Kidney failure facts Kidneys are the organs that help filter waste products from the blood. They are also

involved in regulating blood pressure, electrolyte balance, and red blood cell production in the body.

Renal failure (also kidney failure or renal insufficiency) is a medical condition in which the kidneys fail to adequately filter waste products from the blood.[1] The two main forms are

acute kidney injury (AKI), which is often reversible with adequate treatment, and

chronic kidney disease (CKD), which is often not reversible.

Symptoms of kidney failure are due to the build-up of waste products in the body that may cause

 weakness, shortness of breath , lethargy, and confusion .

Inability to remove potassium from the bloodstream may lead to abnormal heart rhythms and sudden death. 

The diagnosis of kidney failure usually is made by blood tests measuring BUN, creatinine/urea, and glomerular filtration rate (GFR).Depending on the cause, hematuria (blood loss in the urine) and proteinuria(protein loss in the urine) may be noted.

If the kidneys fail completely, the only treatment options available may be o hemodialysis or

o transplant.In renal failure, there may be problems with

increased fluid in the body (leading to swelling),  increased acid levels , raised levels of potassium ,  decreased levels of calcium , increased levels of phosphate , and in later stages anemia. Bone health may also be affected. Long-term kidney problems are associated with an increased risk of

cardiovascular disease

Signs and symptoms

Symptoms can vary from person to person. Someone in early stage kidney disease may not feel sick or notice symptoms as they occur. When kidneys fail to filter properly, waste accumulates in the blood and the body, a condition called AZOTEMIA. Very low levels of azotaemia may produce few, if any, symptoms. If the disease progresses, symptoms become noticeable (if the failure is of sufficient degree to cause symptoms). Renal failure accompanied by noticeable symptoms is termed URAEMIA.[8]

Symptoms of kidney failure include:[8][9][10][11]

HIGH LEVELS OF UREA IN THE BLOOD, which can result in: Vomiting  and/or diarrhea, which may lead to dehydration Nausea Weight loss Nocturnal urination More frequent urination, or in greater amounts than usual, with pale urine Less frequent urination, or in smaller amounts than usual, with dark coloured

urine Blood in the urine Pressure, or difficulty urinating Unusual amounts of urination, usually in large quantities

A BUILD UP OF PHOSPHATES IN THE BLOOD that diseased kidneys cannot filter out may cause: Itching Bone damage Non union in broken bones Muscle cramps  (caused by low levels of calcium which can be associated

with hyperphosphatemia)

A BUILD UP OF POTASSIUM IN THE BLOOD that diseased kidneys cannot filter out (called hyperkalemia) may cause: Abnormal heart rhythms Muscle paralysis

Failure of kidneys to remove excess fluid may cause: Swelling of the legs, ankles, feet, face and/or hands

Shortness of breath due to extra fluid on the lungs (may also be caused by anemia)

Polycystic kidney disease, which causes large, fluid-filled cysts on the kidneys and sometimes the liver, can cause: Pain in the back or side

Healthy kidneys produce the hormone erythropoietin that stimulates the bone marrow to make oxygen-carrying red blood cells. As the kidneys fail, they produce less erythropoietin, resulting in decreased production of red blood cells to replace the natural breakdown of old red blood cells. As a result, the blood carries less hemoglobin, a condition known as ANEMIA. This can result in: Feeling tired and/or weak Memory problems Difficulty concentrating Dizziness Low blood pressure

Normally, proteins are too large to pass through the kidneys, however, they are able to pass through when the glomeruli are damaged. This does not cause symptoms until extensive kidney damage has occurred,[13] after which symptoms include: Foamy or bubbly urine Swelling in the hands, feet, abdomen, or face

Other symptoms include: Appetite loss, a bad taste in the mouth Difficulty sleeping Darkening of the skin Excess protein in the blood With high dose penicillin, renal failure patients may experience seizures [

Use of the term uremiaBefore the advancement of modern medicine, renal failure was often referred to as uremic poisoning. Uremia was the term for the contamination of the blood with urine.IT IS THE PRESENCE OF EXCESSIVE AMOUNT OF UREA IN BLOOD.

