Kidney failure

Patients who have early stage kidney failure may not notice their symptoms, as they are often subtle. The Centre for Disease Control and Prevention (CDC) reported that as much as 90% of people with chronic kidney disease are unaware they have the condition. Symptoms associated with renal failure tend to worsen over time. Some of the symptoms that may be observed in renal failure include:

• Swelling of legs, feet, or ankles due to fluid retention
• Excessive drowsiness
• Increased fatigue
• Shortness of breath
• Reduced urine output
• Persistent nausea
• Pain or pressure in the chest
• Muscle spasms
• 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 may include:

• Swelling of limbs due to fluid retention
• Shortness of breath
• Reduced urine output

A change in the color of urine can serve as an early sign of kidney damage and the progression of the condition:

• Pale yellow or clear urine: Indicates that your body is well-hydrated; this is the ideal color in most cases.
• Dark yellow or amber-colored urine: Suggests dehydration due to insufficient water intake. This can be remedied by increasing fluid consumption and reducing sodas, tea, or coffee.
• Tint of red or pink-colored urine: May indicate the presence of blood, which is a cause for concern. Certain foods like beets or strawberries can also cause this discoloration. Consult your doctor and consider a urine test.
• Orange-colored urine: Typically a sign of dehydration and may indicate accumulated bile in the bloodstream. It is usually not associated with kidney disease.
• Foamy urine: May indicate the presence of protein in the urine, which is a sign of kidney disease.

The three main reasons behind renal failure are as follows:

1. Conditions that slow or impair blood flow to your kidneys. These conditions and diseases can damage the kidneys over time, including:
• Liver failure
• Blood or fluid loss
• Infections
• Heart disease
• Heart attack
• Severe allergic response
• Medications such as naproxen sodium and ibuprofen
• Severe burns
• Extreme dehydration
• High blood pressure medications
2. Conditions that prevent urine from leaving your kidneys. These conditions lead to decreased urine flow, including:
• 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, including 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 fiber contents into the blood
• Hemolysis, the 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, other causes that can lead to kidney failure include:

• Lupus, an autoimmune disorder that can cause inflammation of various organs
• Heavy metal poisoning
• Vasculitis, a condition in which blood vessels become inflamed
• Hemolytic uremic syndrome, 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 certain imaging tests
• Multiple myeloma, cancer of plasma cells in the bone
• Polycystic kidney disease

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 hospitalized for a long time
• Have been admitted to 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 elderly

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 a 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 bacteria 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 the urinary bladder), atheroembolic disease (when plaque from large arteries blocks small arteries like the 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, which can be caused by 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 in your urine. Kidneys filter substances such as blood urea nitrogen and creatinine. The varying levels of these substances can provide insights about your health and kidney function. A rapid rise in the level of these compounds can indicate acute kidney failure. These tests include:
   • Creatinine: A compound produced by your muscles that can help identify 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, created from protein breakdown. 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 indicate that your kidneys aren't functioning properly, as your body is unable to excrete the right amount of sodium.
4. Glomerular filtration rate (GFR)
   This test checks how well the kidneys are working by estimating 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, which may include:
   • 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 individuals 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 three or more months indicate 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 various stages of a disease, depending on your symptoms and signs. These imaging tests can help your doctor identify blockages or other issues affecting your kidneys and urinary tract.
6. Biopsy
   A kidney tissue biopsy is recommended to collect a small sample of kidney tissue. This exam helps identify scarring, infectious organisms, or the presence of other deposits.

You can reduce your risk of developing renal failure by adopting some healthy lifestyle changes. While taking over-the-counter medications, such as:

• Aspirin
• Ibuprofen
• Other non-steroidal anti-inflammatory medications
• Acetaminophen

Make sure to read the prescription label and follow the recommended dosage instructions. Taking excessive amounts 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, consult your doctor before taking new medications. It is important to talk to your doctor and follow their advice for managing your condition. Additionally, exercising regularly and avoiding alcohol can significantly reduce your risk of developing renal failure.

Treatment for renal failure usually requires hospitalization. Typically, individuals who develop renal failure are already hospitalized 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 an illness that has damaged your kidneys, 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 by a lack of fluids in the blood, requiring intravenous fluids.
• Sometimes, an excess of fluids may lead to renal failure, causing fluid retention and swelling in the lower extremities, such as legs and ankles. In such cases, a physician may recommend medications called diuretics to help expel excessive fluids.
• Ultrafiltration may be required for patients who do not respond to diuretics.

Elimination of Nephrotoxic Drugs and Substances

Elimination or replacement with non-nephrotoxic alternatives can be done for medications such as 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 regulate vital functions in your body. Excessive levels of potassium can cause an irregular heartbeat, leading 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 sodium polystyrene sulfonate, glucose along with insulin, or calcium to prevent potassium levels from rising in your blood.

