Overview
Kidney failure, also known as renal failure, refers to a condition in which the kidneys are no longer able to filter waste products and excess fluids from the blood effectively. There are two main types of kidney failure: acute and chronic. Acute kidney failure, also called acute renal failure or acute kidney injury, occurs when the kidneys suddenly lose their filtering ability. This typically develops rapidly, within a few days, and can be reversible if treated promptly. The condition is often seen in hospitalized patients, particularly those who require intensive care. Symptoms may include decreased urine output, swelling, and abnormal blood chemistry. Chronic kidney disease, also known as chronic renal failure, involves a gradual loss of kidney function over time. In the early stages, there may be few signs or symptoms, and the condition might go unnoticed. As the disease progresses, it can lead to end-stage renal disease, also known as end-stage kidney disease or kidney failure. At this point, the kidneys are no longer able to filter waste products and excess fluids effectively, leading to a dangerous accumulation of fluids, electrolytes, and waste products in the body. End-stage renal disease requires either dialysis or a kidney transplant to maintain life. Both acute and chronic kidney failure can have serious consequences if left untreated, potentially causing life-threatening complications. It is crucial to seek medical attention promptly if you suspect kidney problems or experience any of the associated symptoms.
Understanding the disease
Symptoms
Symptoms of kidney failure can include nausea, vomiting, loss of appetite, fatigue, weakness, changes in urination, swelling in the feet and ankles, high blood pressure, shortness of breath, chest pain, difficulty sleeping, decreased mental sharpness, muscle cramps, itching, and metallic taste. These symptoms can be caused by both chronic kidney disease and acute kidney failure. In end-stage renal disease, additional symptoms may include confusion, seizures, or coma. It is important to seek medical attention if you experience any signs or symptoms of kidney failure.
Risk Factors
Risk factors for developing kidney failure include diabetes with poor blood sugar control, kidney disease that affects the glomeruli, polycystic kidney disease, high blood pressure, tobacco use, having a family history of kidney failure, being of Black, Hispanic, Asian, Pacific Islander or American Indian heritage, older age, and a history of frequent use of medications that can damage the kidneys.
Development
Chronic kidney disease develops gradually over time, typically due to the long-term effect of underlying conditions such as diabetes, high blood pressure, or glomerulonephritis. In the early stages, there may be no noticeable symptoms. However, as the disease progresses, it can cause dangerous levels of fluid, electrolytes, and waste to build up in the body. Advanced chronic kidney disease can lead to end-stage kidney failure, which is fatal without artificial filtering (dialysis) or a kidney transplant. Acute kidney failure, on the other hand, develops rapidly within a few days, often due to a sudden injury or illness. It can be caused by various factors, such as decreased blood flow to the kidneys, direct damage to the kidney tissue, or exposure to certain toxins or medications. Symptoms of acute kidney failure may include decreased urine output, swelling, and abnormal blood chemistry. In some cases, acute kidney failure can be reversible with proper treatment, but in severe cases, it may progress to end-stage kidney failure. End-stage renal disease is the advanced stage of chronic kidney disease, where the kidneys no longer function properly. It can also be caused by acute kidney failure if the damage to the kidneys is irreversible. End-stage renal disease requires either dialysis or a kidney transplant for survival, or conservative care to manage symptoms and improve quality of life.
Assessment and Diagnosis
Triage
You should see a doctor if you suspect kidney failure if you experience symptoms such as decreased urine output, swelling in your ankles, feet, or hands, fatigue, nausea, vomiting, or breathing difficulties. Early detection and diagnosis can help manage the condition effectively and prevent further kidney damage.
Diagnosis
To diagnose kidney failure, your doctor may recommend certain tests and procedures, such as urine output measurements, urine tests, blood tests, and imaging tests like ultrasound or CT scanning. Additionally, a kidney biopsy may be performed to examine kidney tissue and determine the underlying cause of the kidney failure.
Management and Treatment
Complications
Potential complications of kidney failure may include fluid retention, leading to swelling in the arms and legs or fluid in the lungs (pulmonary edema). A sudden rise in potassium levels in the blood (hyperkalemia) can impair the heart's function and be life-threatening. Other complications may include anemia, heart disease, weak bones and an increased risk of bone fractures, decreased sex drive or fertility, damage to the central nervous system, decreased immune response, pericarditis (inflammation of the heart membrane), and pregnancy complications.
Prevention
kidney failure can be prevented through certain measures, such as seeking prompt treatment for infections, controlling high blood pressure and blood sugar, managing medical conditions, and not smoking. Additionally, regular appointments for diabetes management and effective treatment of diabetes can help prevent or delay diabetic nephropathy. It's important to work closely with your healthcare team and follow their recommendations to reduce your risk of developing kidney failure.
Treatment
Treatments for kidney failure depend on the underlying cause and the stage of the disease.
- Dialysis: Dialysis is a treatment for end-stage renal disease, which replaces the function of failed kidneys. It is typically required multiple times per week. There are two main types of dialysis: hemodialysis and peritoneal dialysis.
- Kidney transplant: A kidney transplant is an option for those with end-stage renal disease. A healthy kidney from a donor is surgically transplanted to replace the damaged kidney. The success rate of kidney transplants is high, but there is a waiting list for donor kidneys.
- Conservative care: For those with end-stage renal disease who choose not to undergo dialysis or receive a transplant, conservative care focuses on managing symptoms and maintaining quality of life. This may include medications to control blood pressure, managing fluid and electrolyte balance, and addressing specific complications.
- Treating the underlying cause: Addressing the cause of kidney failure can sometimes help to improve kidney function. For example, treating a urinary tract infection or removing a blockage in the urinary system may help restore kidney function. It is essential to work closely with your healthcare provider to determine the most appropriate treatment plan based on your individual circumstances.
Preparing for medical consultation
To prepare for an appointment for kidney failure, follow these steps:
- Review your symptoms: Make a list of your symptoms, including any that seem unrelated to the reason for your appointment, and note when they began.
- Gather medical history: Compile your and your family's medical history, especially any kidney diseases or related conditions.
- Update your medications and supplements: Create a list of all the medications, vitamins, and other supplements you take, including dosages.
- Prepare questions: Write down a list of questions to ask your doctor, such as the most likely cause of your symptoms, the need for tests, treatment options and their risks, and whether hospitalization is necessary.
- Consider support groups: Research local support groups for kidney disease or contact the National Kidney Foundation (NKF) to learn about NKF Peers, a national, telephone-based peer support program. By being well-prepared and informed, you can have a more productive discussion with your doctor about your kidney health concerns.