Kidney Failure

(Renal Failure; Renal Insufficiency)

Definition

When you have kidney failure, one or both kidneys aren't able to work normally. 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.

Kidney failure is divided into two categories:

Acute kidney failure—sudden loss of kidney function
Chronic kidney failure—slow, gradual loss of kidney function

Causes

Kidney disease causes the tiny filters in the kidneys (called nephrons) to lose their ability to filter. Damage to the nephrons may occur suddenly after an injury or poisoning. But, 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:

Pyelonephritis
Glomerulonephritis
Polycystic kidney disease
Birth defects
Bilateral renal artery stenosis
Poisoning
Severe trauma
Viral infections (such as, hepatitis B, hepatitis C, HIV/AIDS)
Long-term use of medicines that contain aspirin, acetaminophen, or ibuprofen
Abnormal build-up of substances within the kidneys (such as, amyloidosis, protein build-up)
Toxic reaction to drugs or x-ray dyes
Systemic diseases (such as, lupus, polyarteritis, Wegeners granulomatosis
Conditions that severely decrease the amount of blood (such as, burns, pancreatitis, peritonitis)
Conditions that make it difficult to urinate (such as, enlarged prostate, kidney stones, tumors)

Renal Failure

A blockage from kidney stones has caused renal failure.

Risk Factors

Risk factors that increase your chance of developing kidney failure include:

Diabetes
Genetics: polycystic kidney disease, type 1 diabetes
Race: African American
High blood pressure
Lupus or other autoimmune diseases
Long-term use of pain medications containing aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) in high doses
Liver failure, jaundice
Respiratory failure
HIV
Cancer
Recent open heart surgery
Recent surgery on an abdominal aortic aneurysm
Condition that obstructs urine flow
Enlargement of the prostate gland

Symptoms

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, insomnia
Low urine output (or no urine output in severe cases), frequent urination
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

The doctor will ask about your symptoms and medical history, and perform a physical exam. Tests may include:

Blood Tests

If the kidneys are not working properly, the blood test will show:

An increase in:
- Potassium
- Phosphorus
- Parathyroid hormone
- Creatinine
- Blood urea nitrogen
A decrease in serum calcium

Other Tests

24-hour urine protein test—to see if your body is losing protein in the urine
Renal ultrasound—uses sound waves to study the renal system (kidneys, bladder, and ureters)
Biopsy—to test for kidney cell functioning

Treatment

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 (such as, furosemide, mannitol)
Blood pressure medications (such as, ACE inhibitors)
Medicine to treat anemia (such as, epoetin alfa [Epogen, Procrit], ascorbic acid [vitamin C])
Sodium polystyrene sulfonate or insulin in dextrose—to control high potassium levels
Calcium acetate—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

Dialysis is a process that takes over for the kidneys and filters waste from the blood. This may be done on a short-term basis until kidney function improves or it may be done until you have a kidney transplant.

Kidney Transplant

This may be the right option for some patients. Having a successful transplant depends on many factors, such as what is causing the kidney damage and your overall health.

Blood Tests

Your doctor will monitor these blood levels:

Sodium
Potassium
Calcium
Phosphate
Red blood cells
Hematocrit
Platelets

Lifestyle Changes

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.
If you have chronic kidney disease, you may need to limit how much protein you eat. Talk to a dietician.
Limit how much cholesterol and sodium you eat.
If you have severe kidney disease, limit how much potassium you eat. If your kidneys are failing, get help from a dietician.

If you are diagnosed with kidney failure, follow your doctor's instructions.

Prevention

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

Urology Care Foundation http://www.urologyhealth.org

CANADIAN RESOURCES

Canadian Diabetes Association http://www.diabetes.ca

The Kidney Foundation of Canada http://www.kidney.ab.ca

References

Chronic kidney disease. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated October 12, 2012. Accessed October 16, 2012.

Johnson CA, Levey AS, et al. Glomerular filtration rate, proteinuria, and other markers. Am Fam Physician. 2004;70:1091-1097.

Johnson CA, Levey AS, et al. Clinical practice guidelines for chronic kidney disease in adults: part I. Definition, disease stages, evaluation, treatment, and risk factors. Am Fam Physician. 2004;70:869-876.

Kidney Disease Outcomes Quality Initiative. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis. 2003;42:S1-201.

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:S1-S9.

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:S1-266.

Snivel CS, Gutierrez C. Chronic kidney disease: prevention and treatment of common complications. Am Fam Physician. 2004;70:1921-1928.

Use of herbal supplements in chronic kidney disease. National Kidney Foundation website. Available at: http://www.kidney.org/atoz/content/herbalsupp.cfm. Accessed October 16, 2012.

The kidneys and how they work. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://kidney.niddk.nih.gov/kudiseases/pubs/yourkidneys/#10. Updated February 2009. Accessed October 16, 2012.

1/4/2011 DynaMed Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: 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 Sep 22.

Revision Information

Reviewer: Adrienne Carmack, MD
Review Date: 10/2012
Update Date: 10/31/2012

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.