Starting around 1847, this included reduced urine output, which was thought to be caused by the urine mixing with the blood instead of being voided through the urethra.[citation needed] The term uremia is now used for the illness accompanying kidney failure.[24]

Chronic kidney disease

Chronic kidney disease is the slow loss of kidney function over time. The main function of the kidneys is to remove wastes and excess water from the body.

Causes

Chronic kidney disease (CKD) slowly gets worse over time. In the early stages, there may be no symptoms. The loss of function usually takes months or years to occur. It may be so slow that symptoms do not appear until kidney function is less than one-tenth of normal.

The final stage of chronic kidney disease is called end-stage renal disease (ESRD). At this stage, the kidneys are no longer able to remove enough wastes and excess fluids from the body. The patient needs dialysis or a kidney transplant.

Chronic kidney disease and ESRD affect more than 2 out of every 1,000 people in the United States.

Diabetes and high blood pressure are the two most common causes and account for most cases.

Many other diseases and conditions can damage the kidneys, including:

Autoimmune disorders (such as systemic lupus erythematosus and scleroderma)

Birth defects of the kidneys (such as polycystic kidney disease) Certain toxic chemicals Glomerulonephritis Injury or trauma Kidney stones  and infection Problems with the arteries leading to or inside the kidneys Some pain medications and other drugs (such as cancer drugs) Reflux nephropathy  (in which the kidneys are damaged by the backward flow

of urine into the kidneys) Other kidney diseases

Chronic kidney disease leads to a buildup of fluid and waste products in the body. This condition affects most body systems and functions, including:

Blood pressure control Red blood cell production Vitamin D and bone health

Symptoms

The early symptoms of chronic kidney disease are also symptoms of other illnesses. These symptoms may be the only signs of kidney disease until the condition is more advanced.

Symptoms may include:

Appetite loss General ill feeling  and fatigue

Headaches Itching (pruritus) and dry skin Nausea Weight loss  without trying to lose weight

Other symptoms that may develop, especially when kidney function has gotten worse, include:

Abnormally dark or light skin Bone pain Brain and nervous system symptoms:

o Drowsiness  and confusiono Problems concentrating or thinkingo Numbness  in the hands, feet, or other areaso Muscle twitching  or cramps

Breath odor Easy bruising, bleeding, or blood in the stool Excessive thirst Frequent hiccups Low level of sexual interest and impotence Menstrual periods stop (amenorrhea) Shortness of breath Sleep problems, such as insomnia, restless leg syndrome, and obstructive

sleep apnea Swelling of the feet and hands (edema) Vomiting, typically in the morning

Exams and Tests

High blood pressure is almost always present during all stages of chronic kidney disease. A nervous system exam may show signs of nerve damage. The health care provider may hear abnormal heart or lung sounds when listening with a stethoscope.

A urinalysis may show protein or other changes. These changes may appear 6 months to 10 or more years before symptoms appear.

Tests that check how well the kidneys are working include:

Creatinine clearance Creatinine  levels BUN

Chronic kidney disease changes the results of several other tests. Every patient needs to have the following checked regularly, as often as every 2 - 3 months when kidney disease gets worse:

Albumin Calcium Cholesterol Complete blood count  (CBC) Electrolytes Magnesium Phosphorous

Potassium Sodium

Causes of chronic kidney disease may be seen on:

Abdominal CT scan Abdominal MRI Abdominal ultrasound Kidney biopsy Kidney scan Kidney ultrasound

This disease may also change the results of the following tests:

Erythropoietin PTH Bone density test Vitamin D

Treatment

Controlling blood pressure will slow further kidney damage.

Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) are used most often.

The goal is to keep blood pressure at or below 130/80 mmHg

Other tips for protecting the kidneys and preventing heart disease and stroke:

Do not smoke. Eat meals that are low in fat and cholesterol. Get regular exercise (talk to your doctor or nurse before starting to exercise). Take drugs to lower your cholesterol, if needed. Keep your blood sugar under control. Avoid eating too much salt or potassium.

