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Kidney Failure

(Renal Failure; Renal Insufficiency)

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 two categories:

Anatomy of the Kidney

Glomerulonephritis
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Causes    TOP

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 two 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:

Risk Factors    TOP

Factors that increase your chance of kidney failure include:

Symptoms    TOP

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 in severe cases
  • 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    TOP

The doctor will ask about your symptoms and medical history. A physical exam will be done.

Tests may include:

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

Treatment    TOP

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 renal failure, 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    TOP

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

Kidney Transplant    TOP

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    TOP

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    TOP

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.

RESOURCES:

National Kidney Foundation
http://www.kidney.org
National Kidney and Urologic Diseases Information Clearinghouse
http://kidney.niddk.nih.gov

CANADIAN RESOURCES:

Canadian Diabetes Association
http://www.diabetes.ca
The Kidney Foundation of Canada
http://www.kidney.ca

References:

Chronic kidney disease. EBSCO DynaMed website. Available at:
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Updated April 22, 2013. Accessed July 8, 2013.
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. Accessed July 8, 2013.
The kidneys and how they work. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at:
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Updated March 23, 2012. Accessed July 8, 2013.
1/4/2011 DynaMed Systematic Literature Surveillance
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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
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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.
Last reviewed May 2015 by Michael Woods, MD
Last Updated: 10/10/2013

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