Kidney failure

Symptoms Of Kidney Failure

Patients who have early stage kidney failure may not even notice their symptoms since the signs are quite often not noticeable. The Centre For Disease Control and Prevention (CDC) reported that as much as 90 % of people with chronic kidney disease are not aware that they have the disease. The symptoms associated with renal failure tend to worsen with time.

Some of the symptoms that may be seen in renal failure are:

• Swelling of legs, feet or ankles due to retention of fluids 

• Excessive drowsiness

• Increased fatigue 

• Shortness of breath

• Reduced urine output

• Persistent nausea

• Pain or pressure in the chest 

• Muscle spasm 

• Metallic taste 

• Irregular heartbeat

• Irregular sleep pattern

• Back pain

• Fever

• Rash

• Diarrhea

• Pain in the abdomen

• Seizures

• Coma 

Early signs of kidney failure are less noticeable and include the following symptoms such as: 

• Swelling of limbs due to fluid retention 

• Shortness of breath

• Reduced urine output 

A change in color of urine can act as an early sign of damage to your kidneys and the subsequent progress of the condition. 

• Pale yellow or clear urine: This indicates that your body is well hydrated and it’s the ideal color in most cases. 

• Dark yellow or amber colored urine: Drinking less amount of water can cause your urine to look slightly darker in color than normal. This indicates dehydration and can be treated by drinking your fluids while cutting down on sodas, tea or coffee. 

• Tint of red or pink colored urine: If you find your urine to have this colour, then it's a sign of concern. The red tint could be blood and may indicate a medical condition. Eating food like beets or strawberries can also be the reason for red colored urine. In such conditions, talk to your doctor and take a urine test. 

• Orange colored urine: This is also a sign of dehydration. It can indicate the presence of accumulated bile in your bloodstream. Orange colored urine is usually not caused due to a kidney disease. 

• Foamy urine: It may indicate the presence of protein in the urine, which is a sign of a kidney disease.

Types Of Kidney Failure

Kidney failure can be of two types namely:

• Acute kidney failure: Also called acute renal failure or acute kidney injury, it develops rapidly, usually in less than a few days and is potentially reversible. It generally occurs in individuals who are already hospitalised, especially the critically ill patients .

• Chronic kidney failure: This type progresses slowly over at least three months and can lead to permanent kidney damage. In the early stages of chronic kidney disease, the patient may notice only a few signs or symptoms and not realise that he/she has kidney disease until the condition is advanced.

Causes Of Kidney Failure

The three main reasons behind renal failure are as follows:

1. Conditions that slows or impairs blood flow to your kidneys

These are the conditions and diseases that can slow blood flow to the kidney and damage them as time advances. They are: 

• Liver failure 

• Blood or fluid loss

• Infections

• Heart disease

• Heart attack

• Severe allergic response

• Taking medications such as naproxen sodium and ibuprofen 

• Severe burns

• Extreme dehydration

• High blood pressure medications

2. Conditions that prevents urine from leaving your kidneys

These are the conditions that lead to decreased urine flow, which are:

• Prostate, cervical, colon or bladder cancer

• An enlarged prostate

• Nerve damage to your bladder

• Kidney stones

• Presence of blood clots in your urinary tract

3. Conditions and causes that directly damage your kidneys

Damage to the kidneys can result from:

• Deposition of cholesterol 

• Presence of blood clots 

• Medications such as non-steroidal anti-inflammatory drugs that include ibuprofen, naproxen or antibiotics

• Glomerulonephritis, a condition where the tiny filters of the kidney become inflamed

• Chemotherapy 

• Sepsis or infection

• Rhabdomyolysis (the breakdown of muscle tissue leading to the release of muscle fibre contents into the blood)

• Hemolysis (breakdown or destruction of red blood cells)

• Damage to nerves that regulate your bladder 

• Ingestion of large amounts of toxins like ethylene glycol

• Iodinated contrast used during radiographic procedures

In addition, the other causes that can lead to kidney failure are:

• Lupus, an autoimmune disorder that can lead to inflammation of different organs of the body

• Heavy metal poisoning 

• Vasculitis, a condition in which the blood vessels become inflamed 

• Hemolytic uremic condition, a condition that causes the breakdown of red blood cells after an infection

• Scleroderma, an autoimmune disorder of the skin 

• Uncontrolled diabetes

• Dyes used in a few imaging tests

• Multiple myeloma, cancer of plasma cells present in the bone

• Polycystic kidney disease

Risk Factors For Kidney Failure

Usually, a patient experiences kidney failure along with other medical conditions or as a consequence of another disease. You are more likely to have kidney failure if:

