Kidney Failure

Kidney Failure

Kidney failure is when your kidneys stop working well enough for you to live without dialysis or a kidney transplant. Kidney failure can happen very suddenly (called acute renal failure) or slowly over time. In most cases, kidney failure is permanent. This is called end-stage renal disease or ESRD.How is kidney failure (ESRD) different from chronic kidney disease (CKD)?CKD means that your kidneys are damaged. With CKD, your kidneys may still be working some, but theyre not working as well as they should. Kidney failure is the most severe stage of CKD. Kidney failure is when your kidneys are no longer working well enough for you to live without dialysis or a kidney transplant.

What causes kidney failure?

Diabetes and high blood pressure cause most cases of ESRD. Other causes include:

Autoimmune diseases (like lupus and IgA nephropathy)

Genetic diseases (like polycystic kidney disease)

Injuries

Some medicines or other drugs

How can I prevent kidney failure?

The best way to prevent kidney failure is to prevent CKD. If you have CKD, work with your doctor to slow it down. You may not be able to fix the damage that is already done, but you might be able to keep the damage from getting worse. If you have diabetes and high blood pressure, it is very important for you to manage these. Work with your doctor to learn how.

Other ways to help protect your kidneys are to:

Eat a diet low in fat and salt

Exercise most days of the week

Have regular check-ups with your doctor

Avoid tobacco

Limit alcohol

Get more healthy living tips hereWhat are the tests for kidney failure?

The tests for kidney failure are the same as the tests for CKD. If you think that you may be at risk for kidney failure, ask your doctor about these tests:

eGFR (estimated glomerular filtration rate) This test tells your doctor how well your kidneys clean your blood.

Your doctor tests your blood for a kind of waste called creatinine. Healthy kidneys filter creatinine out of your blood. Your doctor will then use your creatinine test result to figure out your eGFR.

An eGFR less than 60 for 3 months or more may be a sign of kidney disease.

Urine Test This test tells your doctor if there is blood or protein in your urine.

Your doctor may test your urine in the office or ask you to collect your urine at home.

Protein or blood in your urine may be a sign of kidney disease.

Blood Pressure This test tells your doctor how hard your heart is working to pump your blood.

High blood pressure can cause kidney disease, but kidney disease can also cause you to have high blood pressure.

For most people, a normal blood pressure is less than 120/80 (120 over 80). Ask your doctor what your blood pressure should be.

Chronic Kidney Disease (CKD)

An estimated 31 million people in the United States are living with chronic kidney disease (CKD).

What is CKD?

The term chronic kidney disease (CKD) means lasting damage to the kidneys that can get worse over time. If the damage is very bad, your kidneys may stop working. This is called kidney failure, or end-stage renal disease (ESRD). If your kidneys fail, you will need dialysis or a kidney transplant in order to live.

Who is at risk?

Anyone can develop kidney disease, but you are more at risk if you:

Have diabetes

Have high blood pressure

Have heart disease

Have a family member with kidney disease

Are African-American, Hispanic, Native American or Asian

Are over 60 years old

How can I prevent CKD?

Diabetes and high blood pressure are the two leading causes of CKD. The best thing you can do to help protect your kidneys is to work with your doctor to keep these in control.

A healthy lifestyle can also help you prevent CKD.

Eat a diet low in fat and salt

Exercise most days of the week

Have regular check-ups with your doctor

Avoid tobacco

Limit alcohol

How do I know if I have CKD?

CKD usually has no symptoms until it is very far along. The only way to be sure how your kidneys are working is to get tested. Being tested for kidney disease is simple. Ask your doctor about these tests:

eGFR (estimated Glomerular Filtration Rate) This test tells your doctor how well your kidneys clean your blood.

Your doctor tests your blood for a kind of waste called creatinine. Healthy kidneys filter creatinine out of your blood. Your doctor will then use your creatinine test result to figure out your eGFR.

An eGFR less than 60 for 3 months or more may be a sign of kidney disease.

Urine Test This test tells your doctor if there is blood or protein in your urine.

Your doctor may test your urine in the office or ask you to collect your urine at home.

Protein or blood in your urine may be a sign of kidney disease.

Blood Pressure This test tells your doctor how hard your heart is working to pump your blood.

High blood pressure can cause kidney disease, but kidney disease can also cause you to have high blood pressure.