Medication to Regulate Calcium Levels

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

Dialysis

This procedure filters and purifies toxins from your blood through a machine, essentially taking over the functions of your kidneys. Depending on the type of dialysis recommended by your doctor, you may be connected to a large machine or 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 in your legs or neck. The machine will regularly clean your blood. People on hemodialysis are typically recommended to receive treatment around three to four times a week at a dialysis center or hospital.
• Peritoneal Dialysis: This method cleans the blood using a dialysis solution and a catheter. A tube is inserted into your abdomen to remove excessive fluids, salt, and potassium. This fluid is then removed from the body and can be done via an automated exchanger while you are asleep. Most children with renal failure are recommended for peritoneal dialysis.

Kidney Transplant

A kidney transplant is a procedure where a specialist replaces a non-functional kidney with a functional kidney from a healthier person. Patients with end-stage renal disease are advised to undergo a kidney transplant as it is the best treatment option available. Living donors are often family members of the patient, making the process of finding a living donor typically faster. There is usually a long wait to find a donor kidney that is compatible with the patient's body. After the surgery, the patient may need to take immunosuppressant drugs for some time to prevent the body from rejecting the new kidney. These drugs have side effects that require constant monitoring.

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 an alarm to ensure you take your medicines every day at the same time. Follow all the instructions given to you by your doctor.
• Follow the diet provided by your doctor.
• Adhere to the diet prescribed by your dietician, which is customized based on your medical condition and is more compatible with your kidneys.
• Stick to the treatment plan established by your doctor and incorporate the necessary lifestyle changes to recover faster.
• Eat a balanced diet and reduce alcohol intake or avoid foods that can harm your kidneys.

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 may 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 characterized by 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 insufficient levels of erythropoietin, a hormone secreted by the kidneys that aids in the production of red blood cells.
• Fluid Retention: Kidneys are responsible for filtering out excess water from your blood and removing toxins along with it. In cases 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, which are the most common cause of death in people 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, causing nausea, drowsiness, breathlessness, and vomiting. It can also result in kidney stones and bone diseases.
• Electrolyte Imbalance: The dysfunctional kidney has a limited ability to regulate electrolyte balance. Hyponatremia (low levels of sodium in the blood) and hyperkalemia (increased potassium concentration in the blood) are important abnormalities seen as a result of kidney failure.
• Cardiac Complications: Major cardiac complications include arrhythmias (irregular heartbeats), pericarditis (inflammation of the heart membrane), and pericardial effusion (fluid buildup in the pericardium). Additionally, volume overload and uremia may lead to direct cardiac injury and impaired cardiac function.
• Malnutrition: Patients with long-term kidney disease are at high risk for malnutrition, characterized by decreased body stores of protein and energy fuels along with micronutrient deficiencies.
• Calciphylaxis: This is a rare and serious condition seen almost exclusively in patients with advanced chronic kidney disease (CKD), characterized by the 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.

Exercising

Leading a healthy lifestyle and engaging in light exercises daily, such as walking, can help in managing your kidney condition. Consult your doctor about what types of exercises would be suitable for your condition.

Diet Changes

• Choose a diet that is low in salt.
• Follow the protein guidelines provided by your doctor.
• The dietary recommendations will depend on the stage of renal failure you are experiencing.

It is crucial to adhere to your doctor's advice, as your diet significantly influences your kidney health. Note: The importance of diet and nutrition in maintaining healthy kidneys cannot be underestimated. Learn more about foods that support kidney health.

Yoga

Engaging in simple exercises like yoga can help reduce stress and anxiety, which can further benefit your kidney health.

Being diagnosed with renal failure can be scary and may 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, consuming a large amount of alcohol can be extremely detrimental to your kidney health. Your kidneys will have to work harder to remove toxins from your body since alcohol does not metabolize out of your system. If you are on dialysis, you will feel the effects of alcohol until you receive your treatment. Drinks such as wine and beer contain high amounts of phosphorus, which can lead to heart diseases and even death if your kidneys are unable to filter out excessive potassium. Consult your doctor about what types of drinks you can consume without jeopardizing your health and the frequency of consumption. Most individuals are advised to eliminate alcohol from their diet completely.
• Dietary changes: It is important to monitor your intake of potassium and sodium through your diet. Aim to consume less than 2,000 milligrams of both nutrients each day. Additionally, you should limit phosphorus intake to below 1,000 milligrams. In the early or moderate stages of renal failure, you may be advised to reduce protein intake. These dietary recommendations will depend on the stage of renal failure and the severity of the condition. Maintaining the health of your kidneys, one of the most vital organs in the body, is crucial.