Kidney failure

Kidney failure often occurs alongside other medical conditions or as a result of an underlying disease. You may be more at risk for kidney failure if you:

• Have been hospitalized for an extended period
• Have spent time in intensive care
• Suffer from heart failure
• Have high blood pressure
• Have uncontrolled diabetes
• Regularly take pain medications like NSAIDs
• Have chronic kidney or liver disease
• Have coronary artery disease
• Are elderly

Several tests are used to diagnose kidney failure. Some common diagnostic methods include:

Urinalysis

Your doctor may request a urinalysis to detect unusual substances in your urine, such as proteins or sugars. The sample is analyzed in a lab, where tests like urinary sedimentation can detect blood cells, cellular casts, and bacteria. Heavy protein levels can indicate conditions like glomerulonephritis, vasculitis, or toxins. The presence of urine eosinophils can help diagnose interstitial nephritis, pyelonephritis, cystitis, atheroembolic disease, or glomerulonephritis. If oxalate crystals are found, the doctor may check for ethylene glycol toxicity.

Urine Volume Measurements

Monitoring urine output is one of the simplest tests to diagnose kidney failure. A decrease in urine output may indicate kidney damage, often due to blockage caused by injury or other conditions.

Blood Tests

Blood tests can help identify substances filtered by the kidneys, such as creatinine and blood urea nitrogen (BUN). Elevated levels of these substances can indicate kidney problems. Creatinine, a product of muscle breakdown, is usually removed by the kidneys, and high levels in the blood suggest impaired kidney function. Blood tests also measure electrolytes like potassium and sodium, which help with fluid balance in the body. High sodium levels may indicate kidney dysfunction.

Glomerular Filtration Rate (GFR)

The GFR test assesses how well the kidneys are filtering blood. This test estimates the volume of blood that passes through the kidneys' glomeruli each minute. The GFR calculation involves factors such as age, creatinine levels, sex, ethnicity, height, and weight. A GFR below 60 mL/min/1.73 m² over three months indicates chronic kidney disease, and a GFR below 15 mL/min/1.73 m² signals kidney failure, requiring urgent medical intervention.

Imaging

Imaging techniques like MRI, ultrasound, and CT scans can be used to identify any blockages or abnormalities in the kidneys or urinary tract that may contribute to kidney failure.

Biopsy

A kidney biopsy involves taking a small sample of kidney tissue to examine under a microscope. This helps identify issues like scarring, infections, or deposits in the kidneys that may contribute to kidney failure.

To lower the risk of developing kidney failure, adopting a healthy lifestyle is crucial. When taking over-the-counter medications such as aspirin, ibuprofen, or other non-steroidal anti-inflammatory drugs (NSAIDs), or pain relievers like acetaminophen, always read the label and follow the recommended dosage. Overuse of these medications can increase the risk of kidney damage.

If you have pre-existing health conditions that put you at higher risk for kidney failure, it's essential to consult with your doctor before starting any new medications. It's also advisable to work closely with your healthcare provider to manage any underlying conditions effectively. Regular physical activity and avoiding excessive alcohol consumption can significantly help reduce the likelihood of kidney failure.

Specialists to Consult

You should see a doctor if you experience symptoms such as difficulty maintaining normal blood pressure despite medication, fluctuating blood sugar levels, swelling in the feet or ankles due to fluid retention, shortness of breath, nausea, chest pain, or seizures. These signs may indicate kidney failure. Consult the following specialists for diagnosis:

• General physician
• Nephrologist
• Urologist

Treating kidney failure typically requires hospitalization, especially since most individuals with kidney failure are already admitted due to other health complications or pre-existing medical conditions. The length of hospitalization depends on the severity of the kidney failure and its cause. Your doctor will closely monitor your kidney recovery and determine when it's appropriate for you to be discharged. In some cases, recovery can be managed at home.

Treating the Underlying Cause

If kidney failure is caused by injury or a disease that has harmed the kidneys, addressing the root cause is crucial in managing kidney failure. Treatment options will vary depending on the cause and the severity of the condition.

Fluid Level Management

If kidney failure occurs due to a fluid deficit in the bloodstream, intravenous fluids may be necessary. On the other hand, if kidney failure leads to fluid retention, causing swelling in the legs and ankles, diuretics may be prescribed to help remove excess fluid from the body. In cases where diuretics are ineffective, ultrafiltration may be required.

Eliminating Nephrotoxic Drugs and Substances

Your doctor may recommend stopping medications that can damage the kidneys, such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and non-steroidal anti-inflammatory drugs (NSAIDs), and replace them with safer alternatives.

Controlling Blood Potassium Levels

Excess potassium can cause irregular heartbeats and muscle weakness, posing serious risks. If your kidneys cannot filter potassium effectively, your doctor may restrict dietary potassium and prescribe medications like sodium polystyrene sulfonate, glucose with insulin, or calcium to control potassium levels.

