severe ]]>trauma]]>
- Viral infections (eg, ]]>hepatitis B]]> , ]]>hepatitis C]]> , ]]>HIV/AIDS]]> )
- Long-term use of medicines that contain ]]>aspirin]]> , ]]>acetaminophen]]> , ]]>ibuprofen]]>
- Abnormal build-up of substances within the kidneys (eg, ]]>amyloidosis]]> , protein build-up)
- Toxic reaction to drugs or ]]>x-ray]]> dyes
- Systemic diseases (eg, ]]>lupus]]> , ]]>polyarteritis]]> , ]]>Wegener’s granulomatosis]]>
- Conditions that severely decrease the amount of blood (eg, ]]>burns]]> , ]]>pancreatitis]]> , ]]>peritonitis]]> )
- Conditions that make it difficult to urinate (eg, ]]>enlarged prostate]]> , ]]>kidney stones]]> , tumors)
These factors increase your chance of developing kidney failure. Tell your doctor if you have any of these risk factors:
- Genetics: polycystic kidney disease]]> , ]]>type 1 diabetes]]>
- Race: African Americans
- High blood pressure
- Lupus or other autoimmune diseases
- Long-term use of ]]>pain medications]]> containing aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) in high doses
- Liver failure, ]]>jaundice]]>
- Respiratory failure
- Recent ]]>open heart surgery]]>
- Recent surgery on an ]]>abdominal aortic aneurysm]]>
- Condition that obstructs urine flow
- Enlargement of the prostate gland
Some kidney diseases begin without any symptoms. As the disease progresses, some of the following symptoms may develop:
- Fluid retention
- Swollen hands and feet, numbness of hands and feet, itchy skin
- Fatigue, insomnia]]>
- Low urine output (or no urine output in severe cases), 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
The doctor will ask about your symptoms and medical history, and perform a physical exam. Tests may include:
If the kidneys are not working properly, the blood will show:
An increase in:
- Parathyroid hormone
- Blood urea nitrogen
- A decrease in serum calcium
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 cases of acute renal failure]]> , treatment focuses on the illness or injury that caused the problem.
- Restricting fluids
- Doing daily weight checks
- Eating a high-carbohydrate, ]]>low-protein diet]]>
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 (eg, ]]>furosemide]]> , ]]>mannitol]]> )
- Dopamine, atrial natriuretic peptide (ANP)—to dilate blood vessels in the kidneys, increase urine flow, flush out sodium
- Blood pressure medications (eg, ACE inhibitors)
- ]]>Sodium polystyrene sulfonate]]> or insulin in dextrose—to control high potassium levels
- ]]>Calcium acetate]]> —to control high phosphorus levels
Talk to your doctor other medications that your 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]]> is a process that takes over for the kidneys and filters waste from the blood. This may be done for short-term, until kidney function improves. Or, it may be done you have a ]]>kidney transplant]]> .
This may be the right option for some patients. Having a successful ]]>transplant]]> depends on many factors, such as what is causing the kidney damage and your overall health.
Your doctor will monitor these blood levels:
Red blood cells
- Your doctor may inject a hormone called erythropoietin to help manage ]]>anemia]]> .
The following are 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.
- If you have chronic kidney disease, you may need to limit how much ]]>protein]]> you eat. Talk to a dietician.
- Limit how much cholesterol and sodium you eat.
- If you have severe kidney disease, limit how much ]]>potassium]]> you eat. If your kidneys are failing, get help from a dietician.
If you are diagnosed with kidney failure, follow your doctor's instructions .
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.
- Limit the amount of drugs toxic to the kidney.
- If you have chronic kidney failure, talk to your doctor before you become pregnant.
National Kidney Foundation
National Kidney and Neurologic Disease Information Clearinghouse
Canadian Diabetes Association
The Kidney Foundation of Canada
Johnson CA, Levey AS, Coresh J, et al. Glomerular filtration rate, proteinuria, and other markers. Am Fam Physician. 2004;70:1091-1097.
Johnson CA, Levey AS, Coresh J, et al. Clinical practice guidelines for chronic kidney disease in adults: part I. Definition, disease stages, evaluation, treatment, and risk factors. Am Fam Physician. 2004;70:869-876.
Kidney Disease Outcomes Quality Initiative. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis. 2003;42:S1-201.
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:S1-S9.
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:S1-266.
Shannon D. Medications for chronic kidney disease. EBSCO Health Library website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15topicID=81 . Updated April 2007. Accessed July 17, 2008.
Snivel CS, Gutierrez C. Chronic kidney disease: prevention and treatment of common complications. Am Fam Physician. 2004;70:1921-1928.
Use of herbal supplements in chronic kidney disease. National Kidney Foundation website. Available at: http://www.kidney.org/atoz/atozItem.cfm?id=123 . Updated November 2005. Accessed July 16, 2008.
Your kidneys and how they work. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://kidney.niddk.nih.gov/kudiseases/pubs/yourkidneys/#10 . Updated August 2007. Accessed July 16, 2008.
Last reviewed November 2008 by ]]>Adrienne Carmack, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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