Kidney Failure

What is Kidney Failure?

Before kidney failure occurs, patients have "chronic kidney disease" (CKD). Kidney (renal) failure is when kidneys don't work as well as they should, to the point where kidney replacement is required. Kidney replacement can be accomplished by different kinds of dialysis or by kidney transplant. The term "kidney failure" covers a lot of problems. These problems can result in kidney failure:

1.Your kidney doesn't get enough blood to filter

2.Your kidney is hurt by a disease like

3.high blood sugar (diabetes)

4.high blood pressure

5.glomerulonephritis (damage to the kidney's tiny filters; one example: lupus)

6.polycystic kidney disease

7.and many others

Your kidney is blocked by a kidney stone or scar tissue (blockage of ONE kidney usually does not cause kidney failure because the other kidney is not affected; but blockage of two kidneys can lead to an emergency).

Symptoms

The symptoms of CKD are often quite mild; people may have significantly reduced kidney function and not be aware of it. The symptoms of kidney failure can differ based on how bad the kidney failure is, how quickly it is getting worse, and what is causing it.

There are 2 main types of kidney (renal) failure: acute (sudden) and chronic (over time).

Acute Renal Failure – more commonly known today as “acute kidney injury”(AKI)

AKI occurs when the kidneys suddenly stop filtering waste products from the blood.

The signs of AKI can be:

1.swelling of the hands, feet and face (edema)

2.internal bleeding

3.confusion

4.seizures

5.coma

6.abnormal blood and urine tests

7.high blood pressure

Chronic Kidney Disease (CKD; previously known as Chronic Renal Failure – CRF)

CKD builds slowly with very few symptoms in its early stages.

A patient with CKD may not have any symptoms until kidney function declines to 20% or less. At that stage, these signs may appear:

1.abnormal blood and urine tests

2.high blood pressure

3.weight loss for no reason

4.low red blood cell count (anemia)

5.nausea

6.vomiting

7.metal taste in your mouth

8.loss of appetite

9.shortness of breath

10.numbness and tingling

11.confusion

12.coma

13.seizures

14.easy bruising

15.itching

16.fatigue

17.muscle twitches and cramps

18.weak bones that break easily

19.itching

20.swelling of the hands, feet and face (edema)

21.trouble sleeping

Causes

AKI is most likely to happen with:

1.low blood flow (such as after complicated surgery or an accident)

2.swelling (inflammation) of the kidney (such as a reaction to a drug or infection)

3.sudden blockage (such as by a kidney stone)

4.very high blood pressure

With AKI, the kidney often returns to normal or near normal after the cause is treated.

CKD is permanent loss of kidney function. The most common causes are:

1.high blood pressure

2.chronic glomerulonephritis (kidney damage)

3.high blood sugar (diabetes)

4.polycystic kidney disease

5.blocked urinary tract

Diagnosis

Overall kidney function is judged by the level of filtration that occurs. Filtration is accomplished by the tiny blood vessels in the kidney called “glomeruli”. So overall kidney function is called the “glomerular filtration rate” (GFR), measured as the volume of blood filtered per minute (milliters/minute). Normal values are about 100 ml/min, but varies with age and sex. GFR can be estimated (eGFR) using formulas that take into account your age, sex and a blood test called creatinine.

Kidney failure is most often found when the creatinine level is high, indicating that kidney function is reduced. Creatinine is a molecule made by your muscles. A normal kidney will remove creatinine from the blood stream and get rid of it in urine. More creatinine in the blood is a sign that the kidneys aren't cleaning the blood as well as they should. This test can spot something is wrong before a patient with kidney failure feels sick.

Treatment

To treat AKI, you have to treat the cause (such as blood pressure that is too high or too low, a kidney stone or high blood sugar). Sometimes you need dialysis for a short time.

With CKD, treating the cause (such as high blood pressure and/or high blood sugar) can slow the disease. The goal is to prevent CKD from turning into advanced kidney disease, or end stage kidney disease (ESKD, formerly known as end stage renal disease, ESRD).

When kidney function falls below 10% of normal, dialysis or a kidney transplant is usually needed, especially if you have signs of uremia (a buildup of waste in the blood), like nausea, loss of appetite, weight loss and itching.

Types of kidney failure

Five different types of kidney failure exist. Acute kidney failure occurs when your kidneys suddenly stop working properly. Chronic kidney failure occurs over time.

The five types of kidney failure include:

1.Acute prerenal kidney failure. Insufficient blood flow to the kidneys can cause acute prerenal kidney failure. The kidneys can’t filter toxins from the blood without enough blood flow. This type of kidney failure can usually be cured once the cause of the decreased blood flow is determined.

2.Acute intrinsic kidney failure. Acute intrinsic kidney failure can result from direct trauma to the kidneys, such as physical impact or an accident. Other causes include toxin overload and ischemia, which is a lack of oxygen to the kidneys. Ischemia can be caused by severe bleeding, shock, obstruction of the renal blood vessel, and glomerulonephritis, a condition where the tiny blood vessels in your kidneys become inflamed.

3.Chronic prerenal kidney failure. When there isn’t enough blood flowing to your kidneys for an extended period of time, the kidneys begin to shrink and lose the ability to function.

4.Chronic intrinsic kidney failure. This happens when there’s long-term damage to the kidneys due to intrinsic kidney disease. Intrinsic kidney disease develops from a direct trauma to the kidneys, such as severe bleeding or a lack of oxygen.

5.Chronic post-renal kidney failure. A long-term blockage of the urinary tract prevents urination. This causes pressure and eventual kidney damage.

What are the signs of end-of-life kidney failure?

1.Water retention/swelling of legs and feet.

2.Loss of appetite, nausea, and vomiting.

3.Confusion.

4.Shortness of breath.

5.Insomnia and sleep issues.

6.Itchiness, cramps, and muscle twitches.

7.Passing very little or no urine.

8.Drowsiness and fatigue.

What happens when kidney failure starts?

You will feel tired and weak because your body needs clean blood to function properly. Untreated uremia may lead to seizures or coma and will ultimately result in death. If your kidneys stop working completely, you will need to undergo dialysis or kidney transplant.

Can a person recover from kidney failure?

The good news is that acute kidney failure can often be reversed. The kidneys usually start working again within several weeks to months after the underlying cause has been treated. Dialysis is needed until then.

How long do you last if your kidneys are failing?

People with kidney failure may survive days to weeks without dialysis, depending on the amount of kidney function they have, how severe their symptoms are, and their overall medical condition. Is death from kidney failure painful? Not usually.

Can you live without kidneys?

If you have both kidneys completely removed, you will not make any urine. You will need to have kidney dialysis. This is a way of getting rid of waste products and excess water that the kidneys normally filter out of your blood. Dialysis means you can lead a more or less normal life without a working kidney.

What is the cure of kidney failure?

There is no cure for kidney failure, but with treatment many people with kidney failure are able to keep doing activities they want or need to do. Talk to your doctor about which treatment is best for you.

Can you live a normal life with kidney failure?

There is no cure for kidney failure, but with treatment it is possible to live a long, fulfilling life. Having kidney failure is not a death sentence. People with kidney failure live active lives and continue to do the things they love.