Overview and Definition

Renal failure or kidney failure is a condition where the kidneys lose their ability to function in filtering fluids and waste. When this happens, dangerous levels of toxins and fluids accumulate in the body, a condition that can be potentially fatal if left untreated.

The kidneys are a pair of bean-shaped organs found at the lower back of the body. Their main function is to act as filtration system for the blood by removing waste toxins and transferring them into the bladder, to be later removed through urination. When the kidneys become unable to function this way, due to causes to be outlined later, renal failure occurs. The only way to survive with this condition is through dialysis or a kidney transplant.

Causes of Renal Failure

The causes of kidney failure can be classified into three main groups:

1. Renal failure caused by damage to the kidneys

Damage to the kidneys can result in decrease in its function. Among causes of damage include the following conditions or chronic diseases:

  • Diabetes (both Types I and II), which can cause excess sugar (glucose) to accumulate in the blood, causing damage to the glomeruli (renal vessels)
  • Autoimmune disease like systemic lupus erythematosis where the body’s immune system attacks and damages the kidneys
  • Malaria and yellow fever
  • Hypertension, which can also cause damage to the glomeruli
  • Inflammation of the vessels of the kidneys (glomerulonephritis)
  • Untreated infections
  • Drug and alcohol abuse
  • Chemotherapy drugs
  • Overload of toxins such as of heavy metals
  • Congenital underdeveloped kidneys or inherited conditions such as polycystic kidney disease

2. Renal failure caused by loss of blood flow to the kidneys

Commonly the cause of acute renal disease, a sudden loss of blood flow to the kidney can cause it to lose its function. This occurrence is usually caused further by certain conditions such as artery stenosis (narrowing or blockage of the renal artery), cirrhosis of the liver, heart attack, coronary heart disease, dehydration, cholesterol deposits, burns, bad infections and allergic reactions.

3. Difficulty in urination leading to kidney failure

Inability to urinate due usually to obstruction increases the pressure on the kidneys, compromising their function. Certain types of cancer such as colon, prostate, bladder and cervical cancer, as well as kidney stones, blood clots and an enlarge prostrate, can block urine passageways.

Types and Symptoms of Renal Failure

The symptoms usually depend on the type of kidney failure. There are two general types of renal failure:

Acute Renal Failure

Acute renal failure is a condition that occurs when the kidneys suddenly stopped working. With acute renal failure symptoms may appear suddenly which may include:

  • Extreme difficulty in urination
  • Swelling of the lower extremities (legs and feet)
  • Loss of appetite
  • Nausea and vomiting
  • Feeling anxious, confused or sleepy
  • “Flank” pain, or pain in the back below the rib cage

Chronic Renal Failure

Chronic condition means that the disease has persisted and worsened for an extended period of time. This is usually a consequence of several factors that led to the permanent loss of kidney function and the shrinking of the kidneys. Common signs and symptoms of chronic renal failure are as follows:

  • Anemia
  • Unusually dark urine or blood in the urine
  • Decrease in frequency and amount of urination
  • Swollen extremities
  • Insomnia
  • Itchy skin
  • Loss of appetite
  • Muscle cramps and twitches
  • Flank pain
  • Abnormal levels of protein in the urine
  • Unexplained headaches
  • Sudden change in body weight
  • High blood pressure
  • Erectile dysfunction in men

Chronic kidney failure is further classified into five stages, depending on the severity of the renal problem.

Who to See and Types of Treatments Available

Problems involving difficulty in urination usually deserve medical attention. If you experience a combination of the aforementioned symptoms, it is best to visit your doctor immediately. For serious cases, your doctor will refer you to a urologist, a specialist in kidney problems.

You will be asked to undergo several tests to diagnose renal disease. These may include:

  1. Urinalysis - to check whether there are abnormal levels of red or white blood cells, bacteria, proteins or cellular casts in the urine.

  2. Blood samples - to determine whether toxins are being adequately filtered out by the kidneys. Blood tests measure levels of urea and creatinine, high levels of which indicate end-stage kidney problem.

  3. Kidney scans such as magnetic resonance imaging, ultrasound, and computed tomography (CT) scan to determine blockages in urine flow and to check the size and shape of the kidneys

  4. Kidney biopsy - where a sample of kidney tissue is extracted and checked for possible cellular damage

  5. Glomerular filtration rate (GFR) to measure the levels of waste products found in the blood or urine (in milliliters of waste), for proper classification of kidney disease stages.

Treatment of Renal Failure

End-stage kidney failure can only be treated in two ways: through dialysis or kidney transplant. Dialysis is a procedure that involves the use of a machine to remove waste products and excess fluids from the blood, since the kidneys cannot do the job anymore. Blood is pumped out and filtered through a dialyzer (an artificial kidney structure) to remove unwanted substances before being returned back into the body. The procedure involves serious risks including infection.

If available, renal failure patients can live through this condition with a kidney transplant, where the kidneys are replaced with new, compatible ones from a donor. There is usually a long queue for donor kidneys, but if it works perfectly, a renal failure patient can live anew normally with a new set. Immunosuppressive drugs are usually required after transplant surgery.

Apart from these two main treatment methods, renal patients typically have to take in plenty of medications to prevent complications. Medications for the control of blood mineral levels such as potassium, phosphates and calcium, diuretics (or IV fluids if dehydrated), iron supplementation for anemia, antihistamines for itching, anti-emetics for nausea, and vitamin D supplements are typically recommended.

Diet is also central to effective treatment. Patients will be advised to control the amount of protein in meals to prevent the fast progression of the condition, along with control of salt, potassium, and phosphorus intake.

References:

  • Acute kidney failure. (n.d.). MedlinePlus Medical Encyclopedia. http://www.nlm.nih.gov/medlineplus/ency/article/000501.htm

  • Kidney Failure: Choosing a Treatment That’s Right for You. (n.d.). National Kidney and Urologic Diseases Information Clearinghouse. http://kidney.niddk.nih.gov/kudiseases/pubs/choosingtreatment

  • Tests and Procedures - Kidney Biopsy. (n.d.). Johns Hopkins Medicine Health Library. http://www.hopkinsmedicine.org/healthlibrary/testprocedures/urology/kidneybiopsy_92,P07706

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