• Have been hospitalised for a long time

• Have been admitted in intensive care

• Have heart failure 

• Have high blood pressure

• Have uncontrolled diabetes

• Take pain medications like NSAIDs regularly

• Have chronic kidney disease or liver disease

• Have coronary artery disease 

• Are old

Diagnosis Of Kidney Failure

There are several tests that can help your doctor in the diagnosis of acute renal failure. Some of the common tests include the following:

1. Urinalysis

Your doctor may order a urinalysis for which you'll be asked to take a urine sample. The test is ordered if your doctor suspects anything unusual such as the presence of atypical proteins or sugar in the urine. The urine sample is further sent to a lab where an urine analysis is performed. A urinary sedimentation test is carried out to detect the presence of red and white blood cells, a number of tube-shaped bacterias known as cellular casts or levels of bacteria. 

Extremely heavy proteinuria (>3.5 g/d) can occasionally be seen in glomerulonephritis (swelling and redness of the tiny filters in the kidneys called glomeruli), vasculitis (inflammation of the blood vessels), or toxins.

Urine eosinophils have a limited role in differential diagnosis, they can be seen in interstitial nephritis (spaces between the kidney tubules become swollen), pyelonephritis (a type of urinary tract infection), cystitis (inflammation of urinary bladder), atheroembolic disease (when plaque from large arteries go and block small arteries like renal artery), or glomerulonephritis.

The finding of oxalate crystals in acute kidney injury should prompt an evaluation for ethylene glycol toxicity.

2. Urine volume measurements

Urine output measurement is one of the easiest tests that can help in the diagnosis of kidney failure. Low urinary output may indicate the presence of kidney diseases due to a blockage. The blockage can be caused due to an underlying pathology or injury. 

3. Blood tests

You may be ordered to take blood samples through which your doctor can identify the presence and quantity of substances present in your urine. Kidneys filter substances such as blood urea nitrogen and creatinine. The varying levels of these substances can give an idea about your health and the functioning of your kidney. A rapid rise in the level of these compounds can indicate acute kidney failure. These tests include:

• Creatinine: A compound made by your muscles, in particular, can help in the identification of kidney failure since a normal kidney would remove creatinine from the blood and excrete it via urine. 

• Blood urea nitrogen (BUN): Urea is another waste product found in your blood. It is created from protein when broken down. It is also removed from your blood via the kidneys. Blood samples can detect the level of urea nitrogen. 

• Electrolytes: Electrolytes like potassium and sodium help with fluid balance in your body. A high level of sodium can be an indication that your kidneys aren't functioning properly since your body is unable to excrete the right amount of sodium. 

4. Glomerular filtration rate (GFR)

It is a test used to check how well the kidneys are working. Specifically, it estimates how much blood passes through the glomeruli each minute. Glomeruli are the tiny filters in the kidneys that filter waste from the blood.

The lab specialist combines your blood creatinine level with several other factors to estimate your GFR. Different formulas are used for adults and children. The formula includes some or all of the following:

• Age

• Blood creatinine measurement

• Ethnicity

• Sex

• Height

• Weight

The creatinine clearance test, which involves a 24-hour urine collection, can also provide an estimate of kidney function.

According to the National Kidney Foundation, normal results range from 90 to 120 mL/min/1.73 m2. Older people will have lower than normal GFR levels because GFR decreases with age.

Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or test different samples. Talk to your doctor about the meaning of your specific test results.

Levels below 60 mL/min/1.73 m2 for 3 or more months are a sign of chronic kidney disease. A GFR lower than 15 mL/min/1.73 m2 is a sign of kidney failure and requires immediate medical attention.

5. Imaging

Different imaging modalities such as MRI, ultrasound, and CT scan can be recommended at different stages of a disease, depending on your symptoms and signs. These imaging tests can help your doctor identify blockages or other problems that might be affecting your kidney and urinary tract. 

6. Biopsy

A kidney tissue biopsy is recommended to collect a small sample of the kidney tissue. This exam helps in the identification of scarring, infectious organisms, or the presence of any other deposits. 

Prevention Of Kidney Failure

You can reduce your risk of developing renal failure by adopting some healthy lifestyle changes. While taking over-the-counter pills such as aspirin, ibuprofen, or other non-steroidal anti-inflammatory medications, and over-the-counter pain medications such as acetaminophen, make sure to reach the prescription label and follow the recommended dosage instructions. Taking too much of these medications can increase your risk of developing renal failure. 

