Kidney Failure

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Introduction

What is kidney failure?

Kidney failure, also called renal failure, is a life-threatening condition in which there is a buildup of waste and fluid in the body due to severe deterioration of kidney function. The kidneys are vital internal organs located in the upper abdomen. Normally, people have two bean-shaped kidneys that form a part of the urinary tract in the genitourinary system.

Healthy kidneys function continuously and the body’s total blood supply passes through the kidneys several times each minute. The healthy body can continue to function with only one good kidney, as happens when someone volunteers to be a live kidney donor.

Kidney failure is caused by a variety of kidney diseases and other conditions that lead to kidney damage and deterioration of kidney function. Kidney failure can make it difficult or impossible for the kidneys to perform functions that are critical to life and your overall health including:

  • Filtering waste products and excess water and salts from the blood, which are then eliminated from the body through the ureters, bladder and urethra in the form of urine

  • Producing certain hormones, such as renin, which helps regulate blood pressure

  • Producing the active form of vitamin D (calcitriol)

  • Regulating electrolytes and other vital substances, such as sodium, calcium, and potassium

  • Regulating the level and quality of fluid in the body

  • Stimulating red blood cell production

There are two general types of kidney failure:

  • Acute renal failure is a condition in which there is damage and deterioration of kidney function that occurs suddenly, generally over a period of days. Acute renal failure can be caused by such conditions as shock, acute pyelonephritis, urinary tract obstruction, or ingestion of certain toxic substances. In some cases, acute renal failure can be totally reversible without long-term consequences.

  • Chronic kidney failure is a condition in which there is damage and deterioration of kidney function that occurs over a long period of time (months to years). Chronic kidney failure is generally caused by long-term diseases, such as diabetes and hypertension.

Once permanent kidney damage has occurred due to kidney disease or other conditions, such as uncontrolled hypertension, it cannot be reversed or cured. Seek prompt and regular medical care if you have risk factors for kidney disease, such as hypertension or diabetes. Patient compliance with a good treatment plan may prevent, slow or stop progression of kidney damage and minimize complications.

Kidney failure is a life-threatening condition because it critically affects the kidneys' ability to function normally. However, rapid diagnosis and treatment of underlying causes of acute kidney failure may reverse the condition. Seek immediate medical care (call 911) if you, or someone you are with, have symptoms of kidney failure, such as severe shortness of breath, bloody stools or urine, sudden decrease in urine output or lack of urinating, severe flank pain, or a change in consciousness or alertness. You should also seek immediate medical care (call 911) if you, or someone you are with, have overdosed on a drug or ingested a toxic substance.

Symptoms

What are the symptoms of kidney failure?

Symptoms of kidney failure, kidney disease, and other underlying causes of kidney failure can vary. General symptoms can include:

  • Cloudy or discolored urine

  • Difficulty urinating

  • Dizziness upon attempted standing

Serious symptoms that might indicate a life-threatening condition

You should seek immediate medical care (call 911) if you, or someone you are with, have any of these symptoms of kidney failure or serious kidney disease:

  • Blood clots in urine or bloody urine (hematuria)

  • Bloody stools or black, tarry stools

  • Change in level of consciousness or alertness, such as passing out or unresponsiveness

  • Change in mental status or sudden behavior change, such as confusion, delirium, lethargy, hallucinations or delusions

  • Seizure

  • Severe flank pain that can move or radiate to the lower abdomen, groin, labia, or testicles

  • Shortness of breath or difficulty breathing

  • Sudden decrease in urination or lack of urination

You should also seek immediate medical care (call 911) if you, or someone you are with, have overdosed on a drug or ingested a toxic substance.

Causes

What causes kidney failure?

Kidney failure can be caused by a wide variety of underlying diseases, disorders or conditions that lead to kidney damage, such as obstruction, infection, malignancy, inflammation, deformity, toxic ingestion, or a reduced blood supply to the kidneys. Underlying causes include:

  • Diabetes, which can damage the kidneys over time

  • Diseases that cause inflammation and damage to the kidney, such as nephritis and glomerulonephritis

  • Heart failure

  • Hypertension (high blood pressure)

  • Infections, such as repeated bladder infections, pyelonephritis (kidney infection), or septicemia (blood infection)

  • Kidney cancer

  • Liver failure

  • Medications, such as intravenous (IV) drug abuse, overdose of certain drugs, or long-term use of certain medications, such as nonsteroidal anti-inflammatory drugs

