Renal Failure: Summary and Overview

Kidney or renal failure is the loss of the ability of the kidneys to remove excess fluid and salts (electrolytes) as well as waste from your body. Acute renal failure happens quickly and suddenly.  Chronic renal failure happens gradually - over a period of weeks, months, or years. Both are serious conditions that require immediate medical attention.

Renal Failure: Causes

The causes of renal failure are different depending on whether the condition is acute or chronic.

Acute Renal Failure

Acute renal failure is caused by three different types of conditions: diseases which may damage the kidneys, conditions that slow blood flow to the kidneys and those that block urine from leaving the body.

Diseases or conditions that may damage the kidneys include:

• Autoimmune kidney diseases, e.g. lupus
• Urinary tract infection
• Toxins, such as alcohol, heavy metals and cocaine
• Malignant hypertension
• Transfusion reaction
• Scleroderma

Disease that may block blood flow to the kidneys:

• Cholesterol deposits that block blood flow in the kidneys
• Multiple myeloma

Decreased blood flow due to very low blood pressure, which can result from:

• Burns
• Dehydration
• HemorrhageInjury
• Septic shock
• Serious illness
• Surgery

Diseases that block urine from leaving the body:

• Cancers, including bladder, cervical, colon, prostate
• Blood clots in the urinary tract
• Enlarged prostate
• Kidney stones
• Damage to the nerves that control the bladder

Chronic Renal Failure

Chronic renal failure is generally caused by are diabetes mellitus (type 1 or type 2 diabetes) and high blood pressure. It causes the kidneys to stop working, leading to end-stage renal disease (ESRD). Some of the causes are the same as acute renal failure. They include:

• Kidney infection
• Polycystic kidney disease (multiple cysts in the kidneys)
• Autoimmune disorders, such as lupus
• Hardening of the arteries, which can damage blood vessels in the kidney
• Kidney stones
• Urinary tract blockages and reflux
• Excessive use of medications or recreational drugs (e.g. cocaine, speed) that are metabolized through the kidneys

Renal Failure: Symptoms

Acute Kidney Failure

Signs and symptoms of acute kidney failure may include:

• Decreased urine output, excessive urination at night, no urination, although occasionally urine output remains normal
• Bloody stools
• Nosebleeds
• Hand tremor
• Bruising easily
• Decreased sensation, especially in the hands and feet
• Flank pain
• Metallic taste in your mouth
• Swelling (edema) in your legs, ankles or feet
• Drowsiness
• Shortness of breath
• Fatigue
• Confusion
• Nausea
• Seizures or coma in severe cases
• Chest pain or pressure

Sometimes acute kidney failure causes no signs or symptoms and is detected through laboratory tests done for another reason.

Chronic Kidney Failure

The early symptoms of chronic kidney disease can be difficult to detect as they are also symptoms of other illnesses. Kidney disease can be hard to diagnose as the symptoms can affect few or many parts of the body, and unless you are familiar with the symptoms, seem to point to another condition rather than kidney problems.

Symptoms may include:

• Appetite loss
• General ill feeling and fatigue
• Sleep problems
• Decreased mental sharpness
• Muscle cramps and twitchiness
• Headaches
• Itching and dry skin
• Nausea
• Weight loss without trying to lose weight
• Decreased urine output or no urine output
• Easy bruising, bleeding, or blood in the stool
• Excessive thirst
• Frequent hiccups
• Low level of sexual interest and impotence
• Menstrual periods stop (amenorrhea)

The future of the condition and the ease of treatability depends on the medical problem that caused the kidney failure, how much kidney damage has occurred, and what, if any, complications are present. As the kidneys are highly adaptable, symptoms of kidney failure may not appear until irreversible damage has occurred to the organ.

Renal Failure: Diagnostic Tests

Whether acute or chronic kidney failure, there are a number of tests that your doctor may recommend for diagnosis. 

• Blood tests. Kidney function tests look for the level of waste material that is normally filtered by the kidney. Examples include creatinine, urea, potassium, and magnesium. In general the blood becomes more acidic with renal failure because of these waste products.
• Urine tests. Analyzing a sample of your urine may reveal abnormalities that point to chronic kidney failure.
• Imaging tests. Your doctor may use ultrasound, intravenous pyelogram, ultrasound, MRI, and CT scan to image and assess your kidneys.
• Kidney biopsy: Your doctor may remove a sample of kidney tissue and have it sent to a lab for testing. Kidney biopsy is often done using a long, thin needle that's inserted through your skin and into your kidney, before a tissue sample is removed.

Renal Failure: Treatment

Treatment of renal failure depends on whether it is acute or chronic. If acute, the goal is total recovery. Chronic kidney failure has no cure, so the goals are to treat the underlying cause of the kidney failure, treating its complications and prevent further deterioration of the condition.

Treatment of the underlying condition: there are many different possible causes of acute and chronic renal failure and so treatment depends on a correct diagnosis and finding the treatment that is right for you. For example, if the renal failure is caused by a urinary tract infection, the doctor will likely prescribe antibiotics as the first line of treatment.

Treatment of the complications depends on the severity and other symptomology. For example, doctors may prescribe medications to stop the swelling that can occur with kidney failure (diuretics) or a low-protein diet to minimize the waste products in your blood. Potassium and sodium are two electrolytes that can build up in the blood with renal failure so low-potassium and low-sodium diets may be part of your treatment and disease management.

If waste products are building up in your blood, you will likely be a candidate for dialysis. It removes the excess metabolic waste and water. During dialysis, a machine pumps blood out of your body through an artificial kidney (dialyzer) that filters out waste. The blood is then returned to your body.

If there is significant damage and you have endstage renal disease, you may be a candidate for a kidney transplant.

Renal Failure: Prevention

As there a number of different diseases and conditions that cause acute and chronic kidney failure, complete prevention is impossible. However, you can minimize your risk and the stressors on your kidneys by limiting your consumption of alcohol, quitting smoking, maintaining a healthy body weight, regular exercise such as yoga, relaxation techniques such as qi gong, and taking all medications according to the dosage and timing prescribed.

Renal Failure: Conclusion

Treatment of renal failure depends on whether the condition is acute or chronic. Acute renal failure is fully treatable, and patients are expected to make a full recovery. There is no cure for chronic renal failure, although its symptoms can be managed. The first step of treatment is identifying the underlying cause of renal failure. For chronic renal failure, there are a number of procedures, medications and lifestyle changes that will help manage the symptoms of the disease and prevent the condition from worsening.

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