Kidney Failure

Definition

Kidney failure is when your kidneys don’t work as they should. There are two main types:

• Acute kidney injury (AKI)—happens quickly
• Chronic kidney disease (CKD)—happens over a long time

Waste and excess fluids are screened out in the kidneys and passed as urine. Filters in the kidneys help to control how much fluid and healthy elements like sodium leave the body. Kidney failure makes it hard for the body to keep fluids and other important elements in balance.

Anatomy of the Kidney

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Causes

Kidney failure is caused by injury to the filters and other areas of the kidneys. AKI is most often caused by trauma, infection, or a toxin that cause sudden injury. CKD is often caused by long term health problems. These problems cause wear and tear to kidneys over time. The two most common causes of CKD are:

• Diabetes—harms the tiny tubules that filter blood
• High blood pressure —harms the blood vessels

Other common causes:

• A kidney infection— pyelonephritis
• Glomerulonephritis
• Genetic diseases such as polycystic kidney disease
• Narrowed blood vessels— bilateral renal artery stenosis
• Structural problems—some may exist at birth
• Medicines or drugs
• Dyes given for x-rays

Risk Factors

The risk of kidney failure is higher with:

• Long term health conditions
• Certain structural problems
• Autoimmune diseases such as systemic lupus erythematosus
• Cancer
• Severe trauma
• Infections such as HIV
• Long term use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs)
• Blood volume problems caused by burns , bleeding, or dehydration
• Blockage in the urinary tract from an enlarged prostate , kidney stones , or tumors
• Recent heart surgery

Symptoms

Symptoms are usually not present in early stages. Later stages may cause:

• Swelling in your feet and ankles
• Puffiness around face
• Itchy skin
• Muscle cramps and twitches
• Nausea or vomiting
• Loss of hunger
• Weight loss
• Urinary problems
• Trouble sleeping
• Feeling tired
• Changes in mental state
• Seizures
• Coma

Diagnosis

The doctor will ask about symptoms and past health. Urine tests will be done to look for signs of kidney problems such as:

• Blood
• Certain proteins
• Levels of other elements normally found in the blood

Blood tests will also be done to measure levels of some elements. Images of the kidney may be taken with:

• Renal ultrasound
• CT scan
• Kidney biopsy

Treatment

The goal of kidney failure treatment is to slow further damage. Treatment may also be needed to balance fluids and clean waste from the blood. AKI may only need short term support. The kidneys may recover enough fucntion once they recover from injury.

CKD may need more long term treatment.

Lifestyle Changes

Changes in day to day habits can ease stress on the kidneys. It may slow damage to kidneys. Steps may include:

• Watching your intake of fluids
• Making nutritional changes such as restricting protein, cholesterol, salt, or potassium
• Being as active as you can be
• Checking your weight daily to watch fluid levels
• Checking your blood pressure at home
• Changing how you use pain medicine
• Following your care plan for diabetes or high blood pressure

Medicines

Medicines help manage:

• The balance of salt, minerals, and fluids in your body
• Blood pressure
• Diabetes
• Anemia

Your doctor may also change medicines you take if they harm your kidneys.

Dialysis

Dialysis takes over the work of the kidneys. You may need it for a short time while they heal. Some people need it for life. Others use it until a kidney transplant is ready.

There are 2 main types:

• Hemodialysis —Blood with wastes is taken from the body and filtered through a machine. Clean blood is returned to the body.
• Peritoneal dialysis —A cleansing fluid fills the space in the belly. Wastes are drawn from the blood into the fluid. The fluid then drains out of the body.

Kidney Transplant

A transplant may work for some people. A healthy kidney comes from a donor. It’s placed next to the existing kidney during surgery. The new kidney should work well enough for you to stop dialysis.

An effective transplant may depend on the cause of kidney damage and your overall health.

Prevention

To lower your chances of kidney problems:

• Follow your care plans if you have high blood pressure or diabetes.
• Don’t use medicines that cause harm to your kidneys. Your doctor will make changes as needed.
• Use NSAIDs as advised.
• Drink only in moderation. Moderation is 2 drinks a day or less for men or 1 drink a day or less for women.
• If you’re at high risk for kidney problems, see your doctor as advised.