(Renal Failure; Renal Insufficiency)
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. When one or both of the kidneys are not able to perform these functions, kidney failure may result.
Kidney failure is divided into 2 categories:
- Acute kidney failure—sudden loss of kidney function
- Chronic kidney failure—slow, gradual loss of kidney function
Anatomy of the Kidney
Kidney disease occurs when nephrons lose their ability to function normally. Nephrons are cells in the kidney that filter the blood. Damage to the nephrons may occur suddenly after an injury or poisoning. Many kidney diseases take years or even decades to cause damage that is noticeable.
The 2 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:
- Kidney infection—pyelonephritis
- Genetic disorders, such as polycystic kidney disease
- Bilateral renal artery stenosis
- Birth defects
- Abnormal build-up of substances within the kidneys such as amyloidosis and protein build-up
- Toxic reaction to drugs or injections of contrast material used for imaging studies, such as CT scans
Factors that increase your chance of kidney failure include:
- Chronic diseases that affect kidney function
- Genetic abnormalities or birth defects that affect kidney function
- Autoimmune disorders, such as systemic lupus erythematosus, polyarteritis, and Wegeners granulomatosis
- Severe trauma
- Viral infections, such as hepatitis B, hepatitis C, and HIV
- Long-term use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs), especially in high doses
- Conditions that affect blood volume, such as burns, pancreatitis, peritonitis, bleeding, and dehydration
- Conditions that make it difficult to urinate such as enlarged prostate, kidney stones, and tumors
- Recent heart surgery, such as open heart surgery or abdominal aortic aneurysm repair
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 and/or insomnia
- Low or no urine output
- 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
You will be asked about your symptoms and medical history. A physical exam will be done.
Your bodily fluids and tissues may be tested. This can be done with:
- Blood tests
- Urine tests
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
Medications used in acute or chronic kidney failure may include:
- Diuretics —to flush out the kidneys, increase urine flow, and rid the body of excess sodium
- Blood pressure medications
- Medications to treat anemia
- Sodium polystyrene sulfonate or insulin in dextrose to control high potassium levels
- Medications to control high phosphorus levels
Talk to your doctor about other medications you are taking. These include prescribed and over-the-counter medications, as well as herbs and supplements. Since the kidneys are no longer working properly, waste can build up in your body.
This may be the right option for some people. Having a successful transplant depends on many factors, such as what is causing the kidney damage and overall health.
You can take the following steps to help your kidneys stay healthy longer:
- Have your blood pressure checked regularly. Take medication to control high blood pressure.
- If you have diabetes, control your blood sugar. Ask your doctor for help.
- Avoid the chronic use of pain medications.
- Depending on the severity of kidney disease, there may be dietary restrictions on protein, cholesterol, sodium, or potassium.
In some cases, you cannot prevent kidney failure, but there are some steps you can take that will lower your risk:
National Kidney Foundation
National Kidney and Urologic Diseases Information Clearinghouse
Canadian Diabetes Association
The Kidney Foundation of Canada
Chronic kidney disease (CKD) in adults. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115336/Chronic-kidney-disease-CKD-in-adults. Updated August 23, 2016. Accessed September 28, 2016.
Johnson CA, Levey AS, Coresh J, Levin A, Lau J, Eknoyan G. Glomerular filtration rate, proteinuria, and other markers. Am Fam Physician. 2004;70(6):1091-1097.
Johnson CA, Levey AS, Coresh J, Levin A, Lau J, Eknoyan G. Clinical practice guidelines for chronic kidney disease in adults: part I. Definition, disease stages, evaluation, treatment, and risk factors. Am Fam Physician. 2004;70(5):869-876.
Kidney Disease Outcomes Quality Initiative. K/DOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease. Am J Kidney Dis. 2004;43(5 Suppl 1):S1-S290.
Kidney Disease Outcomes Quality Initiative. Kidney disease outcomes quality initiative (K/DOQI) clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39(2 Suppl 1):S1-S266.
National Kidney Foundation. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis. 2003;42(4 Suppl 3):S1-S201.
Snivel CS, Gutierrez C. Chronic kidney disease: prevention and treatment of common complications. Am Fam Physician. 2004;70(10):1921-1928.
Use of herbal supplements in chronic kidney disease. National Kidney Foundation website. Available at: https://www.kidney.org/atoz/content/herbalsupp. Published 2015. Accessed June 1, 2016.
The kidneys and how they work. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/health-information/health-topics/Anatomy/kidneys-how-they-work/Pages/anatomy.aspx. Updated May 2014. Accessed June 1, 2016.
1/4/2011 DynaMed Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Deved V, Poyah P, James MT, et al. Ascorbic acid for anemia management in hemodialysis patients: A systematic review and meta-analysis.. Am J Kidney Dis. 2009;54(6):1089-1097.
10/10/2013 DynaMed Systematic Literature Surveillance http://www.ebscohost.com/dynamed Di lorio B, Molony D, Bell C, et al. Sevelamer versus calcium carbonate in incident hemodialysis patients: Results of an open-label 24-month randomized clinical trial. Am J Kidney Dis. 2013;62(4):771-778.
Last reviewed June 2016 by Adrienne Carmack, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.