Kidney Failure: Causes and Treatment

Kidney Failure: Causes and Treatment

Kidney failure, also known as renal failure, occurs when your kidneys lose the ability to filter waste products and excess fluids from your blood effectively. This can lead to a buildup of toxins in the body, causing a range of health problems. Kidney failure can be acute (sudden) or chronic (gradual). This article provides a comprehensive overview of kidney failure, covering its causes, symptoms, stages, diagnosis, treatment options, and lifestyle management.

Understanding kidney failure is crucial for early detection, management, and improving quality of life.

Kidney Failure

Types of Kidney Failure

There are two main types of kidney failure:

1. Acute Kidney Injury (AKI)

• Sudden onset: AKI develops rapidly, over a few hours or days.
• Potentially reversible: With prompt treatment, kidney function may recover.
• Causes:
  • Decreased blood flow to the kidneys: Due to dehydration, blood loss, heart failure, or severe infection (sepsis).
  • Direct damage to the kidneys: From medications (e.g., NSAIDs, some antibiotics), toxins, contrast dye used in imaging tests, or certain medical conditions (e.g., glomerulonephritis).
  • Blockage of the urinary tract: Due to kidney stones, an enlarged prostate, or tumors.

2. Chronic Kidney Disease (CKD)

• Gradual onset: CKD develops slowly, over months or years.
• Progressive and irreversible: Kidney damage worsens over time, eventually leading to end-stage renal disease (ESRD).
• Causes:
  • Diabetes: The leading cause of CKD.
  • High blood pressure (hypertension): The second leading cause of CKD.
  • Glomerulonephritis: Inflammation of the kidney’s filtering units (glomeruli).
  • Polycystic Kidney Disease (PKD): An inherited disorder that causes cysts to grow in the kidneys.
  • Other kidney diseases: Such as pyelonephritis (kidney infection) and interstitial nephritis.
  • Long-term use of certain medications: Such as NSAIDs.
  • Obstruction of the urinary tract:

Stages of Chronic Kidney Disease (CKD)

CKD is classified into five stages based on the estimated glomerular filtration rate (eGFR), a measure of how well your kidneys are filtering waste products from your blood.

CKD Stages

• Stage 1: Kidney damage with normal or increased GFR (eGFR ≥ 90 mL/min/1.73 m²).
• Stage 2: Mildly reduced kidney function (eGFR 60-89 mL/min/1.73 m²).
• Stage 3: Moderately reduced kidney function (eGFR 30-59 mL/min/1.73 m²).
  • Stage 3a: eGFR 45-59
  • Stage 3b: eGFR 30-44
• Stage 4: Severely reduced kidney function (eGFR 15-29 mL/min/1.73 m²).
• Stage 5: Kidney failure (eGFR < 15 mL/min/1.73 m²) or on dialysis. Also known as end-stage renal disease (ESRD).

Note: GFR is calculated using a formula that takes into account your blood creatinine level, age, sex, and race.

Symptoms of Kidney Failure

The symptoms of kidney failure vary depending on the type (acute or chronic) and the severity of the kidney damage. In the early stages of CKD, there may be few or no symptoms.

Symptoms of Acute Kidney Injury (AKI)

• Decreased urine output (oliguria) or no urine output (anuria).
• Swelling (edema) in the legs, ankles, or feet.
• Shortness of breath.
• Fatigue.
• Nausea and vomiting.
• Confusion.
• Chest pain or pressure.
• Seizures or coma (in severe cases).

Symptoms of Chronic Kidney Disease (CKD)

• Fatigue and weakness.
• Loss of appetite.
• Nausea and vomiting.
• Swelling (edema) in the legs, ankles, feet, or hands.
• Shortness of breath.
• Itching (pruritus).
• Dry skin.
• Muscle cramps.
• Sleep problems (insomnia).
• Changes in urination (urinating more or less often than usual, foamy urine).
• High blood pressure (hypertension).
• Anemia (low red blood cell count).
• Bone disease.
• Cognitive problems (difficulty concentrating, memory problems).
• Decreased sex drive or erectile dysfunction.

Diagnosing Kidney Failure

Diagnosing kidney failure involves a combination of medical history, physical examination, and various tests.

Diagnostic Tests

• Medical History and Physical Examination: The doctor will ask about your symptoms, medical history, family history, and medications. They will also check your blood pressure and look for signs of fluid overload (edema).
• Blood Tests:
  • Serum Creatinine: Creatinine is a waste product that is normally filtered by the kidneys. Elevated creatinine levels indicate reduced kidney function.
  • Blood Urea Nitrogen (BUN): Urea is another waste product filtered by the kidneys. Elevated BUN levels can also indicate kidney problems.
  • Estimated Glomerular Filtration Rate (eGFR): Calculated from the serum creatinine level, age, sex, and race. A lower eGFR indicates reduced kidney function.
  • Electrolytes: To check levels of sodium, potassium, calcium, and phosphorus.
  • Complete Blood Count (CBC): To check for anemia.
• Urine Tests:
  • Urinalysis: To check for protein, blood, and other abnormalities in the urine.
  • Urine Protein-to-Creatinine Ratio (UPCR) or Albumin-to-Creatinine Ratio (UACR): Measures the amount of protein in the urine, which is a sign of kidney damage.
  • 24-Hour Urine Collection: To measure the amount of creatinine and protein excreted in the urine over a 24-hour period.
• Imaging Tests:
  • Kidney Ultrasound: To assess the size and shape of the kidneys and look for any blockages or abnormalities.
  • CT Scan or MRI: May be used to get more detailed images of the kidneys.
• Kidney Biopsy: In some cases, a small sample of kidney tissue is removed and examined under a microscope to determine the cause of kidney damage.

