Introduction
Signs and symptoms
- High blood pressure
- Unexplained weight loss
- Anemia
- Nausea or vomiting
- A general sense of discomfort and unease (malaise)
- Fatigue
- Headaches that seem unrelated to any other cause
- Decreased mental sharpness
- Muscle twitches and cramps
- Bloody or tarry stools, which could indicate bleeding in your intestinal tract
- Yellowish-brown cast to your skin
- Persistent itching
Causes
- Diabetes. Diabetes mellitus is a leading cause of chronic kidney failure in the United States. Chronic kidney failure is related to both type 1 and type 2 diabetes.
- High blood pressure (hypertension). Untreated or inadequately treated high blood pressure is another common cause of chronic kidney failure in the United States. The added force of elevated blood pressure exerted on the glomeruli can cause damage and scarring. When this happens, the nephrons containing the damaged glomeruli eventually lose their ability to filter waste from your blood.
- Obstructive nephropathy. This occurs when urine outflow is blocked over time by an enlarged prostate, kidney stones or tumors, or by vesicoureteral reflux, a condition that results from urine backing up into your kidneys from your bladder. The backflow pressure in your kidneys reduces their function.
- Kidney diseases. These include clusters of cysts in the kidneys (polycystic kidney disease), kidney infection (pyelonephritis) and inflammation of the glomeruli (glomerulonephritis), a condition that causes your kidneys to leak protein into your urine and damages nephrons.
- Kidney (renal) artery stenosis. This is a narrowing or blockage of the kidney artery before it enters your kidney. In older adults, blockages often result when fatty deposits accumulate under the lining of the artery walls (atherosclerosis). Kidney artery stenosis can also affect young women in the form of a condition known as fibromuscular dysplasia, which causes the walls of the arteries to become thicker. Both conditions are often associated with high blood pressure.
- Toxins. Ongoing exposure to fuels and solvents, such as carbon tetrachloride, and lead — in lead-based paint, lead pipes, soldering materials, jewelry and even alcohol distilled in old car radiators — can lead to chronic kidney failure.
Risk factors
- High blood pressure (hypertension)
- Sickle cell disease
- Lupus erythematosus
- Atherosclerosis
- Chronic glomerulonephritis
- Congenital kidney disease
- Kidney disease present at birth (congenital)
- Bladder outlet obstruction
- Overexposure to toxins and to some medications
When to seek medical advice
Screening and diagnosis
- Ultrasound imaging. This test uses high-frequency sound waves and computer technology to generate images of your kidneys. Ultrasound images can indicate the shape and structure of your kidneys and reveal obstructions contributing to the problem.
- Computerized tomography (CT) scan. This test uses computers to create more detailed images of your internal organs — including your kidneys — than conventional X-rays do.
- Magnetic resonance imaging (MRI). Instead of X-rays, this test uses magnetic fields and radio waves to generate cross-sectional pictures of your body.
- Kidney biopsy. Sometimes your doctor may remove a small sample of kidney tissue to be examined microscopically. Kidney tissue analysis permits a more specific diagnosis of the kidney disease.
Complications
- Fluid retention. This may lead to swollen tissues, congestive heart failure or fluid in your lungs (pulmonary edema).
- A sudden rise in potassium levels in your blood (hyperkalemia). This could impair your heart's ability to function and may be life-threatening.
- Weak bones that fracture easily.
- Anemia.
- Stomach ulcers.
- Dry skin, changes in skin color.
- Insomnia.
- Damage to your central nervous system.
- Decreased immune response, leaving you more vulnerable to infection.
- Pericarditis, an inflammation of the sac-like membrane that envelops your heart (pericardium).
- End-stage kidney disease, characterized by irreversible damage to your kidneys. This requires either dialysis or a kidney transplant for survival.
One of the most serious complications affecting children with chronic kidney failure is a failure to grow. In addition to regulating fluids and ridding the body of waste, the kidneys produce a hormone (erythropoietin) that helps generate red blood cells and metabolize human growth hormone. The kidneys also regulate the interactions of calcium and vitamin D, both of which are essential for bone growth.