For most people, a normal blood pressure is less than 120/80 (120 over 80). Ask your doctor what your blood pressure should be.

How is CKD treated?

With CKD, the damage to your kidneys is usually permanent. It cannot be fixed, but you can take steps to help slow down the CKD and keep the damage from getting worse.

Control your blood sugar if you have diabetes

Keep a healthy blood pressure

Eat a heart healthy diet (low in salt and fat)

Exercise most days of the week

Keep a healthy weight

Do not smoke or use tobacco

Limit alcohol

Talk to your doctor about medicines that might help protect your kidneys

If you treat kidney disease early, you may be able to slow it down!

If kidney disease is not treated, it can cause your kidneys to fail, and you will need dialysis or a kidney transplant in order to live.

Blood in Urine (Hematuria)

The medical name for having blood in your urine is hematuria (hee-muh-TOOR-ee-uh).

How will I know if I have hematuria?

Hematuria may cause your urine to look pink, red or brown. But you may have blood in your urine that cant see. In this case, your doctor will need to look at a sample of your urine under a microscope to see the blood cells. This is why a urine test is part of a regular checkup.

What causes hematuria?

Many conditions can cause you to have blood in your urine. Some causes include:

Strenuous exercise

Urinary tract infections

Kidney stones Kidney injury Cancer in the urinary tract

Talk to your doctor to find out what is causing blood to be in your urine. He or she may ask for urine samples and blood tests to help find the cause. If your doctor cannot find the cause of your hematuria through these tests, he or she may also suggest an imaging test to get a picture of your urinary tract.

In some cases, the cause for hematuria is never found.

How will I know if I have hematuria?

If you have macrohematuria, the blood will make your urine look red or brown.

If you have microhematuria, you will not be able to see the blood in your urine. In this case, your doctor will need to look at a sample of your urine under a microscope to see the blood cells. For this reason, urine tests are part of regular checkups.

How is it treated?

The treatment for hematuria will depend on what is causing it. Talk to your doctor about what is causing the blood in your urine and what treatment is right for you.

ClassificationKidney failure can be divided into two categories: acute kidney injury or chronic kidney disease. The type of renal failure is differentiated by the trend in the serum creatinine; other factors that may help differentiate acute kidney injury from chronic kidney disease include anemia and the kidney size on sonography as chronic kidney disease generally leads to anemia and small kidney size.

Acute kidney injuryMain article: Acute kidney injuryAcute kidney injury (AKI), previously called acute renal failure (ARF),[3]

HYPERLINK "https://en.wikipedia.org/wiki/Renal_failure" \l "cite_note-4" [4] is a rapidly progressive loss of renal function,[5] generally characterized by oliguria (decreased urine production, quantified as less than 400 mL per day in adults,[6] less than 0.5 mL/kg/h in children or less than 1 mL/kg/h in infants); and fluid and electrolyte imbalance. AKI can result from a variety of causes, generally classified as prerenal, intrinsic, and postrenal. The underlying cause must be identified and treated to arrest the progress, and dialysis may be necessary to bridge the time gap required for treating these fundamental causes.

Chronic kidney diseaseMain article: Chronic kidney diseaseChronic kidney disease (CKD) can also develop slowly and, initially, show few symptoms.[7] CKD can be the long term consequence of irreversible acute disease or part of a disease progression.

Acute-on-chronic kidney failureAcute kidney injuries can be present on top of chronic kidney disease, a condition called acute-on-chronic kidney failure (AoCRF). The acute part of AoCRF may be reversible, and the goal of treatment, as with AKI, is to return the patient to baseline kidney function, typically measured by serum creatinine. Like AKI, AoCRF can be difficult to distinguish from chronic kidney disease if the patient has not been monitored by a physician and no baseline (i.e., past) blood work is available for comparison.