Regulating Calcium Levels

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

Dialysis

Dialysis is a procedure that helps remove waste products and excess fluids from the blood when the kidneys are no longer functioning properly. There are two main types of dialysis:

• Hemodialysis: This involves inserting a catheter into a vein in your leg or neck, where a machine cleans your blood. Hemodialysis typically requires treatment three to four times a week at a dialysis center.
• Peritoneal Dialysis: In this type of dialysis, a catheter is inserted into your abdomen, allowing a dialysis solution to remove excess fluids, salt, and potassium. This process can be automated during sleep. Peritoneal dialysis is often preferred for children with kidney failure.

Kidney Transplant

A kidney transplant involves replacing a damaged kidney with a healthy one from a donor. This is often the best treatment for those with end-stage renal disease. Finding a living donor, often a family member, can speed up the process. After the transplant, patients may need to take immunosuppressant medications to prevent the body from rejecting the new kidney. These medications have side effects and require regular monitoring.

Kidney failure can lead to a variety of complications, including:

Bone and Muscle Weakness

Disruptions in calcium and phosphorus levels due to kidney failure can result in weakened bones. An imbalance in electrolytes may also lead to muscle weakness, which can cause heart rhythm disturbances or even paralysis.

Uremia

Kidney failure can lead to the accumulation of nitrogenous waste products in the body. At elevated levels, this can cause mental status changes and increase the risk of bleeding.

Anemia

When the kidneys fail to function properly, it can result in anemia, a condition characterized by low red blood cell count. This is primarily caused by insufficient levels of erythropoietin, a hormone produced by the kidneys that stimulates red blood cell production.

Fluid Retention

The kidneys play a key role in filtering excess water and toxins from the blood. In kidney failure, fluid retention may occur, leading to swelling in the lower limbs.

Heart Disease

Heart disease is a common complication in individuals with kidney failure. It is one of the leading causes of death for those on dialysis. Inflammation of the heart lining can result in chest pain.

Metabolic Acidosis

Kidney failure can cause an accumulation of acid in the blood, which may lead to symptoms such as nausea, dizziness, shortness of breath, and vomiting. It can also result in kidney stones and bone-related issues.

Electrolyte Imbalance

When the kidneys are not functioning properly, they may struggle to regulate electrolyte balance. Conditions such as hyponatremia (low sodium levels) and hyperkalemia (high potassium levels) are common in kidney failure.

Cardiac Complications

Individuals with kidney failure may experience various cardiac issues, including arrhythmias (irregular heartbeats), pericarditis (inflammation of the heart membrane), and pericardial effusion (fluid buildup around the heart). Additionally, fluid overload and uremia may directly harm the heart and impair its function.

Malnutrition

Long-term kidney disease puts patients at a higher risk of malnutrition, which is marked by a depletion of protein and energy reserves, along with deficiencies in essential nutrients.

Calciphylaxis

This rare but serious condition primarily affects patients with advanced chronic kidney disease (CKD). It involves the accumulation of calcium in small blood vessels in the skin and fatty tissues.

Secondary Complications

Some individuals with kidney failure may develop secondary complications such as:

• Fluid buildup in the lungs
• Nerve damage
• Depression
• Liver failure
• Gout (elevated uric acid levels)
• Skin infections
• Diabetic nephropathy

Exercise

Maintaining a healthy lifestyle with regular light exercise, such as walking, can assist in managing kidney health. Always consult your doctor to determine the most suitable type of exercise for your condition.

Dietary Modifications

It is essential to follow a diet low in salt and adhere to the protein recommendations provided by your healthcare provider. These dietary instructions will vary depending on the stage of your kidney failure. Following your doctor’s advice is crucial, as your diet directly impacts kidney function.

Yoga

Engaging in simple exercises like yoga can help manage stress and anxiety, which in turn benefits kidney health.

Managing kidney failure requires diligent care at home. Here are some tips for home management:

• Take your prescribed medications on time as directed by your doctor.
• Set up reminders or alarms to ensure you take your medications consistently.
• Follow the dietary guidelines provided by your healthcare provider and dietician.
• Stick to the treatment plan recommended by your doctor, incorporating necessary lifestyle changes to support recovery.
• Maintain a balanced diet and limit alcohol and foods that could harm your kidneys.

Being diagnosed with kidney failure can be overwhelming and frightening. However, advances in medical science have created multiple treatment options that allow you to lead a healthy life and give your kidneys time to recover. Along with medical treatments, making lifestyle adjustments is key to managing your condition. These include:

Limiting Alcohol Intake

Excessive alcohol consumption can severely impact kidney function, especially in people with kidney disease. Alcohol makes the kidneys work harder to remove toxins from the body, as it does not easily metabolize. Those on dialysis may feel the effects of alcohol until the procedure is completed. Alcoholic beverages such as wine and beer are high in phosphorus, which can cause heart issues or even death if the kidneys cannot remove excess potassium. It’s advisable to discuss alcohol consumption with your doctor and, in most cases, avoid alcohol altogether.

Dietary Changes

Monitoring potassium and sodium intake is essential. You should aim to consume no more than 2,000 milligrams of each per day. Additionally, phosphorus intake should be limited to below 1,000 milligrams. In the earlier or moderate stages of kidney failure, you may be advised to reduce protein consumption. Your doctor will tailor dietary recommendations based on the severity and stage of your kidney condition.