  • Polycystic kidney disease (inherited disease that causes formation of large cysts in the kidneys that damage kidney tissue)

  • Reduced blood flow to the kidneys due to shock or renal artery stenosis (narrowing of the renal arteries)

  • Systemic lupus erythematosus (disorder in which the body attacks its own healthy cells and tissues) and other autoimmune diseases that can attack the kidneys

  • Toxic exposure to poisonous substances

  • Trauma or injury to the kidney or arteries that supply blood to the kidneys

  • Urinary tract obstruction, which can be caused by a kidney stone, tumor, congenital deformity, or enlarged prostate gland

What are the risk factors for kidney failure?

Kidney failure can affect people of any age and any race or cultural background. However, a number of factors increase the risk of developing kidney failure. Risk factors include:

  • African American, Native American, Hispanic American, Asian, or Pacific Islander ethnicity

  • Age 65 years or older

  • Diabetes

  • Exposure to radiographic contrast material

  • Family history of kidney disease or kidney failure

  • Heart disease or liver disease

  • High cholesterol, atherosclerosis (buildup of plaque on the walls of the arteries), and peripheral artery disease (PAD)

  • Hypertension (high blood pressure)

  • Intravenous (IV) drug abuse

  • Liver disease

  • Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen and naproxen)

  • Obesity

  • Recent major surgery or serious or life-threatening illnesses, such as shock and septicemia (blood infection)

  • Smoking

    Reducing your risk of kidney failure

    Not all people who are at risk for kidney failure will develop the condition. However, you may be able to lower your risk of developing kidney failure by:

    • Following your physician’s recommendation for using medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs)

    • Maintaining a healthy weight

    • Not smoking

    • Not using recreational and IV drugs

    • Seeking regular medical care and following your treatment plan for chronic diseases and conditions, such as diabetes, hypertension, obesity, high cholesterol, and heart disease

    Treatments

    How is kidney failure treated?

    Treatment or prevention of kidney failure begins with treatment of the underlying cause. Treatment plans vary depending on the underlying cause or disease. The goal of treatment is to cure or control the underlying condition and prevent excessive fluid and waste from accumulating in the body, as well as to stop or slow the progression of kidney damage. Treatment may also minimize complications of kidney failure.

    General treatment of kidney failure may include:

    • Diet that limits salt, fluids and protein

    • Diuretic medications to help damaged kidneys eliminate fluid

    • Kidney dialysis, which filters waste products from the blood, for people with advanced kidney failure

    • Kidney transplant, a major surgical procedure using a healthy donor kidney to replace severely damaged kidneys, for people with end-stage kidney failure

    • Medications to balance electrolytes in the body or ensure adequate vitamin levels, especially vitamin D

    • Monitoring and control of blood pressure

    • Not smoking or quitting smoking

    • Prompt treatment of bladder infections

    • Reduction or elimination of certain medications that can be hard on the kidneys

    • Regular medical care

    • Weight loss as needed and maintenance of a healthy weight

    What are the possible complications of kidney failure?

    Kidney failure can lead to serious and life-threatening complications. You may be able to reduce your risk of serious complications by seeking regular medical care and following the treatment plan you and your health care professional design specifically for you. Complications include:

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    Medical Reviewer: William C. Lloyd III, MD, FACS
    Last Review Date: 2018 Nov 18
    1. About Chronic Kidney Disease. National Kidney Foundation. http://www.kidney.org/kidneydisease/ckd/index.cfm.
    2. Acute Kidney Failure. PubMed Health, a service of the NLM from the NIH. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001530/#adam_000501.disease.treatment.
    3. Chronic Kidney Disease. Medline Plus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/000471.htm.
    4. Kidney Disease. National Kidney Foundation. http://www.kidney.org/kidneydisease/.
    5. Kidney Disease. Lab Tests Online. http://www.labtestsonline.org/understanding/conditions/kidney-2.html
    6. Kidney Failure. JAMA Patient Page. http://jama.ama-assn.org/content/301/6/686.full.pdf
    7. Bope ET, Kellerman RD (Eds.) Conn’s Current Therapy. Philadelphia: Saunders, 2013.
    8. Domino FJ (Ed.) Five Minute Clinical Consult. Philadelphia: Lippincott Williams & Wilkins, 2013.
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