Definition

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 two categories:

• Acute kidney failure—sudden loss of kidney function
• Chronic kidney failure—slow, gradual loss of kidney function

Causes

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 two 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
• Glomerulonephritis
• 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 x-ray dyes

Risk Factors

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
• Cancer
• 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

Symptoms

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 in severe cases
• 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

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done.

Tests may include:

• Blood tests
• Urine tests
• Biopsy

Images may be taken of your kidneys, bladder, and ureters. This can be done with a renal ultrasound.

Treatment

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.

Prevention

In some cases, you cannot prevent kidney failure, but there are some steps you can take that will lower your risk:

• Maintain normal blood pressure.
• If you have diabetes, control your blood sugar.
• Avoid long-term exposure to toxic substances, such as lead and solvents.
• Do not abuse alcohol or over-the-counter pain medication.
• If you have chronic kidney failure, talk to your doctor before you become pregnant.

National Kidney and Urologic Diseases Information Clearinghouse http://kidney.niddk.nih.gov

The Kidney Foundation of Canada http://www.kidney.ca

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