Signs and symptomsSymptoms can vary from person to person. Someone in early stage kidney disease may not feel sick or notice symptoms as they occur. When kidneys fail to filter properly, waste accumulates in the blood and the body, a condition called azotemia. Very low levels of azotaemia may produce few, if any, symptoms. If the disease progresses, symptoms become noticeable (if the failure is of sufficient degree to cause symptoms). Kidney failure accompanied by noticeable symptoms is termed uraemia.[8]Symptoms of kidney failure include the following:[8]

HYPERLINK "https://en.wikipedia.org/wiki/Renal_failure" \l "cite_note-9" [9]

HYPERLINK "https://en.wikipedia.org/wiki/Renal_failure" \l "cite_note-PD-10" [10]

HYPERLINK "https://en.wikipedia.org/wiki/Renal_failure" \l "cite_note-lifeoptions-11" [11] High levels of urea in the blood, which can result in:

Vomiting and/or diarrhea, which may lead to dehydration Nausea Weight loss

Nocturnal urination

More frequent urination, or in greater amounts than usual, with pale urine

Less frequent urination, or in smaller amounts than usual, with dark coloured urine

Blood in the urine

Pressure, or difficulty urinating

Unusual amounts of urination, usually in large quantities

A buildup of phosphates in the blood that diseased kidneys cannot filter out may cause:

Itching

Bone damage

Nonunion in broken bones

Muscle cramps (caused by low levels of calcium which can be associated with hyperphosphatemia)

A buildup of potassium in the blood that diseased kidneys cannot filter out (called hyperkalemia) may cause:

Abnormal heart rhythms

Muscle paralysis[12] Failure of kidneys to remove excess fluid may cause:

Swelling of the legs, ankles, feet, face and/or hands

Shortness of breath due to extra fluid on the lungs (may also be caused by anemia)

Polycystic kidney disease, which causes large, fluid-filled cysts on the kidneys and sometimes the liver, can cause:

Pain in the back or side

Healthy kidneys produce the hormone erythropoietin that stimulates the bone marrow to make oxygen-carrying red blood cells. As the kidneys fail, they produce less erythropoietin, resulting in decreased production of red blood cells to replace the natural breakdown of old red blood cells. As a result, the blood carries less hemoglobin, a condition known as anemia. This can result in:

Feeling tired and/or weak

Memory problems

Difficulty concentrating

Dizziness Low blood pressure

Normally, proteins are too large to pass through the kidneys, however, they are able to pass through when the glomeruli are damaged. This does not cause symptoms until extensive kidney damage has occurred,[13] after which symptoms include:

Foamy or bubbly urine

Swelling in the hands, feet, abdomen, or face

Other symptoms include:

Appetite loss, a bad taste in the mouth

Difficulty sleeping Darkening of the skin

Excess protein in the blood

With high dose penicillin, people with kidney failure may experience seizures[14]CausesAcute kidney injuryAcute kidney injury (previously known as acute renal failure) - or AKI - usually occurs when the blood supply to the kidneys is suddenly interrupted or when the kidneys become overloaded with toxins. Causes of acute kidney injury include accidents, injuries, or complications from surgeries in which the kidneys are deprived of normal blood flow for extended periods of time. Heart-bypass surgery is an example of one such procedure.

Drug overdoses, accidental or from chemical overloads of drugs such as antibiotics or chemotherapy, may also cause the onset of acute kidney injury. Unlike chronic kidney disease, however, the kidneys can often recover from acute kidney injury, allowing the patient to resume a normal life. People suffering from acute kidney injury require supportive treatment until their kidneys recover function, and they often remain at increased risk of developing future kidney failure.[15]Among the accidental causes of renal failure is the crush syndrome, when large amounts of toxins are suddenly released in the blood circulation after a long compressed limb is suddenly relieved from the pressure obstructing the blood flow through its tissues, causing ischemia. The resulting overload can lead to the clogging and the destruction of the kidneys. It is a reperfusion injury that appears after the release of the crushing pressure. The mechanism is believed to be the release into the bloodstream of muscle breakdown products notably myoglobin, potassium, and phosphorus that are the products of rhabdomyolysis (the breakdown of skeletal muscle damaged by ischemic conditions). The specific action on the kidneys is not fully understood, but may be due in part to nephrotoxic metabolites of myoglobin.

Chronic kidney diseaseChronic kidney disease (CKD) has numerous causes. The most common causes of CKD are diabetes mellitus and long-term, uncontrolled hypertension.[16] Polycystic kidney disease is another well-known cause of CKD. The majority of people afflicted with polycystic kidney disease have a family history of the disease. Other genetic illnesses affect kidney function, as well.