Always talk to your kidney doctor before taking any over-the-counter medicine, vitamin, or herbal supplement. Make sure all of the doctors you visit know you have chronic kidney disease.

Other treatments may include:

Special medicines called phosphate binders, to help prevent phosphorous levels from becoming too high

Treatment for anemia, such as extra iron in the diet, iron pills, iron through a vein (intravenous iron) special shots of a medicine called erythropoietin, and blood transfusions

Extra calcium and vitamin D (always talk to your doctor before taking)

You may need to make changes in your diet. See: Diet for chronic kidney disease for more details.

You may need to limit fluids.

Your health care provider may recommend a low-protein diet. You may have to restrict salt, potassium, phosphorous, and other electrolytes. It is important to get enough calories when you are losing weight.

Different treatments are available for problems with sleep or restless legs syndrome.

Everyone with chronic kidney disease should be up-to-date on important vaccinations, including:

H1N1 (swine flu)  vaccine Hepatitis A vaccine Hepatitis B vaccine Influenza vaccine Pneumococcal polysaccharide vaccine  (PPV)

When the loss of kidney function becomes more severe, you will need to prepare for dialysis or a kidney transplant.

When you start dialysis depends on different factors, including your lab test results, severity of symptoms, and readiness.

You should begin to prepare for dialysis before you need it. Learn about dialysis and the types of dialysis therapies, and how a dialysis access is placed.

Even people who are candidates for a kidney transplant may need dialysis while waiting for a kidney to become available.

Support Groups

See: Kidney disease - support group

Outlook (Prognosis)

Many people are not diagnosed with chronic kidney disease until they have lost most of their kidney function.

There is no cure for chronic kidney disease. Untreated, it usually worsens to end-stage renal disease. Lifelong treatment may control the symptoms of chronic kidney disease.

Possible Complications

Anemia Bleeding from the stomach or intestines Bone, joint, and muscle pain Changes in blood sugar Damage to nerves of the legs and arms (peripheral neuropathy) Dementia Fluid buildup around the lungs (pleural effusion) Heart and blood vessel complications

o Congestive heart failure o Coronary artery disease o High blood pressureo Pericarditis

o Stroke High phosphorous levels High potassium levels Hyperparathyroidism Increased risk of infections Liver damage or failure Malnutrition Miscarriages  and infertility Seizures Swelling (edema) Weakening of the bones and increased risk of fractures

Prevention

Treating the condition that is causing the problem may help prevent or delay chronic kidney disease. People who have diabetes should control their blood sugar and blood pressure levels and should not smoke.

Alternative Names

Kidney failure - chronic; Renal failure - chronic; Chronic renal insufficiency; Chronic kidney failure; Chronic renal failure

UREMIA OR URAEMIA (see spelling differences) is the illness accompanying kidney failure (also called renal failure), in particular the nitrogenous waste products associated with the failure of this organ.[1]

In kidney failure, urea and other waste products, which are normally excreted into the urine, are RETAINED IN THE BLOOD.

Early symptoms include

anorexia and lethargy, and late symptoms can include decreased mental acuity and coma. Other symptoms include fatigue, nausea, vomiting, cold, bone pain, itch, shortness of breath, and seizures.

It is usually diagnosed in kidney dialysis patients when THE GLOMERULAR FILTRATION RATE, A MEASURE OF KIDNEY FUNCTION, IS BELOW 50% OF NORMAL.[2] Uremia can also result in uremic pericarditis. There are many dysfunctions caused by uremia affecting many systems of the body, such as blood (lower levels of erythropoietin), sex (lower levels of testosterone/estrogen), and bones (osteoporosis andmetastatic calcifications). Uremia can also cause decreased peripheral conversion of T4 to T3, producing a functionally hypothyroid state.

Azotemia is another word that refers to high levels of urea, but is used primarily when the abnormality can be measured chemically but is not yet so severe as to produce symptoms.