If you are at a higher risk of developing renal failure due to pre-existing conditions, make sure to consult your doctor before taking new medications. Talk to your doctor and follow their advice for managing your condition. Exercising right and avoiding alcohol can go a long way in reducing your risk of developing renal failure. 

Specialist To Visit

You should visit a doctor if you are experiencing symptoms such as trouble keeping your blood pressure levels within a normal range even after taking the directed medications, your blood sugar levels are fluctuating within a wide range, fluid retention that is causing swelling in your feet or ankles, shortness of breath, nausea, chest pain, and seizures. These symptoms might indicate the possibility of renal failure. You can consult the following doctors for diagnosis:

• General physician

• Nephrologist

• Urologist

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Treatment Of Kidney Failure

Treatment for renal failure usually requires hospitalisation. Typically people who develop renal failure are already hospitalised due to underlying pathology or pre-existing medical conditions. The duration of your stay depends on the severity of your condition and the reason behind your kidney failure. Your doctor will monitor how quickly your kidneys are recovering and decide when to discharge you accordingly. In some cases, you might be able to recover at home. 

Treatment of the cause

If you have developed kidney failure due to an injury to your kidneys or illness that has damaged your kidney, identifying and treating the underlying cause will help in the management of kidney failure. Your treatment options will depend on the cause and severity of the condition. 

Treatments to balance the level of fluids in your body

Your renal failure may be caused due to a lack of fluids in the blood. This would require intravenous fluids. Sometimes an excess of fluids may cause renal failure that usually leads to fluid retention causing swelling of lower extremities such as legs and ankles. In such cases, a physician recommends medications called diuretics that help the body in expelling excessive fluids. Ultrafiltration may be required for patients who are not responding to diuretics.

Elimination of nephrotoxic drugs and substances

Elimination or replacement with non-nephrotoxic alternatives can be done for medications like angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and non steroidal anti-inflammatory drugs (NSAIDs) by your doctor. 

Medications to control blood potassium

Potassium is a salt that helps in regulating vital functions of your body. Excessive levels of potassium can cause an irregular heartbeat that can lead to severe complications and muscle fatigue. If your kidneys are unable to filter potassium from your blood, your doctor may ask you to restrict dietary potassium and prescribe you sodium polystyrene sulfonate, glucose along with insulin, or calcium to prevent the levels of potassium from rising in your blood. 

Medication to regulate calcium levels 

In case your calcium levels drop, your doctor may recommend a calcium infusion to prevent complications.

Dialysis 

This is a procedure that filters and purifies the toxins from your blood through a machine. Essentially, the functions of your kidneys are taken over by the machine. Depending on the kind of dialysis recommended by your doctor, you may be connected to a big machine or you may be asked to use a portable catheter bag. 

There are two types of dialysis:

• Hemodialysis: For hemodialysis, a catheter (tube) will be inserted into one of the veins present in your legs or neck. The machine will regularly clean your blood. People on hemodialysis are recommended to receive treatment around three to four times a week at a dialysis centre or hospital. 

• Peritoneal dialysis: This dialysis cleans the blood using a dialysis solution and a catheter. A tube is inserted into your belly that takes out excessive fluids, salt, and potassium. This fluid is removed from the body and can be done via an automated exchanger while you are asleep. Most children who have renal failure are recommended for peritoneal dialysis.

Kidney transplant 

A kidney transplant is a procedure where a specialist operates on the patient and replaces a non-functional kidney with a functional kidney from a healthier person. Patients with end-stage renal disease are advised to go through with a kidney transplant as that is the best treatment option available for them. 

Living donors are easier to find since most of them are family members of the patient. The process of finding a living donor is usually faster. There is typically a long wait to find a donor kidney that is compatible with the patient's body. The patient undergoing the surgery may have to take immunosuppressant drugs for some time after the surgery to prevent the body from rejecting the new kidney. These drugs have side effects which need constant monitoring. 

Home-care For Kidney Failure

Kidney failure needs rigorous attention and monitoring. Here are a few tips to follow at home:

• If you have been prescribed medications to manage your medical condition, make sure you take those medications on time.

• Label your drugs and set the alarm to make sure you have the medicines every day at the same time. Follow all the instructions given to you by your doctor.

• Follow the diet given to you by your doctor.

• Follow the diet given by your dietician that is customised depending on your medical condition and more compatible with your kidneys. 

• Stick to the right treatment plan, as decided by your doctor, and incorporate the necessary lifestyle changes to recover faster. 

• Eat a balanced diet and cut back on alcohol or foods that damage your kidneys. 