If you're a woman with chronic kidney failure who becomes pregnant, you'll face a number of potential complications. That's because your kidneys must work especially hard to deal with the extra fluids of pregnancy. This may lead to worsening high blood pressure and an increase in the waste products circulating in your blood.
Treatment
The first priority is controlling the condition responsible for your kidney failure and its complications. If you have diabetes or high blood pressure (hypertension), for instance, that means carefully following your doctor's recommendations for diet and exercise and taking any medications as directed. Most people with chronic kidney failure are treated with medications to lower their blood pressure — commonly angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers — and to preserve kidney function. To protect kidney function, your blood pressure may need to be lower than if your kidneys were functioning normally.
You'll also need treatment for complications of chronic kidney failure. For example, anemia may require supplements of the hormone erythropoietin to induce production of more red blood cells. In addition, your doctor may prescribe a form of vitamin D (calcitriol) to prevent weak bones, as well as a phosphate-binding medication to lower the amount of phosphate in your blood. Phosphate binds to calcium in your body thus reducing the amount of calcium available for your bones, making them weak and vulnerable to fracture.
By the time end-stage kidney disease develops, your kidneys are functioning at less than 10 percent to 15 percent of capacity. At this point, the conservative measures used to treat chronic kidney failure — diet, medications and controlling the underlying cause and complications — are no longer enough. Your kidneys aren't able to keep up with waste and fluid clearance on their own, and dialysis or a kidney transplant becomes the only option to support life.
- Hemodialysis. The most common form of dialysis is known as hemodialysis. It removes extra fluids, chemicals and wastes from your bloodstream by filtering your blood through an artificial kidney (dialyzer). Blood is pumped out of your body to the artificial kidney through a vascular access that's created surgically, usually in your arm or leg. Your blood plasma moves across membranes inside the artificial kidney that filter out waste. Less than 1 cup of blood is outside your body at any one time. Most people require approximately 12 hours of dialysis each week, usually divided into three sessions.
- Peritoneal dialysis. Instead of filtering your blood through a machine, this type of dialysis uses the vast network of tiny blood vessels in your own abdomen (peritoneal cavity) to filter your blood. First, a small, flexible tube (catheter) is implanted into your abdomen. Then, a dialysis solution is infused into and drained out of your abdomen for as long as is necessary to remove waste and excess fluid.
- Continuous ambulatory peritoneal dialysis. You perform this type of dialysis yourself at home, exchanging the dialysis solution in your abdomen four times a day, seven days a week. You space out these exchanges throughout the day.
- Continuous cycling peritoneal dialysis. In this type of dialysis, a machine (cycler machine) automatically infuses dialysis solution into and out of your peritoneal cavity over a period of 10 to 12 hours while you sleep.
If you have no other life-threatening medical conditions, a kidney transplant is usually a better option than dialysis because it provides a better quality of life. But you may need dialysis until a suitable kidney donor is found. Finding the right donor may be difficult, however.
Prevention
- Don't abuse alcohol or other drugs, including over-the-counter pain medications such as aspirin, acetaminophen and ibuprofen. Avoid long-term exposure to heavy metals, such as lead, as well as to solvents, fuels and other toxic substances.
- Carefully follow all of your doctor's recommendations for managing your condition if you have a chronic medical condition that increases your risk of kidney failure. The American Diabetes Association recommends yearly prealbumin urine tests for most people with diabetes.
- Consider a pre-pregnancy consultation if you have chronic kidney failure and are thinking of becoming pregnant. Talk with a knowledgeable obstetrician or nephrologist to discuss your risks. If you're already pregnant, be sure to get comprehensive medical care — including prenatal visits every two weeks for at least the first 32 weeks.
Self-care
- Suck on a lemon wedge or a few ice chips.
- Rinse your mouth with water but don't swallow it.
- Eat a piece or two of sour candy or chew gum to increase the moisture level in your mouth.
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