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Kidney failure is the inability of the kidneys to carry out their normal functions – functions including filtering waste products from the blood, regulating blood pressure, maintaining electrolyte balance, and production of red blood cells – due to damage. Kidney failure is also referred to as end-stage kidney/renal disease, ESRD, the final stage of chronic kidney disease. It results when the kidneys are functioning at less than 15% of normal.
There are two types of kidney failure: acute renal failure or acute kidney injury and chronic renal failure.
Acute renal failure results when the kidneys suddenly stop working, usually within two days. The kidneys are said to be injured in acute renal failure as kidney function is rapidly lost. However, normal or almost normal functioning may be recovered with treatment, plus if there are no other serious health issues. Common causes of acute kidney injury include: inadequate blood flow to the kidneys, a heart attack, drug abuse and urinary tract problems.
Chronic kidney failure, the final stage of chronic kidney disease, develops slowly, usually over months and years. Unlike acute renal failure, it is irreversible and the only remedy would be to carry out dialysis or kidney transplant surgery. The number one most common cause of chronic kidney failure is diabetes, followed by high blood pressure. Other less common causes include: nephrotic syndrome, autoimmune diseases like lupus, polycystic kidney disease and urinary tract problems.
Acute renal failure affects about 30 in every 10,000 people in the United States, annually. Chronic kidney failure affects about 10 in every 10,000 people annually. 3 in every 10,000 people newly manifest the condition annually.
Anybody can develop chronic kidney failure at any age. However, the following factors may put you at a greater risk of developing the condition:
Diabetes and high blood pressure are the two most common risk factors for kidney failure with diabetes being the major cause, and high blood pressure being the next.
The progress of chronic kidney failure is rather subtle, as almost no symptoms is observed in the early stages, until when one is nearing the last stage of the condition. The symptoms observed during this stage are usually due to the accumulation of wastes in the blood and the body, a condition called azotemia. Symptoms, if any at all, produced for very low levels of azotemia, are usually few. But as the condition progresses, and the levels of azotemia rise, symptoms begin to become noticeable. The following are symptoms of kidney failure classified based on the accumulation of a certain type of waste product:
Based on accumulation of high levels of urea,
Based on accumulation of excess phosphates (hyperphosphatemia),
Based on accumulation of excess potassium (hyperkalemia),
Based on accumulation of excess fluid,
Other symptoms may include:
To diagnose kidney failure, your doctor will carry out a physical examination on you, and at the same time, ask questions about your family history, and medical history (if you have had any previous medical condition or treatment). Your doctor will then order tests to be carried out based on the result of the physical exam and the information you have provided.
The type of test to be carried out will depend on what he thinks is the cause of your kidney failure, as the most likely cause will determine the test required, and the best suited to confirm the cause. The following tests may be carried out to diagnose kidney failure:
Blood tests: These are carried out in order to measure two substances in your blood – creatinine and urea nitrogen. Creatinine level in the blood increases if the kidneys stop functioning, because they are constantly being removed from your blood by them. Creatinine is a waste product that is normally produced in the blood by muscle activity. Urea nitrogen is the end product of protein digestion, released into the blood, and constantly being removed by the kidney. So, when your kidneys stop functioning, urea nitrogen levels in the blood increase.
Urine tests: A sample of your pee will be collected and tested in the laboratory to check for the presence of blood and protein. Certain electrolytes will also be checked for, e.g. potassium, phosphorus, sodium etc. The results of the test will help your doctor understand the cause of your kidney failure, so that the suitable treatment can be given.
Imaging tests: An enlarged kidney or blockage to your urine flow can be shown by certain imaging tests like ultrasonography/renal ultrasound or a CT scan. An angiogram or magnetic resonance imaging, MRI, can show if the arteries or veins leading to your kidneys are blocked.
Kidney biopsy: This is an invasive method that involves image-guided removal of a thin kidney tissue sample in a bid to test it for disease. This is usually the last resort to providing a diagnosis if other imaging tests does not provide one.
Several treatment options are available for kidney failure and the type depends on the cause of kidney failure. It will be required to follow a strict diet in a bid to restore normal kidney function (in acute kidney failure). In end-stage kidney failure, restoration of normal kidney function is almost impossible, however, the patient is still able to lead a normal life with the treatment options discussed briefly below.
Dialysis: a machine in which the patient is connected to, and does the work of the kidneys – filters and purifies the blood. You may be attached to either a large machine or a portable catheter bag, depending on the type of dialysis. A strict diet of low-potassium, low-salt may be required of you to follow along with dialysis. Dialysis doesn’t cure kidney failure but it can extend life expectancy if you follow your scheduled treatment routine.
Kidney transplant: a kidney transplant can also be performed, and dialysis will, then, no longer be needed. Another person with a healthy kidney will be required to donate one of their kidneys, and it has to be compatible with your body. However, there is usually a long wait, except you are very fortunate. Immunosuppressive drugs must be taken after the surgery to prevent your body from rejecting the newly transplanted kidney, however, some of these drugs have a serious side effects.
Kidney transplant surgery may not be the right treatment for everyone as the surgery can be unsuccessful. So, you have to consult your doctor so as to know if you would be a good candidate for a kidney transplant.