Overuse of common drugs such as ibuprofen, and acetaminophen (paracetamol) can also cause chronic kidney damage.[17]Some infectious diseases, such as hantavirus, can attack the kidneys, causing kidney failure.[18]Genetic predispositionThe APOL1 gene has been proposed as a major genetic risk locus for a spectrum of nondiabetic renal failure in individuals of African origin, these include HIV-associated nephropathy (HIVAN), primary nonmonogenic forms of focal segmental glomerulosclerosis, and hypertension affiliated chronic kidney disease not attributed to other etiologies.[19] Two western African variants in APOL1 have been shown to be associated with end stage kidney disease in African Americans and Hispanic Americans.[20]

HYPERLINK "https://en.wikipedia.org/wiki/Renal_failure" \l "cite_note-21" [21]Diagnostic approachMeasurement for CKDStages of kidney failure

Chronic kidney failure is measured in five stages, which are calculated using a patients GFR, or glomerular filtration rate. Stage 1 CKD is mildly diminished renal function, with few overt symptoms. Stages 2 and 3 need increasing levels of supportive care from their medical providers to slow and treat their renal dysfunction. Patients in stages 4 and 5 usually require preparation of the patient towards active treatment in order to survive. Stage 5 CKD is considered a severe illness and requires some form of renal replacement therapy (dialysis) or kidney transplant whenever feasible.

Glomerular filtration rate

A normal GFR varies according to many factors, including sex, age, body size and ethnic background. Renal professionals consider the glomerular filtration rate (GFR) to be the best overall index of kidney function.[22] The National Kidney Foundation offers an easy to use on-line GFR calculator[23] for anyone who is interested in knowing their glomerular filtration rate. (A serum creatinine level, a simple blood test, is needed to use the calculator).

Use of the term uremiaBefore the advancement of modern medicine, renal failure was often referred to as uremic poisoning. Uremia was the term for the contamination of the blood with urine. It is the presence of an excessive amount of urea in blood. Starting around 1847, this included reduced urine output, which was thought to be caused by the urine mixing with the blood instead of being voided through the urethra.[citation needed] The term uremia is now used for the illness accompanying kidney failure.[24]What are the Stages of Kidney Disease?

Your glomerular filtration rate (GFR) is the best indicator of how well your kidneys are working. In 2002, the National Kidney Foundation published treatment guidelines that identified five stages of CKD based on declining GFR measurements. The guidelines recommend different actions based on the stage of kidney disease.

Increased risk of CKD. A GFR of 90 or above is considered normal. Even with a normal GFR, you may be at increased risk for developing CKD if you have diabetes, high blood pressure, or a family history of kidney disease. The risk increases with age: People over 65 are more than twice as likely to develop CKD as people between the ages of 45 and 65. African Americans also have a higher risk of developing CKD.

Stage 1: Kidney damage with normal GFR (90 or above). Kidney damage may be detected before the GFR begins to decline. In this first stage of kidney disease, the goals of treatment are to slow the progression of CKD and reduce the risk of heart and blood vessel disease.

Stage 2: Kidney damage with mild decrease in GFR (60 to 89). When kidney function starts to decline, your health care provider will estimate the progression of your CKD and continue treatment to reduce the risk of other health problems.

Stage 3: Moderate decrease in GFR (30 to 59). When CKD has advanced to this stage, anemia and bone problems become more common. Work with your health care provider to prevent or treat these complications.

Stage 4: Severe reduction in GFR (15 to 29). Continue following the treatment for complications of CKD and learn as much as you can about the treatments for kidney failure. Each treatment requires preparation. If you choose hemodialysis, you will need to have a procedure to make a vein in your arm larger and stronger for repeated needle insertions. For peritoneal dialysis, you will need to have a catheter placed in your abdomen. Or you may want to ask family or friends to consider donating a kidney for transplantation.

Stage 5: Kidney failure (GFR less than 15). When the kidneys do not work well enough to maintain life, you will need dialysis or a kidney transplant.

In addition to tracking your GFR, blood tests can show when substances in your blood are out of balance. If phosphorus or potassium levels start to climb, a blood test will prompt your health care provider to address these issues before they permanently affect your health.

Types-Each patient is classified into one of the following 5 stages of CKD according to the progression of damage.

Stage 1: Kidney damage withnormal or increased GFR(>90 mL/min/1.73 m2)

Stage 2:Mild reductionin GFR (60-89 mL/min/1.73 m2)

Stage 3:Moderate reductionin GFR (30-59 mL/min/1.73 m2)

Stage 4:Severe reductionin GFR (15-29 mL/min/1.73 m2)

Stage 5:Kidney failure(GFR