Kidney Failure

Overview

Kidney failure, also called renal failure, leads to the loss of function of one or both kidneys. The primary function of kidneys is to filter the waste and send it out of the body through urine. It also helps in filtering the blood. Our body can function adequately with one kidney but when neither kidney works correctly, waste products build up in the body. If this happens, one can feel sick and without the proper treatment, it can also be fatal. The disease takes a toll on more than 10% of the population across the globe. It is more common in older individuals, women and people experiencing diabetes mellitus and hypertension. In 2013, kidney failure ranked 19th as a cause of death. It is estimated that in 2040, the disease will be ranked 5th in causes of death. In the United States, kidney failure affects more than 7,50,000 people every year.

Symptoms of Kidney Failure

In the initial stages of kidney failure, it can be difficult to identify the signs and symptoms but the signs and symptoms of acute kidney failure may include:

• Decreased urine output, although occasionally urine output remains normal
• Fluid retention, causing swelling in your legs, ankles or feet
• Shortness of breath, irregular heartbeat
• Fatigue and confusion
• Nausea and weakness
• Chest pain or pressure
• Seizures or coma in severe cases
• Chronic kidney failure can cause damage to your body even after the initial symptoms have died down. Symptoms of chronic kidney failure include
• Fatigue, nausea and vomiting
• Confusion or trouble concentrating
• Swelling, particularly around your hands, ankles or face
• Peeing more often.
• Cramps Dry or itchy skin
• Poor appetite

Causes of Kidney Failure

The most common causes of kidney failure include Hypertension and diabetes. Acute kidney failure can also occur due to the following reasons:

• A condition that slows blood flow to kidneys
• Experiencing direct damage to kidneys
• The ureters become blocked and wastes can't leave the body through urine
• Autoimmune diseases (IgA nephropathy, lupus nephritis), and genetic diseases (polycystic kidney disease, Fabry disease) are some other diseases that can lead to kidney failure.
• The other causes are drugs and toxins (lead poisoning) or the long-term use of certain medications like NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen and naproxen. Some IV street drugs can also cause permanent damage to your kidneys.

Types
When kidneys suddenly stop working abruptly, it leads to acute kidney failure whereas chronic kidney failure occurs over time. Kidney failure is typically divided into five types.

• Acute prerenal kidney failure: This is caused by insufficient blood flow to the kidneys.
• Acute intrinsic kidney failure: Acute intrinsic kidney failure can result from direct trauma to the kidneys, such as physical impact or an accident, toxin overload, or lack of oxygen to the kidneys (ischemia).
• Chronic prerenal kidney failure: The kidney can lose its ability to function properly and can shrink when there isn’t enough blood flowing to the kidneys for a long period.
• Chronic intrinsic kidney failure: Long-term damage to the kidneys due to intrinsic kidney disease can cause chronic intrinsic kidney failure.
• Chronic post-renal kidney failure: A long-term blockage of the urinary tract prevents urination which can result in pressure and eventual kidney damage.
• Acute post-renal kidney failure: Stones or another blockage in the urinary tract can lead to acute postrenal kidney failure.

One should also know the different stages of kidney failure:

• Stage 1: Characterised by mild kidney damage. The kidney function is at about 90%
• Stage 2: Kidney function is at 89% to 60% and is characterised by mild loss of function
• Stage 3a: At 59% to 45%, there is a mild to moderate loss of kidney function
• Stage 3b: At 44% to 30%, the stage is characterised by moderate to severe loss of function
• Stage 4: With severe loss, the kidney function is at 29% to 15%
• Stage 5: This stage represents kidney failure, with kidneys functioning at less than 15%

Tests and Treatments for Kidney Failure

For chronic kidney disease, the following tests are recommended:

• Blood test: The test checks the level of serotonin, a waste product in the blood. The blood test results, along with age, size, and gender are used to calculate how many millilitres of waste kidneys should be able to filter in a minute. This calculation is called the estimated glomerular filtration rate (eGFR). Healthy kidneys should be able to filter more than 90ml/min.
• Urine test: The test checks the level of substances called albumin and creatinine in urine. Blood or protein levels in the urine can also be checked with the test.
• Ultrasound, MRI or CT scan can be performed to see what the kidneys look like and if there is any blockage
• Kidney biopsy: A small tissue of the kidney is removed to check for any damage by placing the cells under the microscope.
• Urine output measurements: Measuring how much you urinate in 24 hours may help in knowing the cause of kidney failure.

There are two main treatments for kidney failure: Dialysis and Kidney transplant. Some other treatments may include several medications. Take a look at them:

• Dialysis: It is divided into two: Hemodialysis (a machine regularly cleans blood for you. Most people get hemodialysis three to four days a week) and Peritoneal dialysis (a bag is attached with a dialysis solution to a catheter in the abdominal lining. The solution flows from the bag into the abdominal lining, absorbing the waste products and extra fluids and draining back into the bag).
• Kidney transplant: It involves surgically placing a healthy kidney from a donor in place of damaged kidneys. The transplant requires the recipient to take extra care of themselves and take medications throughout life so that the body does not reject a new organ.
• Hypertension medications: Kidney disease can worsen high blood pressure. Therefore, one should take medicines to reduce it.
• Medications to relieve swelling: Chronic kidney disease results in fluid retention which leads to swelling in the legs. Medications called diuretics can help maintain the balance of fluids.
• Medications to reduce cholesterol levels: Statins help in lowering cholesterol. People with chronic kidney disease often have high levels of bad cholesterol.

Prevention for Kidney Failure

Prevention and management of kidney diseases is easy. One should try to bring about healthy changes in their lifestyle. Some measures are:

• Control high blood pressure as it can damage kidneys and increase the chances of kidney disease. Making simple changes to your food habits like reducing the intake of salt, and regular exercising can help in managing blood pressure.
• High blood sugar levels can cause blood vessels inside the kidney to become narrow and clogged, which in return can cause damage to the blood vessels and harm the kidneys.
• DASH (Dietary Approaches to Stop Hypertension) Diet, can help lower blood pressure and blood lipids (fat in the blood), resulting in healthier kidneys. Fruit and vegetables are recommended.
• Other food items to incorporate into the diet include starchy foods, such as potatoes, wholegrain bread, rice or pasta, some dairy products, and some beans or pulses, fish, eggs, or meat as a source of protein
• Try to reduce alcohol intake as drinking excessive amounts of alcohol can cause your blood pressure and cholesterol levels to rise to unhealthy levels. UK’s National Health Service recommends men and women to not drink more than 14 units a week. Also, it advises to spread drinking over three days or more if you drink as much as 14 units a week

FAQs

Q1. Can children be affected by kidney failure?
A1. Children can suffer from kidney failure. Chronic kidney disease is more common in male kids than in female kids. There can be complications as well which include anaemia, electrolyte imbalances, and mineral and bone disorders.

Q2. Are there any symptoms of the same in children?
A2. Kids in the early stages of kidney disease may have few or no symptoms. As kidney disease gets worse, symptoms may include the following:

• Swelling in the feet, legs, hands, or face.
• Increased or decreased urine output. Some children may have to urinate more often and may wet the bed at night.
• Foamy urine due to too much protein in the urine (proteinuria).
• Pink or cola-coloured urine is caused by blood in the urine.

Q3. How long can you live with kidney failure without any treatment?
A3. In the case of acute kidney failure, people may only live a few days to a week without treatment. In chronic kidney disease, people can live for up to a few years.

Q4. Can kidney disease be reversed?
A4. No, the damage due to kidney failure cannot be reversed. However, with the right treatment, the progression of kidney failure can be slowed or stopped.