Kidney failure has many possible causes. Some lead to a rapid decline in kidney function (acute kidney failure). Other lead to a gradual decline in kidney function (chronic kidney failure, also called chronic kidney disease). In addition to the kidney being unable to filter metabolic waste products (such as creatinine and urea nitrogen (from the blood, the kidney is less able to control the amount and distribution of water in the body) fluidbalance (and the level of electrolytes (sodium, potassium, calcium, phosphate) in the blood.
When kidney failure becomes chronic, blood pressure often rises. The kidney loses their ability to product sufficient amounts of a hormone (erythropoietin) that stimulates the formation of new red blood cells, resulting in a low red blood cell count (anemia). In children, kidney failure affects the growth of bones. In both children and adults, kidney failure can lead to weaker, abnormal bones.
Although kidney failure can affect people of all ages, both acute and chronic kidney failure are more common in older than in younger people. Many cause of kidney failure can be treated, and kidney function may recover. The availability of dialysis has transformed kidney failure from a fatal disease to a chronic one.
Kidney Failure Symptoms
Symptoms depend on the severity of kidney failure, its rate of progression, and cause. In some people, the first symptoms of acute kidney failure are water retention, with swelling of the feet and ankles or puffiness of the face and hands. People may pass cola colored urine, which may indicate a number of kidney disease. The amount of urine (which for most healthy adults is between 3 cups) about 750 milliliters (and 2 quarts) about 2 liters (per day often decreases to less than 2 cups) about 500 milliliters (per day or stops completely. Very little urine production is called oliguria, and no urine production is called anuria. However, some people with acute kidney failure continue to produce normal amounts of urine.
As acute kidney failure persists and metabolic waste products accumulate in the body, people may experience fatigue, a decreased ability to concentrate on mental tasks, loss of appetite, nausea, and overall itchiness (pruritus). People with acute kidney failure may experience a rapid heart rate (tachycardia) and light headedness.
If the cause is an obstruction, the backup of urine within the kidney cause the drainage system to stitch (a condition called hydronephrosis (. Urinary obstruction often causes a constant dull ache under the lower ribs but may cause crampy pain ranging from mild to excruciating usually alone the sides (flanks)of the body. Some people with hydronephrosis have blood in their urine. If the obstruction is located below the bladder, the bladder will enlarge. If the bladder enlarges rapidly, people are likely to feel severe pain in the pelvis, just above the public bone. If the bladder enlarges slowly, pain may be minimal, but the lower part of the abdomen may swell because of the markedly distended bladder.
If acute kindly failure develops during hospitalization, the condition often relates to some recent injury, surgery, drugs, or illness such as infection. The symptoms of the cause of the acute kidney failure may predominate. For example, high fever, life threating low blood pressure (shock), and symptoms of heart failure or liver failure may occur before symptoms of kidney failure and be more obvious and urgent.
Some of the conditions that cause acute kidney failure also effect other parts of the body. For example, Good pastures syndrome or Wegener granulomatosis, which damages blood vessels in the lungs, causing a person to cough up blood. Rashes are typical of some cause of acute kidney failure, including polyarteritis nodosa, systemic lupus erythematosus, and some toxic drugs.
Kidney Failure Diagnosis
Blood tests that measure levels of creatinine and urea nitrogen in the blood are needed to confirm the diagnosis. A progressive daily rise in creatinine indicates acute kidney failure. The level of creatinine is also the best indicator of the degree or severity of kidney failure. The higher the level of creatinine is also the best indicator of the degree or severity of kidney failure. The higher the level, the more severe the failure is likely to be. Other blood tests detect metabolic imbalances that occur as kidney failure persists, such as an increase in blood acidity (acidosis, which causes a low bicarbonate level), a high potassium level (hyperkalemia), a low sodium level (hyponatremia), and a high phosphorus level (hyperphosphatemia).
The physical examination finding may help doctors identify the cause of the acute kidney may indicate obstruction with hydronephrosis. Urine test, such as a urinalysis and measurement of certain electrolytes, may enable doctors to determine whether the cause of kidney failure is insufficient blood flow to the kidney, damage to the kidney, or urinary obstruction. Imagine of the kidneys using ultrasonography or computed tomography (CT) is helpful, sometimes by identifying hydronephrosis or an enlarge bladder.
Imagine can also reveal the size of the kidney. X-rays of the arteries or veins that lead to and from the kidney (angiography) may be done if obstruction of blood vessels is the suspected cause. However, angiography is done only when other tests do not provide enough information, because angiography uses radiopaque dye (contrast agent) that contain iodine, which carries a risk of additional kidney damage. Magnetic resonance imaging (MRI)can provide the same type of information. However, MRI has traditionally used gadolinium, a substance that rarely causes a disorder that triggers production of scar tissue in the body (nephrogenic fibrosing dermopathy (. Thus, MRI is now less likely to be used. If other tests do not reveal the cause of kidney failure, a biopsy may be necessary to determine the diagnosis and the prognosis.
Kidney Failure Treatment
Any treatable cause of kidney failure is treated as soon as possible. For example, if obstruction is the cause, a catheter (a tube placed into the bladder), endoscopy, or surgery may be needed to relieve the obstruction. Often, the kidney can heal them, especially if the kidney failure has existed for less than 5 days and there are no complicating problems such as infections. During this time, measures are taken to prevent kidney failure from causing serious problems. Such measures may include the following;
- Restricting use of certain drug
- Restricting fluids, sodium, and potassium in the diet
- Maintaining good nutrition
- Giving drugs if blood levels of potassium or phosphate are too high
- Giving dialysis
Doctor strictly limits the intake of all substance that is eliminated through the kidney, including a large number of drugs. Salt (sodium) and potassium intake is usually restricted. Fluid intake is restricted to replacing the amount lost from the body, unless fluid is needed because there are too little blood flowing to the kidney, Weight is measured every day because a change in weight is a good indicator of whether there is too much or too little water in the body. A healthy diet is provided to people whose condition allows them to eat. Moderate amount of protein are acceptable, typically 0.8 to 1 grams per kilogram of body weight (0.4 to 0.5 grams per pound). Sodium polystyrene sulfonate is sometimes given by mouth or rectally or treats a high level of potassium in the blood. Calcium salts (calcium carbonate or calcium acetate) or sevelamer may be giving by mouth to prevent or treat a high level of phosphorus in the blood. Waste removal can be done through dialysis, usually hemodialysis.
If kidney failure is predicted to be prolonged, dialysis may be needed only temporarily, until the kidney recover their function, usually in several days to several weeks. If the kidneys are too badly damage to recover, then the acute kidney failure becomes chronic.