Treatment for Kidney Failure

Treatment for kidney failure depends on the type (acute or chronic), the underlying cause, the stage of kidney disease, and the individual’s overall health.

Treatment for Acute Kidney Injury (AKI)

• Treat the Underlying Cause: This may involve stopping medications that are harming the kidneys, restoring blood flow to the kidneys, or relieving a urinary tract blockage.
• Supportive Care:
  • Intravenous (IV) Fluids: To correct dehydration.
  • Medications: To control blood pressure, electrolyte imbalances, and other complications.
  • Dialysis: May be needed temporarily to remove waste products and excess fluids from the blood until the kidneys recover.

Treatment for Chronic Kidney Disease (CKD)

• Slow the Progression of Kidney Disease:
  • Control Blood Pressure: Medications such as ACE inhibitors and ARBs are often used to lower blood pressure and protect the kidneys.
  • Control Blood Sugar: In people with diabetes, tight blood sugar control is essential.
  • Manage Cholesterol: Medications such as statins may be used to lower cholesterol levels.
  • Treat Anemia: Erythropoiesis-stimulating agents (ESAs) and iron supplements may be used to treat anemia.
  • Treat Bone Disease: Vitamin D supplements, phosphate binders, and calcimimetics may be used to manage bone disease.
• Manage Complications:
  • Fluid Overload: Diuretics and fluid restriction.
  • Electrolyte Imbalances: Medications and dietary changes.
  • Acidosis: Sodium bicarbonate.
• Dietary Changes:
  • Low-Protein Diet: May be recommended to reduce the workload on the kidneys (but adequate protein intake is still important).
  • Low-Sodium Diet: To help control blood pressure and fluid retention.
  • Low-Potassium Diet: If potassium levels are high.
  • Low-Phosphorus Diet: To help prevent bone disease.
  • A registered dietitian can help create an individualized meal plan.
• Dialysis: When kidney function declines to a very low level (stage 5 CKD or ESRD), dialysis is needed to remove waste products and excess fluids from the blood. There are two main types of dialysis:
  • Hemodialysis: Blood is filtered through a machine outside the body. Typically done 3 times per week for several hours at a dialysis center.
  • Peritoneal Dialysis: A cleansing fluid is circulated through a catheter into the abdominal cavity, and waste products are filtered through the peritoneum (the lining of the abdomen). Can be done at home.
• Kidney Transplant: A kidney transplant is the best treatment option for many people with ESRD. A healthy kidney from a deceased or living donor is surgically implanted into the recipient. Lifelong immunosuppressant medications are needed to prevent rejection of the transplanted kidney.

Living with Kidney Failure: Lifestyle Management

Living with kidney failure requires significant lifestyle adjustments.

Lifestyle Recommendations

• Follow your treatment plan carefully.
• Take medications as prescribed.
• Follow a kidney-friendly diet. Work with a registered dietitian.
• Control blood pressure and blood sugar.
• Limit alcohol consumption.
• Don’t smoke.
• Exercise regularly (as recommended by your doctor).
• Manage stress.
• Get enough sleep.
• Stay hydrated (but follow your doctor’s instructions regarding fluid intake, especially if you have fluid restrictions).
• Avoid NSAIDs (nonsteroidal anti-inflammatory drugs) such as ibuprofen and naproxen, as they can harm the kidneys.
• Regular medical checkups: See your nephrologist (kidney doctor) and other healthcare providers regularly.
• Join a support group: Connecting with others who have kidney disease can provide emotional support and practical advice.

FAQ – Frequently Asked Questions About Kidney Failure

Q1. Can kidney failure be reversed?

A1. Acute kidney injury (AKI) can often be reversed if the underlying cause is treated promptly. Chronic kidney disease (CKD) is generally irreversible, but its progression can be slowed with treatment and lifestyle changes.

Q2. What is the life expectancy of someone with kidney failure?

A2. Life expectancy varies greatly depending on the stage of kidney disease, the underlying cause, the individual’s overall health, and the treatment received. People on dialysis or with a kidney transplant can live for many years.

Q3. Can I prevent kidney failure?

A3. While not all cases of kidney failure are preventable, you can reduce your risk by:

• Controlling diabetes and high blood pressure.
• Maintaining a healthy weight.
• Eating a healthy diet.
• Limiting alcohol consumption.
• Not smoking.
• Avoiding long-term use of NSAIDs.
• Getting regular checkups.

Q4. What are the signs of kidney failure in the early stages?

A4. Early-stage chronic kidney disease (CKD) often has no noticeable symptoms. As the disease progresses, symptoms may include fatigue, loss of appetite, and swelling in the legs or ankles. Regular checkups and blood/urine tests are crucial for early detection.

Q5. What is the difference between hemodialysis and peritoneal dialysis?

A5.

• Hemodialysis: Uses a machine to filter your blood outside your body. It’s usually done at a dialysis center 3 times per week.
• Peritoneal Dialysis: Uses the lining of your abdomen (peritoneum) to filter your blood. A cleansing fluid is instilled into your abdominal cavity through a catheter, and waste products are drawn out. This can be done at home, often while you sleep.

The choice between hemodialysis and peritoneal dialysis depends on individual factors and preferences, and should be discussed with your nephrologist.

Conclusion: Taking an Active Role in Your Kidney Health

Kidney failure is a serious condition, but with early detection, appropriate treatment, and proactive lifestyle management, it’s possible to slow its progression, manage symptoms, and maintain a good quality of life. Work closely with your healthcare team, follow your treatment plan, and make healthy choices to protect your kidneys.