Kidney Failure

Definition

When you have kidney failure, one or both kidneys aren't able to work normally. The kidneys remove waste (in the form of urine) from the body. They also balance the water and electrolyte content in the blood by filtering salt and water.

Kidney failure is divided into two categories:

• Acute kidney failure—sudden loss of kidney function
• Chronic kidney failure—slow, gradual loss of kidney function

Causes

Kidney disease causes the tiny filters in the kidneys (called nephrons) to lose their ability to filter. Damage to the nephrons may occur suddenly after an injury or poisoning. But, many kidney diseases take years or even decades to cause damage that is noticeable.

The two most commons causes of kidney disease are:

• Diabetes—high blood sugar can damage nephrons
• High blood pressure—severe high blood pressure can damage blood vessels in the kidneys

Others causes include:

• Pyelonephritis
• Glomerulonephritis
• Polycystic kidney disease
• Birth defects
• Bilateral renal artery stenosis
• Poisoning
• Severe trauma
• Viral infections (such as, hepatitis B, hepatitis C, HIV/AIDS)
• Long-term use of medicines that contain aspirin, acetaminophen, or ibuprofen
• Abnormal build-up of substances within the kidneys (such as, amyloidosis, protein build-up)
• Toxic reaction to drugs or x-ray dyes
• Systemic diseases (such as, lupus, polyarteritis, Wegeners granulomatosis
• Conditions that severely decrease the amount of blood (such as, burns, pancreatitis, peritonitis)
• Conditions that make it difficult to urinate (such as, enlarged prostate, kidney stones, tumors)

Renal Failure

A blockage from kidney stones has caused renal failure.

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Risk Factors

Risk factors that increase your chance of developing kidney failure include:

• Diabetes
• Genetics: polycystic kidney disease, type 1 diabetes
• Race: African American
• High blood pressure
• Lupus or other autoimmune diseases
• Long-term use of pain medications containing aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) in high doses
• Liver failure, jaundice
• Respiratory failure
• HIV
• Cancer
• Recent open heart surgery
• Recent surgery on an abdominal aortic aneurysm
• Condition that obstructs urine flow
• Enlargement of the prostate gland

Symptoms

Some kidney diseases begin without any symptoms. As the disease progresses, some of the following symptoms may develop:

• Fluid retention
• Swollen and numb hands and feet, itchy skin
• Fatigue, insomnia
• Low urine output (or no urine output in severe cases), frequent urination
• Altered consciousness
• Loss of appetite, malnutrition
• Sores, bad taste in the mouth
• Nausea, vomiting
• Muscle cramps and twitches
• Shortness of breath
• High blood pressure
• Low temperature
• Seizures, coma
• Breath smelling like urine
• Yellowish-brownish skin tone

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. Tests may include:

Treatment

Most chronic kidney diseases are not reversible. But, there are treatments that may be used to help preserve as much kidney function as possible. In the case of acute renal failure, treatment focuses on the illness or injury that caused the problem.

• Restricting fluids
• Doing daily weight checks
• Eating a high-carbohydrate, low-protein diet

Prevention

In some cases, you cannot prevent kidney failure. But, there are some steps you can take that will lower your risk:

• Maintain normal blood pressure.
• If you have diabetes, control your blood sugar.
• Avoid long-term exposure to toxic substances, such as lead and solvents.
• Do not abuse alcohol or over-the-counter pain medication.
• If you have chronic kidney failure, talk to your doctor before you become pregnant.

Revision Information

• Reviewer: Adrienne Carmack, MD
• Review Date: 10/2012
• Update Date: 10/31/2012