Complications Of Kidney Failure

Renal Failure can lead to several complications which include the following:

Bone and muscle weakness

Disruption of minerals like calcium and phosphorus due to renal failure can lead to complications such as the weakening of bones. If your electrolytes are out of balance you can also develop muscle weakness that can cause heart rhythm problems or even paralysis. 

Uremia

Buildup of nitrogenous waste products in the body is seen in kidney failure. At higher concentrations, changes in mental status and bleeding complications might arise.

Anemia 

If your kidneys aren't functioning properly, this can lead to anemia, a condition in which a person has a low red blood cell count. Although there are multiple factors that lead to anemia in kidney failure, the primary cause is thought to be the insufficient levels of erythropoietin -- a hormone secreted by the kidneys that helps in production of red blood cells.

Fluid retention 

Kidneys are responsible for filtering out excess water out of your blood and removing toxins along with it. In case of renal failure, you may be at an increased risk of fluid retention that can cause swelling of the lower extremities. 

Heart disease

Kidney failure can lead to heart diseases. Heart diseases most commonly cause death in people who are on dialysis. Inflammation of the lining of the heart can lead to chest pain. 

Metabolic acidosis 

Renal failure can lead to excessive acid in the blood that can cause nausea, drowsiness, breathlessness, and vomiting. It can also lead to kidney stones and bone diseases. 

Electrolyte imbalance

The dysfunctional kidney has limited ability to regulate electrolyte imbalance. Hyponatremia (low levels of sodium in blood) and hyperkalemia (increased potassium concentration in blood) are important abnormalities seen as a result of kidney failure. 

Cardiac complications

The major cardiac complications are arrhythmias (irregular heart beats), pericarditis (inflammation of the heart membrane), and pericardial effusion (fluid build up in the pericardium). In addition, volume overload and uremia may lead to direct cardiac injury and impaired cardiac function. 

Malnutrition

Patients with long term kidney disease are at a high risk for malnutrition, characterised by decreased body stores of protein and energy fuels along with micronutrient deficiencies. 

Calciphylaxis

It is a rare and serious condition seen almost exclusively in patients with advanced CKD. It is characterised by accumulation of calcium in small blood vessels of the skin and fatty tissues.

Secondary complications 

Some people can develop secondary complications such as: 

• Fluid buildup in the lungs

• Nerve damage

• Depression 

• Liver failure

• Gout (increased levels of uric acid)

• Skin infections

• Diabetic nephropathy

Diabetic kidney disease, also known as diabetic nephropathy, is one of the most common complications of diabetes. Read more about ways to prevent it.Click Here!

Alternative Therapies For Kidney Failure

Exercising 

Leading a healthy lifestyle and doing light exercises daily such as walking can help in managing your kidney condition. Talk to your doctor about what kind of exercises would suit your condition. 

Diet changes 

Choose a diet that is low on salts and follow protein guidelines given by your doctor. The guidelines of what you are supposed to eat will depend on the stage of renal failure that you are on. It is important to follow the advice of your doctor since your diet influences your kidney health.

Note: The role of diet and nutrition in keeping the kidneys healthy and fit cannot be underestimated. Learn more about foods to keep your kidneys healthy.
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Yoga 

Opting for simple exercises such as yoga can help you avoid stress and anxiety that can further help your kidney health. 

Living With Kidney Failure

Being diagnosed with renal failure can be scary and can come as a shock. However, modern science has opened the doors to several possibilities that can allow you to live a healthy life and give time for your kidneys to heal. Along with your medical treatments, it is important to incorporate lifestyle changes that will help you cope with your disease. These include: 

Limiting alcohol intake 

If you have kidney disease, drinking a large amount of alcohol can be extremely detrimental to the health of your kidney. Your kidneys will have to work harder to remove toxins from your body since alcohol doesn't metabolise out of your system. If you are on dialysis, then you will feel the effects of alcohol until you receive your dialysis.

Drinks such as wine and beer contain large amounts of phosphorus that can lead to heart diseases and even death if your kidney is unable to filter out excessive potassium. Talk to your doctor about what kind of drink you can intake without putting your health at risk and the frequency of drinking. Most people would be advised to eliminate alcohol from their diet completely. 

Dietary changes 

It is important to keep a track on the intake of potassium and sodium through diet. You should aim to eat less than 2,000 milligrams every day of both these nutrients. You will also be advised to limit phosphorus intake to below 1,000 milligrams. In the early or moderate stages of renal failure, you might be advised to cut back on protein intake. These dietary recommendations will depend on the stage of the renal failure and the severity of the condition.

Maintaining good health of the kidneys,one of the most vital organs of our body, is highly crucial. Read more about habits to keep your kidneys healthy.
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